Gastroenterology

Question 1

When does stool culture/viral serology need to be done in AGE

Answer 1

if child is very unwell, infant with bloody diarrhoea, returned travelers with symptoms > 10 days, immune compromised

Question 2

GORD clinical features

Answer 2

FTT from vomiting
Refusal/irritability with feeding
Aspiration - chronic cough, wheeze, apnoea, pneumonia 
Oesophagitis - haematemesis, IDA 
Dystonic neck posturing - Sandifer

Question 3

Managing AGE

Answer 3

ORS: 10ml/kg/hr, cont BF and once rehydrated back to normal diet
NG tube: if oral rehydration fails and child more than 5% dehydrated or ongoing losses. If vomit, give ondansetron/slower NGTR, IV fluids
IV fluids: if severe dehydration/NGTR fails
Monitor 4-8hrly; weight, VS, clinical signs of dehydration, urine output, ongoing losses, signs of fluid overload

Question 4

Tests for AGE

Answer 4

Most don’t need.
FBC, VBG
BSL, UEC and ketones if need IV fluids

Question 5

How fast to replace deficit for dehydration after shock is treated

Answer 5

5% dehydration in 24 hours (not including losses)

Question 6

Infantile colic description and when it occurs

Answer 6

Paroxysmal, inconsolable crying/screaming accompanied by drawing up of knees and passage of excessive flatus several times a day, esp evening

Normally occurs in first few weeks of life, resolves by 4 months.

Question 7

Managing infantile colic

Answer 7

Support and reassurance
Gripe water
If severe and persistent, might be due to cow’s milk protein allergy or GORD, so try 2-week trial of whey hydrosylate formula followed by anti-reflux treatment trial

Question 8

When celiac disease occurs and what are its features

Answer 8

At 8-24 months after introduction of wheat-containing weaning foods

Abnormal stools, FTT, abdominal distention, muscle wasting, irritability, short stature, anemia

Question 9

Signs of moderate dehydration (5-9%)

Answer 9

Lethargic, irritable 
Normal/mild tachypnea 
Increased RR
Sunken eyes and fontanelle 
Dry mucous membranes 
Mildly decreased skin throgor 
Prolong CRT

Question 10

Shock (10% or more) signs

Answer 10

Reduced consciousness 
Tachycardia 
Increased respiratory rate, deep acidotic breathin 
Hypotension 
Pale or mottled skin
Cold extremities 
Weak peripheral pulses 
Deeply sunken eyes and fontanelle 
Dry mucous membranes 
Decreased skin turgor 
Markedly prolonged CRT

Question 11

Encopresjs management

Answer 11

If faeces palpable per abdomen

• give macrogol laxative like polyethylene glycol + electrolytes for 2 weeks
• if don’t pass stool spontaneously after, give stimulant laxative like senna/picosulphate +/- lactulose
• if still dont succeed consider edema/manual evacuation under GAV
• then continue with balanced diet with fiber and sufficient fluids, maintenance treatment PEG which is gradually reduced over. a few months
• encourage child to sit on toilet after mealtimes, use of rewards