Gastroenterology

Question 1

What are the causes of unconjugated and conjugated hyperbilirubinaemia and prolonged neonatal jaundice?

Answer 1

Red blood cells broken down to Unconjugated bilirubin (water insoluble) is bound to albumin and taken to liver and there it is conjugated (water soluble) excreted in bile and then in small intestine and converted into urobilinogen, then either expelled via faeces as stercobilin (pigment) or excreted by kidneys in urine or reabsorbed.

Neonatal jaundice (remember conjugated jaundice is ALWAYS pathological, unconjugated can be physiological):

• early (<24hr): haemolysis, sepsis (unconjugated)
• intermediate (24hr-2wk): physiological, breast milk, sepsis, haemolysis (unconjugated)
• prolonged (>2wk): extrahepatic obstruction eg biliary atresia, choledochal cyst, alagille syndrome, hepatitis (conjugated) hypothyroidism, breast milk (unconjugated)

Question 2

What are the functions of the liver and clinical manifestations of paediatric liver disease?

Answer 2

Manifestation

• jaundice (remember to ask about poo colour!)
• incidental finding of abnormal blood test
• symptoms/signs of liver disease (same as adult patients + growth failure)

Question 3

What biochemical markers are used to assess liver disease?

Answer 3

Damage =
Bilirubin - total and split (direct: conjugated, indirect: unconjugated)
ALT/AST
Alkaline phosphatase
Gamma glutamyl transferase 

Function =
Coagulation (prothrombin/INR, APTT)
Albumin
Bilirubin 
(Blood glucose) 
(Ammonia)

Question 4

What are the main differences between breast and formula feeding?

Answer 4

Breast: bonding, perfect nutrition, tailor made passive immunity, increases development of infants active immunity, increases development of infants gut mucosa, reduces infections, antigen load minimal

Bottle: “near perfect” nutrition, no anti infection properties, risk of contamination, no transition of BBVs/drugs, high antigen loaf, expensive, no need for mother, accurate feed volumes, provides vit k, less jaundice

Question 5

What are the key types of infant feeds and when are they used?

Answer 5

• standard formula (cows milk based)
• specialised (cows milk protein allergy, nutrient dense, disease specific)
• pre term formulae
• nutrient dense
• lactose free milk (for lactose intolerance or secondary lactose intolerance)
• soya milks

Question 6

What is the approach to children with faltering growth, under nutrition and obesity?

Answer 6

X

Question 7

Why are the principles underlying the UNICEF baby friendly programme?

Answer 7

“Ten steps”

• have written breast feeding policy
• train all health care staff in skills necessary to implement this policy
• inform all pregnant women about the benefits/management of breastfeeding
• help mothers initiate breastfeeding within a half hour of birth
• show mothers how to breastfeed and how to maintain lactation
• give newborns no food or drink other than breast milk
• practise rooming in
• encourage breast feeding on demand
• no artificial teats/pacifiers
• foster establishment of breast feeding support groups and refer mothers to them on discharge

Question 8

What are the clinical manifestations of food intolerance and cows milk allergy?

Answer 8

Can be immediate eg within minutes, or delayed eg hours to days after

Skin reactions eg red itchy rash, swelling
digestive problems eg stomach ache, vomiting, colic, diarrhoea, constipation
hay fever like symptoms eg runny or blocked nose
eczema

Question 9

What are the key features of the clinical and dietary history to make an effective assessment of a child’s growth and progress?

Answer 9

X