Gastroenterology

Question 1

What are the red flag features in vomiting?

Answer 1

Bilious (IO)
Hematemesis (PUD, esophagitis)
Neonatal projectile vomiting (pyloric stenosis)
Post tussive (Pertussis)
Dysentry (Campylobacter, Salmonella)
Systemic (UTI, Meningitis)
FTT (malabsorption, GERD)

Question 2

What are the features of GERD?

Answer 2

Functionally immature LES relaxes
Resolves within infancy
Complications (FTT, esophagitis, aspiration, dystonia)
Rx - PPI, thick food, H2 antagonists, Domperidone
Sx - fundoplication around LES

Question 3

What are the features of pyloric stenosis?

Answer 3

GOO from pyloric hypertrophy
2-7 weeks after birth projectile vomiting
More common in boys, with family history from mother
Dehydration and feeding loss
Hypochloremic metabolic alkalosis, hypoK and Na
Pyloric mass in RUQ palpable with peristaltic wave
Mx - rehydration, correct metabolic and electrolytes
0.45% saline and 5% dextrose
Pyloromyotomy open or lap
Feed after 6 hours, D after 2 days

Question 4

What are the causes of persistent crying?

Answer 4

Infection (UTI, Meningitis, otitis media)
Fracture
Testicular torsion
Esophagitis
Constipation
Nappy rash
Cerebral palsy
Benign infantile colic

Question 5

What is constipation?

Answer 5

Infrequent passage of hard hard stools with straining and pain with abdominal pain relieved by passing or soiling

Question 6

What are the causes of constipation?

Answer 6

Hirschprung disease
Hypothyroidism
Anorectal anomalies
Anal fissures
Hypercalcemia
Dehydration
Poor toilet conditions

Question 7

What are the red flags of constipation?

Answer 7

No meconium within 24 hrs and distension (Hirschprung)
FTT (hypothyroidism )
LL neuro and incontinence (spina bifida occulta)
Perianal fistulae (Crohns)
Multiple fissures (sexual abuse)

Question 8

What are the complications of chronic constipation?

Answer 8

Overdistended rectum
Loss of fullness and need to defecate
Relaxation of internal sphincter
Encopresis and soiling
Behavioural and bullying

Question 9

How to treat chronic constipation?

Answer 9

Empty the rectum with disimpaction
PEG for 2 weeks
If not working, give stimulant laxative
Sodium picosulfate or senna
Continue maintenance PEG until normal faces
Water intake, high fibre diet, poop after food (GCR)
Star chart and encouragement

Question 10

What are the features of Hirschprung disease?

Answer 10

Aganglionic myenteric and submucosal plexi in a contracted narrow segment of large intestine from rectum proximally
Late neonatal abdominal distension following delayed meconium passage
Later bilious volume
Complication - NEC from C Diff
Dx - suction rectal biopsy
Need surgical excision and anastomosis colostomy

Question 11

What are the features of Crohns Disease?

Answer 11

Abdominal pain, LOW, chronic diarrhoea
Lethargy and malaise
Growth failure and delayed puberty
Oral lesions, perianal skin tags, uveitis, arthralgia, erythema nodosum
high ESR and CRP, IDA, low albumin
Commonly affects distal ileum and proximal colon
Complications - strictures, IO, fistulae
Bx - non caseating epithelioid cell granulomata
Rx - whole protein feed for 2 months, corticosteroids
Maintain remission with MTX, AZT
Last line infliximab, adalimumab
Good prognosis

Question 12

What are the features of Ulcerative Colitis?

Answer 12

Recurrent inflammation and ulceration of colonic mucosa
PR bleeding, chronic diarrhoea and colic
LOW, growth failure
Erythema nodosum, arthritis
Pancolitis
Whole bowel endoscopy to exclude CD
Rx - Aminosalicylate, corticosteroids, AZT

Question 13

What is commonest cause of chronic diarrhoea in children?

Answer 13

Toddler diarrhoea (immature gut hyper motility)
no malabsorption

Question 14

What are the causes of chronic diarrhoea?

Answer 14

Malabsorption
-CF, Coeliac, CD or bowel resection, Biliary atresia/OJ
-Acrodermatitis enteropathica
Non malabsorption
-Toddler diarrhoea (peas and carrots stools)

Question 15

What are the features of Coeliac disease?

Answer 15

Gluten sensitive enteropathy destroys SI mucosa
Profound malabsorption at 8 -24 months age
After wheat food diet
Irritable, FTT, distension
Risk high in T1DM, Down, thyroid autoimmune)
Dx - Serology, biopsy and response to gluten free diet
Later on risk of SI adenoCA

Question 16

What are the DDx for acute abdmonial pain?

Answer 16

Acute appendicitis, IO, Hernia, Peritonitis, Meckel, pancreatitis

UTI, DKA, HSP, SCD, IBD, constipation

Lower lobe pneumonia, torsion of testes, hip joint

Question 17

What are the features of malrotation?

Answer 17

Emergency bilious vomiting from duodenal obstruction
From Ladd bands in first 3 days of life
Decompress, stabilise and transfer for barium scan and surgery

Question 18

What are the features of Meckel diverticulum?

Answer 18

2%, 2 feet, 2 inches,
Ectopic gastric or pancreatic mucosa
Severe rectal bleeding
Technecium scan for uptake, excision

Question 19

What are the features of intussusception?

Answer 19

Invaginaton of proximal bowel into distal bowel
Ileum into cecum
3 months to 2 years commonest cause of IO
Mesenteric compression , venous pressure, bleeding
perforation and peritonitis
Resucitate then surgery
Drawing legs up while crying periodically with sausage in abdomen and bile vomit, redcurrant stool

Question 20

What is functional abdominal pain?

Answer 20

Pain enough to disrupt daily life for 3 months
Periumbilical pain in a well child
90% no organic pathology
Severe anxiety vicious cycle
-Abdominal migraine
-IBS
-functional dyspepsia
50% recover, 25% resolve over time, 25% continue

Question 21

What are the features of IBS?

Answer 21

Abdominal pain relieved by defecation
Explosive loose mucous stools
Bloating
Feeling of incomplete defecation
Constipation and diarrhoea and normal

Question 22

What is post gastroenteritis syndrome?

Answer 22

After AGE, giving a normal diet leads to watery diarrhoea
From temporary lactose intolerance
Take off food and restart ORS, then back to food

Question 23

What are the causes of AGE?

Answer 23

Viral - rotavirus, adenovirus, norovirus, coronavirus

Bacterial -Campylobacter, Shigella, Salmonella, Cholera, ETEC