Gastroenterology and Hepatology

Question 1

On an abdominal radiograph, what does the following indicate:

1. Dilated bowel loops…
2. Abnormal gas pattern…
3. Faecal loading…

Answer 1

1. Intestinal obstruction
2. Intussuscception
3. Constipation

Question 2

When would you investigate using a barium enema?

Answer 2

For diagnosis and treatment of intussuscpetion

Question 3

Pallor and screaming in children is indicative of what diagnosis?

Answer 3

Intussusception

Question 4

In appendicitis, where does the pain migrate from/to?

Answer 4

Periumbilical area to right iliac fossa

Question 5

Where does non-organic pain usually present?

Answer 5

Periumbilically

Question 6

Give five organic causes of recurrent abdominal pain in children

Answer 6

Idiopathic

Hepatitis
IBS
Oesophagitis
Peptic ulcer
IBD
Constipation
Malabsorption
Giardiasis

Pacreatitis

Dysmenorrhoea
PID
Heamatocolpos
Ovarian cyst

Psychogenic
Abdominal migraine
Sickle cell disease

Question 7

Give five causes of acute abdominal pain in children

Answer 7

IBD
Acute appendicitis
HSP
UTI
Mesenteric adenitis - can mimic appendicitis
Intussusception
Diabetes
Lower lobe pneumonia
Peptic ulcer
Renal calculi
Gastroenteritis
Intestinal obstruction
Constipation

Question 8

What is the commonest cause of dehydration in children?

Answer 8

D&V due to gastroenteritis

Question 9

What are the commoner causes of bacterial gastroenteritis?

Answer 9

Shigella
E.coli
Salmonella
Campylobacter

Question 10

How would a child usually present with a sodium value of …over 150?
…under 130?

Answer 10

Over 150
Very thirsty
Skin may feel doughy

Under 130
Lethargic
Dry skin that can be pinched into creases

Question 11

Why does a child get overflow diarrhoea?

Answer 11

Too much stool due to constipation
Soil rather than get diarrhoea
Stool is palpable abdominally and rectally

Question 12

What is posseting?

Answer 12

Vomiting small amounts of milk

Question 13

How should bile-stained vomiting be investigated?

Answer 13

Upper GI contrast e.g. barium meal/swallow

Question 14

When do children usually get projectile vomiting?

Answer 14

Pyloric stenosis

Question 15

What should you check for whilst examining a child for unexplained vomiting?

Answer 15

Signs of raised ICP - papilloedema and hypertension

Question 16

How is ‘chronic constipation’ in children diagnosed?

Answer 16

< 3 bowel movements per week
> 1 episode of faecal incontinence per week
Palpable stools in abdomen or large palpable stools in rectum
Retentive posturing/withdrawing behaviours
Painful defecation

Question 17

What are the complications of chronic constipation?

Answer 17

Incontinence
Faecal impaction
Pelvic floor dyssynergia (EAS contracts when defaecating, tenesmus)

Question 18

What are the red flags for constipation in children?

Answer 18

Symptoms from birth
Failure/delay to pass meconium
Ribbon stools
Locomotor delay/weakness
Distension with vomiting
Dysmorphic anus
Gross distension
Limb deformity (incl. talipes)
Abnormal reflexes
Scoliosis
Abnormal gluteal muscles
Sarcal agenesis

Question 19

Give five organic causes of constipation in infants

Answer 19

Anorectal malformations
Anal fissure - painful defecation
Rectal prolapse
Hirschprung’s - meconium delay, FTT

Question 20

How and when is Hirschprung’s usually diagnosed?

Answer 20

By rectal biopsy

First few weeks of life