Gastrointestinal

Question 1

What organisms commonly cause gastroenteritis?

Answer 1

Rotavirus (50-60%) and adenovirus (10-15%)

Question 2

What general advice can you give for GOR?

Answer 2

Feed upright, hold upright for 20-30mins after feeding, wind in middle & at end of feeding, small frequent feeds, can add thickening agents, can add gaviscon to feeds.

Question 3

How long do V/D last in gastroenteritis?

Answer 3

Vom - 1-2d

Diarrhoea 5-7d

Question 4

What is a potential sequelae of gastroenteritis? What are the Sx and lab findings?

Answer 4

Haemolytic Uraemic syndrome. Sx of AKI, jaundice, schistocytes on blood film, bloody diarrhoea prodrome, low platelets, anaemia

Question 5

What might you see on blood gases in a child with pyloric stenosis?

Answer 5

Metabolic alkalosis (hypochloraemic hypokalaemia).

Also might see high Na and urea + Cr

Question 6

What clinical presentation is linked with pyloric stenosis?

Answer 6

Projectile vomiting, visible peristalsis, pyloric mass, scawny, hungry, weight loss, scaphoid abdomen

Question 7

Management of pyloric stenosis?

Answer 7

NBM, IV fluids - correct hydration & electrolytes, surgery.

Question 8

What are the Sx and blood results in coeliacs?

Answer 8

Short stature, FTT, loose stools, distended abdo, thin skin & loss SC fat, buttock & muscle wasting.
Bloods: anaemic, +ve TTG IgA Abs, +ve anti-endomysial Abs, +ve anti-gliadin Abs, low total IgA

Question 9

How is a diagnosis of coeliac’s confirmed?

Answer 9

Jejunal biopsy

Question 10

What conditions are associated with coeliacs?

Answer 10

Dermatitis herpetiformis, vitiligo, DM

Question 11

When might you get blood in stools with gastroenteritis?

Answer 11

If bacterial cause

Question 12

What is the initial management of gastroenteritis in child?

Answer 12

Oral rehydration therapy - 50ml/kg over 4h

continue breastfeeding.

Question 13

What is a clinitest and when might it be positive?

Answer 13

Detects glucose in stools. +ve in post-gastroenteritis syndrome (temporary lactose intolerant)

Question 14

What types of dehydration are there?

Answer 14

Hyponatraemic = most common. Water and Na lost during D/V. Drinking water increases water but not Na –> lower [Na] –> brain swells –> convulsions

Hypernatraemic = less common. Water loss > Na loss, e.g. due to fever. –> low Na –> brain shrinks –> jittering, increased tone, reflexes, altered GCS, seizures

Question 15

What are the main features that suggest child is in shock from dehydration rather than just clinical dehydration?

Answer 15

Hypotension, long CRT, weak pulses, cold extremities, pale/mottled skin

Question 16

Which abdominal condition can be assoc with pyuria and bacteruria?

Answer 16

Appendicitis

Question 17

What is the most likely cause of bilious vomiting in a 2 day old baby?

Answer 17

Volvulus