Gastrointestinal Disease

Question 1

What is the most common cause of gastroenteritis in children?

Answer 1

Rotavirus

vaccine introduced in July 2013

Question 2

Transmission of rotavirus?

Answer 2

Faecal-oral

Question 3

What type of vaccine is rotavirus vaccine?

Answer 3

Live attenuated (weakened) vaccine given orally

Question 4

Name one very rare risk associated with rotavirus vaccine

Answer 4

Intussusception (Sx = abdo pain, vomiting, red currant stool)

Question 5

When is rotavirus vaccine given?

Answer 5

At 2 months and at 3 months. Must be given at least 4 weeks apart.

Question 6

Define dysentry

Answer 6

Diarrhoea + blood/mucus

Question 7

What 4 bacteria cause dysentry

Answer 7

E.coli, shigella, campylobacter, salmonella

Question 8

What antibiotic is given for amoebic dysentery?

Answer 8

Metronidazole

Question 9

Haemolytic uraemic syndrome (HUS) is a triad of…

Answer 9

1) Microangiopathic haemolytic anaemia (coombs negative)
2) Thrombocytopenia
3) Renal impairment

Question 10

Typical (or infection induced) HUS usually follows infection with what organism?

Answer 10

E.Coli VTEC O157

VTEC = VeroToxin producing E.Coli also known as enterohaemorrhagic E.Coli

Question 11

What are the indications for sending a stool sample in a child with gastroenteritis?

Answer 11

Recent travel abroad
No improvement by day 7 
Uncertain diagnosis
Blood and/or mucus in stool
Suspected septicaemia
Immunocompromised child

Question 12

Antibiotics are not usually indicated in gastroenteritis but what antibiotic would you give for E.coli/shigella/campylobacter if particular severe infection?

Answer 12

Ciprofloxacin

Question 13

What age does pyloric stenosis usually occur?

Answer 13

2 to 8 weeks

Question 14

What sign may you see in the abdomen with a test feed in pyloric stenosis?

Answer 14

Visibile peristalsis

Palpable mass ‘pyloric tumour’

Question 15

Gastro-oesophageal reflux is very common. What groups of babies is GOR more severe in?

Answer 15

Preterm infants
Cerebral palsy
Chronic respiratory disorders

Question 16

What treatment advice can you offer mothers whose children are suffering with reflux?

Answer 16

Feed little and often
Frequent winding during feeds
Feed thickeners
Upright after feeds, elevation of cot head
Antacids e.g. Gaviscon infant; H2 blockers e.g. ranitidine; PPIs e.g. omeprazole

Question 17

What surgery is done for severe reflux? (usually underlying neurological disorder e.g. CP)

Answer 17

Fundoplication (upper midline laparotomy scar)

Question 18

What is the classical blood picture of pyloric stenosis?

Answer 18

Hypokalaemic, hypochloraemic alkalosis

Question 19

How is pyloric stenosis managed?

Answer 19

• Rehydration and correction of alkalosis by giving IV NaCl

- Surgery: Ramstedts pyloromyotomy (see ramstedts scar)