Gastrointestinal Disease

Question 1

Causes of hepatomegaly

Answer 1

• Infection
• CHF
• Infiltration (tumours)
• Storage (fat - CF, glycogen storage diseases)
• Idiopathic

Question 2

Causes of splenomegaly

Answer 2

• Infection (malaria)
• Haematological (hereditary spherocytosis, sickle cell)
• Extramedullary haempoesis (thalassaemia)
• Portal HTN
• Neoplastic

Question 3

Causes of hepatosplenomegaly

Answer 3

• Infection (EBV, CMV)
• Portal HTN
• Infiltration (leukaemia, lymphoma)
• Haematological (thalassaemia)
• Idiopathic

Question 4

Top causes of rectal bleeding

Answer 4

• Local (anal fissure)
• Swallowed blood from epistaxis
• Gastroenteritis (bacterial)
• Acid ulceration (hiatus hernia, peptic ulcer, Meckel’s diverticulum)
• Intussusception
• IBD

Question 5

Coeliac disease

Answer 5

• Most commonly occurs around introduction of gluten at 6-9 months
• Stools pale and bulky
• Abdomen distended, buttocks wasted
• TTG-IgA test used to test - can be diagnostic after 2 tests
• Duodenal necessary if TTG only mildly elevated
  
  • Villous atrophy
  • Crypt hyperplasia
  • Increased intraepithelial lymphocytosis

Question 6

Pyloric stenosis

Answer 6

• M>F
• 5-10% FHx in parents
• Projectile, non-bile stained vomiting at 4-6 weeks of life
• Diagnosis made by test feed or USS
• Treatment is Ramstedt pyloromyotomy (open of laparoscopic)

Question 7

Acute appendicitis

Answer 7

• Uncommon under 3 years
• When occurs may present atypically

Question 8

Mesenteric adenitis

Answer 8

• Central abdominal pain and URTI
• Conservative management

Question 9

Intussusception

Answer 9

• Telescoping bowel
• Proximal to or at the level of ileocaecal valve
• 6-9 months of age
• Colicky pain, D+V, sausage-shaped mass, red jelly stool
• Treatment is reduction with air insufflation

Question 10

Malrotation

Answer 10

• High caecum at the midline
• Feature in exopthalmos, congenital diaphragmatic hernia, intrinsic duodenal atresia
• May be complicated by the development of volvulus, an infant with volvulus may have bile stained vomiting
• Diagnosis is made by upper GI contrast study and USS
• Treatment is by laparotomy, if volvulus is present (or at high risk of occurring then a Ladd’s procedure is performed)

Question 11

Hirschsprung’s disease

Answer 11

• Absence of ganglion cells from myenteric and submucosal plexuses
• Full-thickness rectal biopsy for diagnosis
• Delayed passage of meconium and abdominal distension
• Treatment is with rectal washouts initially, after that an anorectal pull through procedure

Question 12

Oesophageal atresia

Answer 12

• Associated with tracheo-oesophageal fistula and polyhydramnios
• May present with choking and cyanotic spells following aspiration
• VACTERL associations (ventral, anal, cardiac, trans-oesophageal fistula, renal and limb anomalies)

Question 13

Meconium ileus

Answer 13

• Usually delayed passage of meconium and abdominal distension
• The majority have cystic fibrosis
• X-Rays will not show a fluid level as the meconium is viscid, PR contrast studies may dislodge meconium plugs and be therapeutic
• Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs

Question 14

Biliary atresia

Answer 14

• Jaundice > 14 days
• Increased conjugated bilirubin
• Urgent Kasai procedure

Question 15

Necrotising enterocolitis (NEC)

Answer 15

• Prematurity is the main risk factor
• Early features include abdominal distension and passage of bloody stools
• X-Rays may show pneumatosis intestinalis and evidence of free air
• Increased risk when empirical antibiotics are given to infants beyond 5 days
• Treatment is with total gut rest and TPN, babies with perforations will require laparotomy