GI

Question 1

define intussusception

Answer 1

invagination (telescoping) of proximal bowel into a distal segment (commonly ileum) that passes into the caecum through the ileocaecal valve

Question 2

clinical features of intussusception

Answer 2

paroxysmal severe colicky abdominal pain
brings up legs to chest
pale + lethargic
vomiting
passage of “red currant jelly stool”
abdominal distension
palpable mass in RUQ - often ‘sausage’ shaped

Question 3

investigations of intussusception

Answer 3

air enema
US scan of abdomen - shows ‘target’ sign’

complications include:
free abdominal air
presence of gangrene

Question 4

management of intussusception

Answer 4

rectal air insufflation 
contrast enema (only if stable)

Question 5

indications of surgery in intussusception

Answer 5

failure or non-operative management
peritonitis or perforation present
haemodynamically unstable

Question 6

complications of intussusception

Answer 6

bowel perforation
peritonitis
obstruction
gut necrosis

Question 7

common examination presentation of child with intussusception

Answer 7

red currant jelly stool 
drawing up of legs 
sausage shape in abdomen 
recent viral URTI 
intestinal obstruction (vomiting, absolute constipation and distension)

Question 8

define pyloric stenosis

Answer 8

a condition of hypertrophy (thickening and narrowing) of the outlet of pyloric sphincter of the stomach

Question 9

clinical features of pyloric stenosis

Answer 9

projectile vomiting after feeds 
failure to thrive 
pale and poor growth 
visible perastalsis of stomach
firm round mass in upper abdomen (large olive)

Question 10

common blood gas finding in children with pyloric stenosis

Answer 10

hypokalaemic hypocholoric (low chloride) metabolic alkalosis

Question 11

investigations of pyloric stenosis

Answer 11

abdominal US to visualise the thickened pylorus

Question 12

management of pyloric stenosis

Answer 12

pyloromyotomy (Ramstedt’s)

fluids resus

Question 13

define appendicits

Answer 13

inflammation of the appendix

Question 14

causes of appendicitis

Answer 14

obstruction of appendix allowing multiplying of bacteria and invasion of wall

causes pressure necrosis and eventual perforation

Question 15

clinical features of appendicitis

Answer 15

peri-umbilical pain progressing to right iliac fossa
nausea and vomiting 
fever 
tachycardia 
anorexia 
constipation

Question 16

signs of appendicitis

Answer 16

pain over right iliac fossa
+ve Rovsing’s sign
rebound and percussion tenderness

Question 17

what can rebound and percussion tenderness indicate?

Answer 17

peritonitis due to a rupturing of the appendix

Question 18

investigations in appendicitis

Answer 18

VBG 
urine HCG and dip 
bloods (FBC, CRP, U+Es, LFTs, clotting, amylase and cross match) 
CXR
CT AP 
US of RIF

Question 19

management of appendicitis

Answer 19

appendectomy or laparotomy

Question 20

complications of appendicitis

Answer 20

local abscess
perforation
gangrene

Question 21

define paediatric constipation

Answer 21

a child defecating less than 3x per week or has significant difficulty passing stool

Question 22

what is considered chronic constipation?

Answer 22

association of passing stools that are pellet like and difficult to pass

Question 23

causes of paediatric constipation

Answer 23

low fibre diet
dislike of using the toilet
pain on passing stool
anal fissures

Question 24

diagnosis of paediatric constipation

Answer 24

history
palpation of impacted faeces on abdo examination
abdominal US

Question 25

management of paediatric constipation

Answer 25

movicol disimpaction regime followed by maintenance movicol high fibre diet advise parents to encourage good toilet habits

Question 26

define Hirschsprungs Disease

Answer 26

incorrect innervation of the distal colon causing lack of aganglionic colon distension - leads to stool being trapped in proximal colon

Question 27

clinical features of Hirschsprung's Disease

Answer 27

``` delay in passing meconium (>48hrs) chronic constipation abdominal pain and distension vomiting poor weight gain failure to thrive ```

Question 28

investigations of Hirschsprung's Disease

Answer 28

history DRE rectal suction biopsy

Question 29

management of Hirschsprungs

Answer 29

surgical removal of aganglionic colon

Question 30

complication of Hirschsprungs

Answer 30

Hirschsprungs-associated enterocolitis (HAEC)

Question 31

define HAEC

Answer 31

inflammation and obstruction of intestines due to Hirschsprungs Disease

Question 32

clinical features of HAEC

Answer 32

fever abdominal distension diarrhoea (blood) septic features

Question 33

complications of HAEC

Answer 33

toxic megacolon | bowel perforation

Question 34

management of HAEC

Answer 34

antibiotics fluid resus decompression of obstruction

Question 35

define biliary atresia

Answer 35

a rare condition where the bile ducts of the infant become progressively fibrosed and destroyed

Question 36

clinical features of biliary atresia

Answer 36

prolonged jaundice dark urine chalky white stool

Question 37

investigations in biliary atresia

Answer 37

bloods (FBC, CRP, LFTs +TFTs) cholangiography hepatic scintigraphy abdominal US

Question 38

findings on cholangiography in biliary ateresia

Answer 38

failure to show normal architecture of the biliary tree

Question 39

management of biliary atresia

Answer 39

Kasai procedure (hepatoportoenterostomy)

Question 40

what type of bilirubin caused biliary atresia?

Answer 40

conjugated

Question 41

define meconium ileus

Answer 41

a condition in which the meconium becomes thickened and sticky, thus causing intestinal obstruction

Question 42

what condition is meconium ileus associated with?

Answer 42

cystic fibrosis - chloride channel mutations cause the mucous to become excessively thick

Question 43

clinical features of meconium ileus

Answer 43

delay in passing meconium (>48hrs for 1st poo) bilious green vomiting abdominal distension

Question 44

investigations in meconium ileus

Answer 44

abdominal XR

Question 45

findings on XR in meconium ileus

Answer 45

bubbly apperance of intestines | lack of air-fluid levels

Question 46

management of meconium ileus

Answer 46

'drip and suck' stomach drainage with NG tube and IV fluids | enemas to remove sticky meconium

Question 47

clinical features of mesenteric adenitis

Answer 47

diffuse abdominal pain recent PMH of URTI low grade fever abdominal tenderness

Question 48

investigations in mesenteric adenitis

Answer 48

enlarged mesenteric lymph nodes and NORMAL appendix

Question 49

management of mesenteric adenitis

Answer 49

hospital admission for overnight monitoring | safety net parents