GI

Question 1

GORD prevalence

Answer 1

40% of infants
within 1st 2 weeks of life

Question 2

pathophysiology Gord infants

Answer 2

tone of muscular portion of lower oesophagus is too low..made worse by
- short, narrow oesophagus
- delayed gastric emptying
- shorter, lower oesophageal sphincter is above diaphragm
- liquid diet and high calorie intake - distending the stomach
- larger ratio of gastric volume to oesophageal volume
- recumbent position

Question 3

risk factors GORD infants

Answer 3

prematurity
parental hx of heartburn
obesity
hiatus hernia
hx of repaired congenital diaphragmatic hernia or oesophageal atresia
neurodisability such as cerebral palsy

Question 4

symptoms GORD infants

Answer 4

crying, unusual neck postures, back arching
feeding difficulties
hoarseness
chronic cough
episode of pneumonia
faltering growth
retrosternal or epigastric pain

Question 5

hx gord infants

Answer 5

full feeding history
relationship of sx to feeds

Question 5

GORD infants ddx

Answer 5

pyloric stenosis
intestinal obstruction
acute surgical abdomen
upper GI bleed
sepsis
raised ICP
bacterial gastroenteritis
UTI

Question 6

GORD when consider other diagnoses

Answer 6

if onset >6 mths of age or sx persist beyond 1 year

Question 6

GORD infants management

Answer 6

reassurance - effortless regurgitation
alginate mixed with water after feeds if breastfed
make sure not over ded or decreased frequency, can try feed thickener if formula fed

Question 7

GORD infants complications/prognosis

Answer 7

90% spontaneously resolve within 1st year of life
complications - reflux oesophagitis, recurrent aspiration pneumonia, recurrent acute otitis media, dental erosion
apnoea
ALTE

Question 8

coeliac immune mechanisms

Answer 8

T cell mediated immune disorder, development of anti-gluten CD4 T cell response, anti gluten antibodies, autoantibodies against tissue transglutaeminase, endomysium and activation of intraepithelial lymphocytes…result in epithelial cells destruction and villous atrophy

Question 9

gluten foods

Answer 9

bread
beers
biscuit
breakfast cereal
cakes
pasta
pies

Question 10

coelic associated conditiions

Answer 10

type 1 DM
down’s
turner’s
thyroid disease
RA
addison’s

Question 11

coeliac younger children sx

Answer 11

GI sx - loose stools, steatorrhoea, anorexia, abdo pain
9-24 mths of age
failure to thrive
weight loss
histology - crypt hyperplasia and villous atrophy

Question 12

coeliac older children sx

Answer 12

more likely to have extra-intestinal sx
can also have intestinal

Question 13

silent form coeliac

Answer 13

damaged small intestine mucosa + positive serology
no clinical sx

Question 13

latent form coeliac

Answer 13

predisposing gene HLADQ2 and/or HLADQ8
normal intestinal mucosa
posittive serology is possible

Question 14

potential form coeliac

Answer 14

normal mucosa,positive autoimmune serology, geneticallly predisposed to develop at some point, may or not have sex

Question 15

atypical form coeliac

Answer 15

osteoporosis, peripheral neuropathy, anaemia, infertility
no intestinal sx

Question 16

extra-intestinal sx coeliac

Answer 16

dermatitis herpetiformis
dental enamel hypoplasia
osteoporosis
delayed puberty
short stature
iron def anaemia
liver and billiary tract disease
arthritis
peripheral neuropathy

Question 17

coeliac ddx

Answer 17

tropical sprue
CF
IBD

Question 18

investigations coeliac

Answer 18

offer serological testing - gluten in diet for at least 6mths
- total IgA and tTG
- then try EMA
- if total IgA deficient consider IgG EMA
- genetic testing
- endoscopic intestinal biopsy
gold standard is duodenal biopsy, classified by Marsh

Question 19

complications coeliac

Answer 19

anaemia
osteoporosis
refractory coelic disease
malignancy
fertility issues
depression/anxiety

Question 20

cow’s milk protein allergy epidemiology

Answer 20

7% of formula or mixed fed infants
0.5% of exclusively breastfed infants

Question 21

cow’s milk protein allergy pathophysiology

Answer 21

IgE mediated - type 1 hypersensitivity. CD4 TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein…triggers histamines and other cytokines from mast cells and masophils
non IgE - T cell activation

Question 22

cow's milk protein allergy risk factors

Answer 22

personal hx of atopy fhx of atopy not breastfeeding (exclusively breastfeeding is protective factor)

Question 23

clinical features cow's milk allergy

Answer 23

ige - acute,prutirits, eyrhtema, acute urticaria, angioedema, nausea, vomiting, diarrhoea lower and upper resp sx non ige - non acute, delayed, pruritus, erythema, atopic eczema, GORD,loose stools, blood in stool, infantile colic, food aversion, constipation, perianal redness, apllor, faltering growth, lower resp sx

Question 24

CMPA investigations

Answer 24

clinical feature specific IgE antibodies but low specificity non IgE - clinically diagnosed

Question 25

CMPA management

Answer 25

avoidance of cow's milk including in mothers die for at least 6 mths of until 9-12 months old if formula fed - alternative formula - extensively hydrolyed or amino acid

Question 26

CMPA complication

Answer 26

malabsoprtion iron def anaemia faltering growth anaphylaxis (rare)

Question 27

rotavirus

Answer 27

most common cause of infantile gastoenteritis vaccine against at 8 and 12 weeks faecal oral route or by environmental contamination peaks over winter mths

Question 28

norovirus

Answer 28

commonest cause in all age groups faecal oral or environmental contamination

Question 29

adenovirus

Answer 29

resp infection too gastroenteritis <2 yrs of age

Question 30

campylobacter

Answer 30

most common bloody diahrroea undercooked meat and unpasteurised milk

Question 31

e.coli

Answer 31

some strains such as VTEC - haemorhhagic colitis and haemolytic uraemic syndrome contaminated food, person to person contact, contact with infected animals

Question 32

increased risk of dehydration in infants gastroenteritis

Answer 32

children <6mths children >5 diarrhoeal stools in last 24 hrs childre vomited >2x in last 24 hrs children who stopped breastfeeding during illness

Question 33

when should ddx be considered in children with gastroenteritis

Answer 33

temp >38 if <3mths or >39 if >3mths old breathlesness altered GCS meningism blood in stool bilious vomit severe abdo pain abdo distention`

Question 34

gastroenteritis investigations

Answer 34

stool sample - if septicaemia, blood in stool or child is immunocompromised blood test - Na, K, Cr, Ur and glu if IV fluids going to be used or signs of hypernatraemia

Question 35

gastoenteritis manegemtn

Answer 35

continue breast feeding encourage fluid intake decreased diuretic drink intake oral rehydration salt solution (50ml/kg over 4 hrs plus maintenance fluid) if dehydrated Iv hydration

Question 36

gastroenteritis following rehydration

Answer 36

full strength milk and slowly re introduce child's solidfood hygiene not return to school until at least 48 hours passed since last episode and not swim for 2 weeks after last episode

Question 37

gastroenteritis complications

Answer 37

haemolytic uraemic syndrome - which can result in acute renal failure and haemolytic anaemia arthritis, carditis, erythema nodosum and conjuncitivits, reiter's syndrome toxic megacolon acquired lactose intolerance

Question 38

see crohn's

Question 39

see UC