GI

Question 1

Duodenal atresia AXR

Answer 1

double bubble

Question 2

Obstruction AXR

Answer 2

air fluid levels

Question 3

Bilious vomiting few hours after birth may be due to…

Answer 3

duodenal atresia

Question 4

Bilious vomiting within 24h of birth may be due to…

Answer 4

jejunal/ileal atresia

Question 5

Bilious vomiting with failure to pass meconium may be due to…

Answer 5

• meconium ileus
• meconium plug
• rectal atresia
• Hischsprung

Question 6

Bilious vomiting 1-7 days after birth may be due to…

Answer 6

malrotation with volvulus

Question 7

Bilious vomiting in 2nd week of life may be due to…

Answer 7

NEC

Question 8

What is the SURGICAL Mx for GORD in children?

Answer 8

Nissen fundoplication

Question 9

When does pyloric stenosis present?

Answer 9

2-8 weeks of age

Question 10

What metabolic state does pyloric stenosis cause?

Answer 10

hypokalaemic hypochloraemic alkalosis (low Na, K and Cl)

Question 11

Signs of pyloric stenosis on abdo exam

Answer 11

• palpable olive-like mass in RUQ

- visible peristalsis

Question 12

What fluids are given in pyloric stenosis?

Answer 12

normal saline + potassium (to correct electrolyte imbalance)

Question 13

1st line disimpaction regimen

Answer 13

Movical paediatric plan:

polyethylene glycol (macrogol) + electrolyte

escalating over 1-2 weeks/until impaction resolves

Question 14

Maintenance Mx of constipation

Answer 14

polyethylene glycose + electrolyte (Movical paediatric plan) ± stimulant laxative (e.g. senna)

Question 15

What does explosive discharge of liquid stool and gas following PR exam suggest?

Answer 15

Hischsprung

Question 16

Diagnosis of Hischsprung

Answer 16

Suction rectal biopsy:

• absence of ganglion cells
• presence of large acetylcholinesterase-positive nerve trunks

Question 17

When does intussusception present?

Answer 17

any age but peak 3 months - 2 years

Question 18

How does intussusception present

Answer 18

• often prodromal period of viral illness (e.g. gastroenteritis) if PRIMARY intussusception
• paroxysmal, severe colicky pain with pallor
• (bile stained) vomit
• sausage shaped mass in abdomen
• redcurrant jelly/bloody stool
• abdo distension
• shock

Question 19

Doughnut/target sign on US

Answer 19

intusussception

Question 20

CIs to radiological reduction via rectal air insufflation for intussusception

Answer 20

• peritonitis
• shock
• perforation
• known pathological lead point (secondary intussusception)

Question 21

How does Meckel diverticulum present

Answer 21

• most are asymptomatic
• may present with: severe rectal bleeding, usually with acute reduction in Hb
• may also have intussusception, volvulus or diverticulitis (mimicking appendicitis)

Question 22

What Ix is indicated in any child with dark green vomit, and why?

Answer 22

upper GI contrast study to assess internal rotation (?malrotation and volvulus)

Question 23

What are the adhesions called in malrotation?

Answer 23

Ladd bands

Question 24

What Ix is always indicated in chronic/recurrent abdo pain in children?

Answer 24

urine MC&S for UTI