GI

Question 1

Presentation of constipation

Answer 1

Less than 3 stools a week

Hard stools that are difficult to pass
Rabbit dropping stools

Straining and painful passages of stools

Abdominal pain

Holding an abnormal posture

Rectal bleeding associated with hard stools

Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools

Hard stools may be palpable in abdomen

Loss of the sensation of the need to open the bowels

Question 2

Lifestyle factors affecting constipation

Answer 2

Habitually not opening the bowels
Low fibre diet
Poor fluid intake and dehydration
Sedentary lifestyle
Psychosocial problems such as a difficult home or school environment

Question 3

What are some secondary causes of constipation?

Answer 3

Hirschsprung’s disease
    Cystic fibrosis (particularly meconium ileus)
    Hypothyroidism
    Spinal cord lesions
    Sexual abuse
    Intestinal obstruction
    Anal stenosis
    Cows milk intolerance

Question 4

Management of Constipation

Answer 4

Correct any reversible contributing factors

Recommend a high fibre diet and good hydration

Start laxatives (movicol is first line)

Faecal impaction may require a disimpaction regimen with high doses of laxatives at first

Encourage and praise visiting the toilet. This could involve scheduling visits, a bowel diary and star charts.

Question 5

Red flag signs of severe abdo pain

Answer 5

Persistent or bilious vomiting
    Severe chronic diarrhoea
    Fever
    Rectal bleeding
    Weight loss or faltering growth
    Dysphagia (difficulty swallowing)
    Nighttime pain
    Abdominal tenderness

Question 6

Initial investigtions that may indicate pathology include:

Answer 6

Anaemia can indicate inflammatory bowel disease or coeliac disease

Raised inflammatory markers (ESR and CRP) can indicate inflammatory bowel disease

Raised anti-TTG or anti-EMA antibodies indicates coeliac disease

Raised faecal calprotectin indicates inflammatory bowel disease

Positive urine dipstick indicates a urinary tract infection

Question 7

causes of vomiting in babies / children

Answer 7

Overfeeding
    Gastro-oesophageal reflux
    Pyloric stenosis (projective vomiting)
    Gastritis or gastroenteritis
    Appendicitis
    Infections such as UTI, tonsillitis or meningitis
    Intestinal obstruction
    Bulimia

Question 8

Management of GORD in babies

Answer 8

Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)
Gaviscon mixed with feeds
Thickened milk or formula

Question 9

when does pyloric stenosis typically present?

Answer 9

first few weeks of life

Question 10

Features of pyloric stenosis

Answer 10

projectile vomiting shortly after being fed
olive mass in abdo
failing to thrive baby

Question 11

what would a blood gas anaylasis of a baby with pyloric stenosis show?

Answer 11

hypochloric (low chloride) metabolic alkalosis

Question 12

investigations for pyloric stenosis

Answer 12

test feed
abdominal USS
blood gases

Question 13

management of pyloric stenosis

Answer 13

laparoscopic pyloromyotomy

Question 14

which antibodies rise with active coeliac disease?

Answer 14

anti-tissue transglutaminase (anti-TTG)

anti-endomysial (anti-EMA)

Question 15

symptoms of coeliac

Answer 15

Failure to thrive in young children
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia secondary to iron, B12 or folate deficiency
Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen

Question 16

genes in coeliac

Answer 16

HLA-DQ2 gene (90%)

HLA-DQ8 gene

Question 17

associations of coeliac

Answer 17

Type 1 diabetes
    Thyroid disease
    Autoimmune hepatitis
    Primary biliary cirrhosis
    Primary sclerosing cholangitis
    Down’s syndrome

Question 18

treatment of coeliac

Answer 18

gluten free diet

Question 19

when does biliary atresia commonly present?

Answer 19

shortly after birth (first few weeks?)

Question 20

presentation of biliary atresia

Answer 20

prolonged (conjagated) jaundice
pale stool
dark urine

Question 21

investigations for biliary atresia

Answer 21

stool colour
split bilirubin test
liver biopsy
uss

Question 22

treatment for bilary atresia

Answer 22

Kasai portoenterostomy

Question 23

what is Hirschsprung’s disease?

Answer 23

congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum.

Question 24

presentation of hirschsprungs disease

Answer 24

Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive

Question 25

presentation of Intussusception

Answer 25

Severe, colicky abdominal pain
    Pale, lethargic and unwell child
    “Redcurrant jelly stool”
    Right upper quadrant mass on palpation. This is described as “sausage-shaped”
    Vomiting (bilious) 
    Intestinal obstruction

Question 26

investigation of choice for intussusception and what would you see?

Answer 26

USS- target sign

Question 27

management of intussception?

Answer 27

pneumostatic reduction (air enema)

Question 28

what age does intussusception usually occur/present?

Answer 28

6months- 2yrs