GI pathologies

Question 1

Give some common causes of acute abdominal pain in children:

Answer 1

Gastroenteritis
Constipation
UTI
Acute appendicitis
Volvulus
Intussusception
HSP
DKA
Renal / biliary / uteric stones

Question 2

A patient presents with pallor and intermittent colicky pain (screaming). They are between the ages of 3-24 months - what is the most likely diagnosis?

Answer 2

Intussusception

Question 3

Red current jelly stool is a classic sign of what?

Answer 3

Intussusception

Question 4

What is the most common cause of diarrhoea in children

Answer 4

Rotavirus

Question 5

In a patient with intussusception, what examination finding would you expect?

Answer 5

Sausage shaped mass on abdominal palpation

Question 6

On AXR what would be seen in intussusception?

Answer 6

Doughnut sign

Question 7

Define intussusception and state where is intussusception most likely to occur?

Answer 7

Telescoping of one part of the bowel into another.

75% of cases involved the ileum and the caecum

Question 8

How is intussusception managed?

Answer 8

Air or barium enema

if fails or patient has peritonitis –> laparotomy is required.

Question 9

Perforation in acute appendicitis is rare in paediatrics true or false?

Answer 9

False

Perforation is extremely common, especially in much younger - up to 90% so appendectomy is always required!

Question 10

What investigations would be appropriate in patients with suspected appendicitis?

Answer 10

USS of abdomen
Or abdominal ct
(Ab xray is useless)
Dipstick urine to rule out UTI

Question 11

Define volvulus:

Answer 11

Torsion of a malrotated intestine i.e. when a preexisting malrotation leads to the intestines twisting around each other. Can result in an infarcted bowel

Question 12

Patient presents with acute abdominal pain, which is severe and unrelenting in nature, abdominal distension accompanied with bilious vomit. What is the most likely diagnosis?

Answer 12

Volvulus

Question 13

When would you see the coffee bean sign on an xray/

Answer 13

In a patient with a volvulus

Question 14

Bile stained vomit in the first few days of life is most likely to be indicative of what?

Answer 14

Duodenal or ileal atresia

Congenital malrotation

Question 15

Infant presents with vomiting after every feed, some failure to thrive, but always hungry. Potentially some episodes of crying in pain / colicky. What’s the likely diagnosis?

Answer 15

Reflux disease

Question 16

Any febrile illness in infants can cause diarrhoea - true or false?

Answer 16

True.
Infants and paediatric patients often present with diarrhoea as the main symptom of any form on infection including UTIs, CNS and chest infections.

Question 17

What form of acid-base disturbance would be seen in an infant with pyloric stenosis and why?

Answer 17

Metabolic alkalosis

Loss of H+ ions from persistent vomiting

Question 18

What are some red flag signs in a dehydrated patient?

Answer 18

Sunken eyes
Altered responsiveness
Tachycardia
Tachypnoea
Reduced skin turgor 
(sunken fontanelles)

Question 19

2y/o child presents with failure to thrive, anorexia, irritable, vomiting and diarrhoea which is pale and foul smelling. Signs include abdominal distension and pallor. What is the most likely diagnosis?

Answer 19

Coeliacs disease

Question 20

What is a common parasitic cause of diarrhoea in children?

Answer 20

Giardia lamblia

Question 21

When would faecal calprotectin be found in a stool sample?

Answer 21

In patients who suffer from inflammatory bowel disease.

Question 22

What can commonly occur in children following an episode of gastroenteritis and why does it happen?

Answer 22

Short term lactose intolerance

The mucosal surface cells are stripped off the bowels during the gastroenteritis episodes; these cells contain lactase. The child will require lactofree substances for few weeks but it is not a permanent change.

Question 23

What diagnosis must be considered in a child with abdominal pain if they are African / Caribbean ?

Answer 23

Sickle cell anaemia

Question 24

What % of children will experience recurrent abdominal pain and how many will be from an organic source?

Answer 24

10-15% of schoolchildren will experience stomach pain

Only 1/10 of these will be from an organic source.

Question 25

How is chronic constipation officially diagnosed?

Answer 25

They must have the symptoms for minimum 1 month and have two of the following:

• Less than 3 defecation a week
• At least one episode of soiling per week (post toilet trained)
• History of excessive stool retention or retention posturing
• Passing of stools with very large diameter
• Passing of stools which are painful and hard/dry

Question 26

What are some of the risk factors for constipation?

Answer 26

Diet and dehydration
Holding of stools 
Change in routine
Lack of exercise
Genetics
Medications

Question 27

What are some conditions in paediatrics which can lead to secondary constipation?

Answer 27

Hypothyroidism
Coeliac disease
Cystic fibrosis

Question 28

List some investigations you would do in acute abdominal pain and why?

Answer 28

FBC - leukocytosis = appendicitis and UTI
Urine dipstick - UTI or haematuria = HSP
Urine culture - Infection source
Abdo Xray - Dilated bowel loops, faecal loading etc
Abdo USS - Intussusception, renal tract abnormality
CRP / ESR - will be raised in IBD and infections