Paediatric Gastro Med and Surg

Question 1

What are the main causes of gastro abdo pain?

Answer 1

1) IBS
2) IBD
3) Constipation
4) Peptic ulcer
5) Malrotation
6) Appendicitis
7) Abdo migraine
8) Gastritis

Question 2

What are the main gynae causes of abdo pain?

Answer 2

1) Ovarian torison
2) Ectopic pregnancy
3) PID
4) Dysmenorrhoea

Question 3

What are the main HPB causes of abdo pain?

Answer 3

1) Hepatitis
2) Gall stones
3) Pancreatitis

Question 4

What are the main uro causes of abdo pain?

Answer 4

1) PUJ obstruction
2) UTI

Question 5

What are the main signs of appendicitis?

Answer 5

1) Pyrexia
2) Anorexia
3) Vomiting
4) RIF rebound tenderness
5) Abdo pain: Central that localises to RHS

Question 6

What is the main concern about central trauma and bruising to the abdo?

Answer 6

Mid line structures such as spleen, bowel, liver and pancreas could be damaged

Question 7

What are the main differentials for abdo pain and rectal bleeding?

Answer 7

1) Polyps
2) Haemorrhoids
3) Prolapse
4) Anal fissure
5) infective causes
6) Meckel diverticulum
(Melaena: Gastritis/Duo ulcer)

Question 8

What is meckel diverticulum, main signs and treatment?

Answer 8

W: Remnant of vitelline duct: Yolk sac join to midgut lumen in foetus
MS: Severe rectal bleeding, intussusception, volvulus
T: Surgical resection

Question 9

What are the main DD for abdo mass?

Answer 9

1) Organomegaly
2) Nephroblastoma/Wilm’s tumour
3) Appendicitis
4) Constipation

Question 10

What are some DD’s for vomiting?

Answer 10

1) GORD
2) Infection e.g. Gastro
3) Food allergy/intolerance
4) Appendicitis/Coeliac/Int Obs
5) Over feeding
6) Necrotising enterocolitis
7) Malrotation -> Biliary vomit
8) DKA

Question 11

What causes of intestinal obstruction can lead to vomiting?

Answer 11

1) Pyloric stenosis
2) Duodenal atresia
3) Intussusception
4) Hirschsprung’s

Question 12

What is Pyloric and it’s main signs?

Answer 12

D: Hypertrophy of pyloric muscle causing gastric outlet obstruction
S: W Loss, visible gastric peristalsis/palpable mass on test feed and vomiting: Projectile, milk, straight after feeding

Question 13

What investigations and BG results for pyloric stenosis neonate?

Answer 13

Inv: U&E, B Gas, USS (P Sphincter hypertrophy)
BG: Metabolic alkalosis V K+/Cl-
- Baby vomits up all HCl so kidneys go into overdrive with ^ K+ secretion
Treat: IV fluids, Repeat BG to monitor alkalosis, stop feed–>stop vomit and pyloromyotomy

Question 14

Malrotation: How does it present, investigate and consequence

Answer 14

P: Obstruction w/ bilious vomiting, abdo pain and tenderness
Inv: Urgent upper GI contrast study to assess intestinal rotation
Con: SMA blood supply to small intestine can be compromised –> Infarct

Question 15

Duodenal Atresia: Presentation, Sign and Syndrome

Answer 15

P: Congenital absence/complete closure of duodenum –> Int obstruction in neonates
AXR: Double bubble sign
S: 20-40% Down’s

Question 16

Intussusception: Definition and Signs

Answer 16

D: Proximal bowel telescopes into distal segment: Obstruction, inflammation, bloody stools
Signs: Colicky pain, vomiting, abdo mass and redcurrant jelly stool

Question 17

Intussusception: Investigations and Treatment

Answer 17

Inv: USS ‘target sign’, Abdo XR
Treatment: Gas in anal canal to V intussusception, Analgesia and IV fluids if shocked

Question 18

Any child presenting with dark green vomiting needs what urgent investigation?

Answer 18

An urgent upper GI contrast study to assess intestinal rotation.