Paediatric Gastroenterology

Question 1

Diagnosis 4-12 wk old presenting with projectile, non-bilous vomiting?

Answer 1

Pyloric stenosis

Question 2

What is the vomit like in PS?

Answer 2

White curd-like

Question 3

What are other symptoms of PS?

Answer 3

Weight loss
Not feeding
Shock
DEHYDRATION

Question 4

Investigation for PS?

Answer 4

Test feed

• Examing abdomen that distends as it reaches pylorus
• USS
• Bloods
• Blood gases

Question 5

What will be seen on USS in PS?

Answer 5

Long thickened pylorus

Question 6

What blood gas results will be seen in PS?

Answer 6

Metabolic alkalosis

Question 7

What may be seen on bloods in PS?

Answer 7

Hypochloreamia

Hypokalaemia

Question 8

Treatment PS?

Answer 8

Fluids replacement

Pyloric myotomy

Question 9

3 causes of effortless vomiting?

Answer 9

Relaxation in LOS
Hiatus hernia
Neuromuscular disorder

Question 10

What is sanifer’s syndrome?

Answer 10

Spastic torticollis

Dystonic movements

Question 11

Investigation for effortless vomiting?

Answer 11

Barium swallow if dysphagia

Gold standard = pH study

Question 12

Management of effortless vomiting?

Answer 12

Thickened feed
Oral stimulation
Exclusional diet if support fails - may be sensitivity
NG feeding - serious

Question 13

What surgery can be done for effortless vomiting if it is causing failure to thrive or aspiration?

Answer 13

Nissen fundoplication

Question 14

What is CMPA?

Answer 14

Cow’s milk protein allergy

Question 15

% of CMPA?

Answer 15

2-5%

Question 16

What does not mediate CMPA?

Answer 16

IgE

Question 17

What is thought to mediate CMPA?

Answer 17

T cells

Question 18

What are the symptoms of CMPA?

Answer 18

Slow developing
Over hours and day
Diarrhoea and vomiting
Poor feeding
Reflux

Failure to thrive

Question 19

What symptom may be present if it is IgE CMPA?

Answer 19

Eczema

Question 20

Investigation for CMPA?

Answer 20

Exclusion trial diet for 6 months (mother)

Question 21

Treatment for CMPA?

Answer 21

Formula - extensively hydrolysed formula

Exclude cows milk from mothers diet

Dietetics referral

Calcium supps

Question 22

What can be tried at 6 months or 1year?

Answer 22

Milk challenge

• Baked milk
• Cooked milk
• Yoghurt
• Solids
• Normal milk

Question 23

What are the symptoms of an IgE allergy?

Answer 23

Reaction within 2 hours
Urticaria
Angiodema
Pruritis
Conjunctivitis
Wheeze/stridor

Anaphylaxis

Question 24

What are causes of BILOUS vomiting?

Answer 24

Intestinal atresia
Malrotation causing a volvulus
Intussiception
Ileus
Crohns - strictures

Question 25

What is green vomit always caused by?

Answer 25

Pathology

Question 26

What is investigation for bilous vomiting?

Answer 26

AxR - Intussiception = target sign Contrast meal Surgical opinion

Question 27

What are causes of chronic constipation/soiling?

Answer 27

``` Poor diet Bad potty training Illness Medication Psychological ```

Question 28

What can chronic constipation lead to/withholding

Answer 28

Bowel impaction | - Large hard stool

Question 29

What are signs of bowel impaction?

Answer 29

Diarrhoea - watery

Question 30

Treatment of bowel impaction?

Answer 30

Laxatives high dose Fluids Totally empty colon then slowly wean off treatment

Question 31

Investigations of chronic constipation?

Answer 31

History AxR if red flags

Question 32

3 types of laxatives?

Answer 32

Osmotic - lactulose Stimulant - senna Isotonic - movicol

Question 33

Treatment of Crohns?

Answer 33

5-ASA Azothioprine Methotrexate Infliximab

Question 34

What are the 3 main causes of diarrhoea in kids?

Answer 34

MOTILITY DISTURBANCE SECRETORY OSMOTIC/MALABSORPTIVE

Question 35

What are the motility disturbance causes of diarrhoea?

Answer 35

IBS | Toddler diarrhoea

Question 36

What are the secretory causes of diarrhoea?

Answer 36

Infection IBD Congenital hypothyroidism

Question 37

What are the osmotic/malabsorptive causes of diarrhoea?

Answer 37

CF Chronic liver disease (lack of bile) Coeliac Food allergy

Question 38

What is the pathology of secretory diarrhoea?

Answer 38

Driven by Cl- CFTR channels

Question 39

What is the pathology of osmotic diarrhoea?

Answer 39

Movement of water across the bowel to equalise equilibrium

Question 40

What is a red flag in the history?

Answer 40

Nocturnal defecation

Question 41

Define acute

Answer 41

<1 week

Question 42

Define persistent

Answer 42

2-4 weeks

Question 43

Define chronic

Answer 43

>4 weeks | More than 4 stools per day

Question 44

Investigation for diarrhoea?

Answer 44

Faeces analysis | - Define type of diarrhoea

Question 45

What will faeces analysis show with secretory diarrhoea?

Answer 45

Large volume | Continues with fasting

Question 46

What will faeces analysis show with osmotic diarrhoea?

Answer 46

Small volume | Stops with fasting

Question 47

What genes cause coeliac?

Answer 47

HLA - DQ2/DQ8

Question 48

What is coeliac?

Answer 48

Gliadin sensitivity

Question 49

Investigations coeliac?

Answer 49

Anti - TTG Anti-endomysial Duodenal biopsy

Question 50

What may cause false positive anti-TTG?

Answer 50

IgA deficiency

Question 51

What should be tested if IgA is low?

Answer 51

Anti-endomysial Ab

Question 52

What levels of anti-TTG mean a duodenal biopsy is unnessesary?

Answer 52

10x normal with normal IgA

Question 53

Tx coeliac?

Answer 53

Gluten free diet for life

Question 54

What does untreated coeliac increase risk of?

Answer 54

Small bowel lymphoma

Question 55

What would be seen on duodenal biopsy in coeliac?

Answer 55

Crypt hypertrophy Villous atrophy Lyphocytic infiltration