Paediatric Gastroenterology

Question 1

name a few systemic signs of constipation in children

Answer 1

irritability
poor appetite
abdominal pain
low energy
straining
overflow diarrhoea

Question 2

name a few causes for constipation in children

Answer 2

diet (lack of fibre, choices eg vegetarian)
dehydration
illness
medication
family history (IBD)
social circumstances (school toilets)
psychological circumstances (rushed by others)
organic cause

Question 3

what is faecal holding in children, and why does it occur?

Answer 3

it’s conscious clenching to stop defecation. often a reflex after child has had previous painful bowel movement experience

Question 4

social management of chronic constipation in children?

Answer 4

• educate parents

- dietary advice

Question 5

psychological management of chronic constipation in children?

Answer 5

• remove adversive factors
• soften stool/remove pain to stop faecal holding
• promote praise for bowel movement

Question 6

medical management of chronic constipation in children?

Answer 6

• osmotic laxatives (movicol/laxido)

- stimulant laxatives (senna)

Question 7

what is impaction and how is it treated?

Answer 7

large hard stool building up in rectum/colon

treated by emptying rectum/colon with laxatives/manually and promoting regular bowel movement

Question 8

what happens to the internal anal sphincter during impaction in constipation?

Answer 8

internal sphincter is forced open, bowel becomes desensitised to stimulus of being full

Question 9

what is the extent of ulcerative colitis often presented in children?

Answer 9

pancolitis

Question 10

what is the extent of crohn’s disease often presented in children?

Answer 10

panenteric

Question 11

how does ulcerative colitis present in children?

Answer 11

bloody diarrhoea
abdominal pain
no systemic symptoms

Question 12

how does crohn’s disease present in children?

Answer 12

depends on area affected, but in general:
no diarrhea
abdominal pain
weight loss
malabsorption
stunted growth

Question 13

what laboratory investigations are carried out to diagnose IBD in children?

Answer 13

• FBC
• ESR & CRP
• faecal calprotectin
• stool sample (rule out infective cause)

Question 14

how much of the GI tract wall if affected in CD and UC?

Answer 14

UC - only mucosa/submucosa

CD - transmural involvement

Question 15

name a few non-GI symptoms that may be present in IBD in children

Answer 15

rash (erythema nodosum)
uveitis
arthritis

Question 16

what are the main aims of IBD treatment in children?

Answer 16

• initiate and maintain remission
• correct any nutritional deficiencies
• maintain growth and development

Question 17

why are steroids not given to children under 2 years of age?

Answer 17

because steroids can cause significant growth stunting

Question 18

what imaging investigations are carried out to diagnose IBD in children?

Answer 18

• endoscopy/colonoscopy
• mucosal biopsy
• MRI/barium meal

Question 19

how is crohn’s disease remission induced in children?

Answer 19

• nutritional therapy

- steroids

Question 20

how is crohn’s disease remission maintained in children?

Answer 20

• thiopurines (azathioprine)

Question 21

how is ulcerative colitis remission induced in children?

Answer 21

• 5-ASA

- steroids

Question 22

how is ulcerative colitis remission maintained in children?

Answer 22

• 5-ASA

- thiopurines (azathioprine)

Question 23

for which type of IBD could surgery be curative?

Answer 23

ulcerative colitis

Question 24

for which type of IBD is surgery not curative but aimed at alleviating complications?

Answer 24

crohn’s disease

Question 25

which type of IBD can present with systemic symptoms in children?

Answer 25

crohn's disease

Question 26

on examination during a test feed of a child, what can be seen in pyloric stenosis?

Answer 26

- olive tumour | - visible gastric peristalsis

Question 27

what type of vomit characterises pyloric stenosis?

Answer 27

projectile, non-bilious vomit

Question 28

name three signs of pyloric stenosis

Answer 28

- olive tumour - visible gastric peristalsis - projectile, non bilious vomit

Question 29

what investigations should be done for a child with potential pyloric stenosis?

Answer 29

- abdominal ultrasound | - FBC, U&E

Question 30

what metabolic picture is seen in children with pyloric stenosis, and why?

Answer 30

metabolic alkalosis, caused by loss of hydrochloric acid through vomit

Question 31

how is pyloric stenosis treated?

Answer 31

surgical pyloromyotomy

Question 32

how is pyloric stenosis diagnosed?

Answer 32

- ultrasound

Question 33

name some symptoms of pyloric stenosis, noted by parents of child

Answer 33

- poor feeding - projectile vomiting - weight loss - irritability

Question 34

why does bilious vomiting in children ring alarm bells?

Answer 34

because an intestinal obstruction is the most likely cause for it

Question 35

what is the most common cause of effortless vomiting?

Answer 35

gastroesophageal reflux

Question 36

what imaging investigation is done if a child presents with bilious vomiting?

Answer 36

abdominal xray with contrast

Question 37

what are the management options for gastroesophageal reflux in children?

Answer 37

- feeding advice (thicken feed) - nutritional support (calorie increase, milk free, NG tube) - medical treatment (gaviscon, prokinetics, PPI) - surgery (fundoplication)

Question 38

which three types of diarrhoea can occur in children, and what are they associated with?

Answer 38

motility diarrhoea - toddler's diarrhoea, IBS osmotic diarrhoea - malabsorption (coeliac, allergy, CF) secretory diarrhoea - inflammation (IBD, infection)

Question 39

how is an intestinal obstruction diagnosed in children who present with bilious vomiting?

Answer 39

- abdominal xray + contrast | - exploratory laparotomy

Question 40

name a few causes of intestinal obstruction in children

Answer 40

- intestinal atresia - volvulus/malrotation - ileus - intussusception

Question 41

name a few symptoms a child with gastroesophageal reflex may present with

Answer 41

- vomiting - haematemesis - poor feeding - failure to thrive - recurrent chest infections - cough/wheeze

Question 42

when necessary, what investigations are carried out to diagnose gastroesophageal reflux in children?

Answer 42

- fluoroscopy/barium swallow - pH/impendance monitoring - endoscopy

Question 43

do children always need to have investigations for gastroesophageal reflux?

Answer 43

no

Question 44

what is the pathophysiology of osmotic diarrhoea?

Answer 44

undigested/intolerated food stays in the digestive tract and draws water into the lumen by osmosis

Question 45

what is the pathophysiology of secretory diarrhoea?

Answer 45

toxin production by organism triggers electrolyte secretion into the lumen, drawing water in

Question 46

which genes are involved in coeliac disease?

Answer 46

HLA-DQ2 | HLA-DQ8

Question 47

name a few symptoms of coeliac disease

Answer 47

- bloatedness - diarrhoea - short stature - constipation - fatigue - dermatitis herpetiformis

Question 48

which skin condition is associated with coeliac disease?

Answer 48

dermatitis herpetiformis

Question 49

which antibodies found in serological tests indicate coeliac disease in children?

Answer 49

anti-tissue transglutaminase anti-endomysial anti-gliadin

Question 50

what is the treatment for coeliac disease in children?

Answer 50

gluten free diet

Question 51

against which protein contained in gluten does the immune system mount a reaction in coeliac disease?

Answer 51

gliadin

Question 52

which class of antibody is sometimes deficient in people with coeliac disease?

Answer 52

IgA