Paediatric Gastroenterology Flashcards
What two congenital anomalies of the GI tract commonly occur in conjunction?
Tracheo-oesophageal fistula and oesophageal atresia
What conditions may be associated with tracheo-oesophageal fistula and oesophageal atresia?
Down’s syndrome and Edward’s syndrome
Oesophageal atresia may be suspected antenatally because of the finding of what on antenatal ultrasound scan?
Polyhydramnios
When is the diagnosis of oesophageal atresia made postnatally?
If an NG tube cannot be passed into the stomach
How is tracheo-oesophageal fistula and oesophageal atresia treated?
Nil by mouth until surgical anastamosis
What are the two overlapping risk factors for gastroschisis and exomphalos?
Smoking and drug abuse in pregnancy
What is a risk factor for gastroschisis that is not a risk factor for exomphalos?
Young maternal age
Where is the herniation in a) gastroschisis? b) exomphalos?
a) to the right of the umbilicus b) the umbilical cord
In which condition is the herniated intestine not covered in peritoneum- exomphalos or gastroschisis?
Gastroschisis
Which defect of the abdominal wall is more likely to occur as part of an associated condition- exomphalos or gastroschisis?
Exomphalos
What is the typical presentation of Hirschsprung’s disease?
Failure to pass meconium within 48 hours of birth
In which condition does the withdrawal of the finger at the end of a rectal examination trigger the explosive passage of stool?
Hirschsprung’s disease
How is the diagnosis of Hirschsprung’s disease made?
Rectal biopsy
Many infants who have Hirschsprung’s disease go on to have what problems in childhood?
Problems with continence and constipation
How does malrotation leading to volvulus typically present?
Bilious vomiting
What investigation is used to make a diagnosis of malrotation and volvulus?
Upper GI contrast studies
How and when does biliary atresia usually present?
In the first few weeks of life with prolonged jaundice
How is a diagnosis of biliary atresia confirmed?
Radioisotope scans
Up to 30% of cases of duodenal atresia are associated with what condition?
Down’s syndrome
A ‘double bubble’ appearance on abdominal x-ray is suggestive of what diagnosis?
Duodenal atresia
Vomiting which is described as non-forceful regurgitation of stomach contents is most suggestive of what diagnosis?
Gastro-oesophageal reflux
What would be the most significant sign of severe gastro-oesophageal reflux, which would warrant treatment?
Poor weight gain
What is a common exacerbating factor for gastro-oesophageal reflux, particularly in bottle fed babies?
Overfeeding
90% of cases of gastro-oesophageal reflux resolve by what age?
1 year
At what age would pyloric stenosis typically present?
3-8 weeks
Vomiting which is described as projectile, and is non-bilious, is most likely to be caused by what condition?
Pyloric stenosis
What acid-base balance will be seen in babies with pyloric stenosis?
Hypokalaemic, hypochloraemic metabolic alkalosis
What investigation is used to diagnose pyloric stenosis?
Abdominal ultrasound
How is pyloric stenosis treated?
Pyloromyotomy
Central abdominal pain which later migrates to the right iliac fossa is most suggestive of what diagnosis?
Appendicitis
What are the two best investigations to perform in someone with suspected appendicitis?
Inflammatory markers and abdominal ultrasound
What is a condition that can mimic appendicitis?
Meckel’s diverticulum
What is the most common symptom in children with Meckel’s diverticulum?
PR bleeding
What is the most common site of intussusception?
Terminal ileum
Intermittent episodes of pain characterised by drawing up the legs and inconsolable crying is most suggestive of what diagnosis?
Intussusception
In what condition may a sausage shaped mass be palpable in the abdomen?
Intussusception
Redcurrant jelly stools, is a late sign of what condition?
Intussusception
What investigation can be used to diagnosis intussusception?
Abdominal ultrasound
If the child is haemodynamically stable, how is intussusception treated?
Air enema
What is a common cause of abdominal pain which usually occurs after a viral infection at a distal site, and may mimic appendicitis?
Mesenteric adenitis
When is toddler’s diarrhoea diagnosed?
When a preschool child frequently passes loose stools, but is otherwise well and thriving
The presence of undigested food, particularly vegetables, in the stool, is suggestive of what diagnosis?
Toddler’s diarrhoea
What is the most common cause of gastroenteritis in children?
Rotavirus
Why may loose stools continue for a week or two in children with rotavirus?
Lactase deficiency
What is used as a screening test for children with suspected coeliac disease?
Anti-TTG antibody levels
When may results of an anti-TTG antibody screen give false negatives?
If the individual is IgA deficient, or if the diet is gluten-free at the time of testing
What is the confirmatory test to diagnose coeliac disease?
Small bowel biopsy (showing villous atrophy)
How can the diagnosis of IBD be confirmed?
Upper and lower GI endoscopies with samples taken for biopsy
What investigation can be used to identify lesions in the small bowel if Crohn’s disease is suspected?
Barium follow through
What is the first line treatment for acute Crohn’s disease in children?
Exclusive enteral nutrition
What is the first line treatment for acute ulcerative colitis, and second line treatment for acute Crohn’s disease in children?
Corticosteroids
What is the first line agent for ongoing maintenance of ulcerative colitis?
Aminosalicylates, e.g. mesalazine
What is the first line agent for ongoing maintenance of Crohn’s disease?
Immunosuppressants, e.g. azathioprine or methotrexate
For which children is vitamin D supplementation recommended?
Those aged 6 months to 5 years who are not drinking > 500mls of milk daily
What is the most severe clinical manifestation of severe vitamin D deficiency?
Rickets
Bowed legs, rachitic rosary and tender, swollen joint, especially in the wrists and ankles, are features of a deficiency of which micronutrient?
Vitamin D
Acrodermatitis enteropathica is an autosomal recessive condition leading to impaired absorption of what micronutrient?
Zinc
What is the most serious consequence of a deficiency of vitamin A?
Night blindness
Reye’s syndrome is a rare disease that causes liver damage. The use of what medication in children has been implicated in its aetiology?
Aspirin
Constipation which is associated with peri-anal pain and bleeding can be associated with what underlying pathology?
Anal fissure
What type of incontinence is commonly seen in children with constipation?
Overflow incontinence
Constipation, associated with a history of delayed passage of meconium at birth, is suggestive of what two potential diagnoses?
CF or Hirschsprung’s disease
What is usually found on abdominal examination of a child with constipation?
Mass in the left iliac fossa
How often should an infant under 6 months old pass stool?
3 times per day
How often should a child aged over 3 years of age pass stool?
Once per day
What is the first line treatment for children with constipation who have faecal impaction?
Polyethylene glycol 3350 + electrolytes (Movicol paediatric plan), escalating dose regimen
In children with constipation, if the Movicol paediatric plan doesn’t lead to disimpaction after two weeks, what should be tried next?
Add a stimulant laxative (i.e. Senna)
What dietary advice should be offered to families of children with constipation?
Increase fibre and fluid intake
