Paediatric Gastroenterology

Question 1

What two congenital anomalies of the GI tract commonly occur in conjunction?

Answer 1

Tracheo-oesophageal fistula and oesophageal atresia

Question 2

What conditions may be associated with tracheo-oesophageal fistula and oesophageal atresia?

Answer 2

Down’s syndrome and Edward’s syndrome

Question 3

Oesophageal atresia may be suspected antenatally because of the finding of what on antenatal ultrasound scan?

Answer 3

Polyhydramnios

Question 4

When is the diagnosis of oesophageal atresia made postnatally?

Answer 4

If an NG tube cannot be passed into the stomach

Question 5

How is tracheo-oesophageal fistula and oesophageal atresia treated?

Answer 5

Nil by mouth until surgical anastamosis

Question 6

What are the two overlapping risk factors for gastroschisis and exomphalos?

Answer 6

Smoking and drug abuse in pregnancy

Question 7

What is a risk factor for gastroschisis that is not a risk factor for exomphalos?

Answer 7

Young maternal age

Question 8

Where is the herniation in a) gastroschisis? b) exomphalos?

Answer 8

a) to the right of the umbilicus b) the umbilical cord

Question 9

In which condition is the herniated intestine not covered in peritoneum- exomphalos or gastroschisis?

Answer 9

Gastroschisis

Question 10

Which defect of the abdominal wall is more likely to occur as part of an associated condition- exomphalos or gastroschisis?

Answer 10

Exomphalos

Question 11

What is the typical presentation of Hirschsprung’s disease?

Answer 11

Failure to pass meconium within 48 hours of birth

Question 12

In which condition does the withdrawal of the finger at the end of a rectal examination trigger the explosive passage of stool?

Answer 12

Hirschsprung’s disease

Question 13

How is the diagnosis of Hirschsprung’s disease made?

Answer 13

Rectal biopsy

Question 14

Many infants who have Hirschsprung’s disease go on to have what problems in childhood?

Answer 14

Problems with continence and constipation

Question 15

How does malrotation leading to volvulus typically present?

Answer 15

Bilious vomiting

Question 16

What investigation is used to make a diagnosis of malrotation and volvulus?

Answer 16

Upper GI contrast studies

Question 17

How and when does biliary atresia usually present?

Answer 17

In the first few weeks of life with prolonged jaundice

Question 18

How is a diagnosis of biliary atresia confirmed?

Answer 18

Radioisotope scans

Question 19

Up to 30% of cases of duodenal atresia are associated with what condition?

Answer 19

Down’s syndrome

Question 20

A ‘double bubble’ appearance on abdominal x-ray is suggestive of what diagnosis?

Answer 20

Duodenal atresia

Question 21

Vomiting which is described as non-forceful regurgitation of stomach contents is most suggestive of what diagnosis?

Answer 21

Gastro-oesophageal reflux

Question 22

What would be the most significant sign of severe gastro-oesophageal reflux, which would warrant treatment?

Answer 22

Poor weight gain

Question 23

What is a common exacerbating factor for gastro-oesophageal reflux, particularly in bottle fed babies?

Answer 23

Overfeeding

Question 24

90% of cases of gastro-oesophageal reflux resolve by what age?

Answer 24

1 year

Question 25

At what age would pyloric stenosis typically present?

Answer 25

3-8 weeks

Question 26

Vomiting which is described as projectile, and is non-bilious, is most likely to be caused by what condition?

Answer 26

Pyloric stenosis

Question 27

What acid-base balance will be seen in babies with pyloric stenosis?

Answer 27

Hypokalaemic, hypochloraemic metabolic alkalosis

Question 28

What investigation is used to diagnose pyloric stenosis?

Answer 28

Abdominal ultrasound

Question 29

How is pyloric stenosis treated?

Answer 29

Pyloromyotomy

Question 30

Central abdominal pain which later migrates to the right iliac fossa is most suggestive of what diagnosis?

Answer 30

Appendicitis

Question 31

What are the two best investigations to perform in someone with suspected appendicitis?

Answer 31

Inflammatory markers and abdominal ultrasound

Question 32

What is a condition that can mimic appendicitis?

Answer 32

Meckel's diverticulum

Question 33

What is the most common symptom in children with Meckel's diverticulum?

Answer 33

PR bleeding

Question 34

What is the most common site of intussusception?

Answer 34

Terminal ileum

Question 35

Intermittent episodes of pain characterised by drawing up the legs and inconsolable crying is most suggestive of what diagnosis?

Answer 35

Intussusception

Question 36

In what condition may a sausage shaped mass be palpable in the abdomen?

Answer 36

Intussusception

Question 37

Redcurrant jelly stools, is a late sign of what condition?

Answer 37

Intussusception

Question 38

What investigation can be used to diagnosis intussusception?

Answer 38

Abdominal ultrasound

Question 39

If the child is haemodynamically stable, how is intussusception treated?

Answer 39

Air enema

Question 40

What is a common cause of abdominal pain which usually occurs after a viral infection at a distal site, and may mimic appendicitis?

Answer 40

Mesenteric adenitis

Question 41

When is toddler's diarrhoea diagnosed?

Answer 41

When a preschool child frequently passes loose stools, but is otherwise well and thriving

Question 42

The presence of undigested food, particularly vegetables, in the stool, is suggestive of what diagnosis?

Answer 42

Toddler's diarrhoea

Question 43

What is the most common cause of gastroenteritis in children?

Answer 43

Rotavirus

Question 44

Why may loose stools continue for a week or two in children with rotavirus?

Answer 44

Lactase deficiency

Question 45

What is used as a screening test for children with suspected coeliac disease?

Answer 45

Anti-TTG antibody levels

Question 46

When may results of an anti-TTG antibody screen give false negatives?

Answer 46

If the individual is IgA deficient, or if the diet is gluten-free at the time of testing

Question 47

What is the confirmatory test to diagnose coeliac disease?

Answer 47

Small bowel biopsy (showing villous atrophy)

Question 48

How can the diagnosis of IBD be confirmed?

Answer 48

Upper and lower GI endoscopies with samples taken for biopsy

Question 49

What investigation can be used to identify lesions in the small bowel if Crohn's disease is suspected?

Answer 49

Barium follow through

Question 50

What is the first line treatment for acute Crohn's disease in children?

Answer 50

Exclusive enteral nutrition

Question 51

What is the first line treatment for acute ulcerative colitis, and second line treatment for acute Crohn's disease in children?

Answer 51

Corticosteroids

Question 52

What is the first line agent for ongoing maintenance of ulcerative colitis?

Answer 52

Aminosalicylates, e.g. mesalazine

Question 53

What is the first line agent for ongoing maintenance of Crohn's disease?

Answer 53

Immunosuppressants, e.g. azathioprine or methotrexate

Question 54

For which children is vitamin D supplementation recommended?

Answer 54

Those aged 6 months to 5 years who are not drinking > 500mls of milk daily

Question 55

What is the most severe clinical manifestation of severe vitamin D deficiency?

Answer 55

Rickets

Question 56

Bowed legs, rachitic rosary and tender, swollen joint, especially in the wrists and ankles, are features of a deficiency of which micronutrient?

Answer 56

Vitamin D

Question 57

Acrodermatitis enteropathica is an autosomal recessive condition leading to impaired absorption of what micronutrient?

Answer 57

Zinc

Question 58

What is the most serious consequence of a deficiency of vitamin A?

Answer 58

Night blindness

Question 59

Reye's syndrome is a rare disease that causes liver damage. The use of what medication in children has been implicated in its aetiology?

Answer 59

Aspirin

Question 60

Constipation which is associated with peri-anal pain and bleeding can be associated with what underlying pathology?

Answer 60

Anal fissure

Question 61

What type of incontinence is commonly seen in children with constipation?

Answer 61

Overflow incontinence

Question 62

Constipation, associated with a history of delayed passage of meconium at birth, is suggestive of what two potential diagnoses?

Answer 62

CF or Hirschsprung's disease

Question 63

What is usually found on abdominal examination of a child with constipation?

Answer 63

Mass in the left iliac fossa

Question 64

How often should an infant under 6 months old pass stool?

Answer 64

3 times per day

Question 65

How often should a child aged over 3 years of age pass stool?

Answer 65

Once per day

Question 66

What is the first line treatment for children with constipation who have faecal impaction?

Answer 66

Polyethylene glycol 3350 + electrolytes (Movicol paediatric plan), escalating dose regimen

Question 67

In children with constipation, if the Movicol paediatric plan doesn't lead to disimpaction after two weeks, what should be tried next?

Answer 67

Add a stimulant laxative (i.e. Senna)

Question 68

What dietary advice should be offered to families of children with constipation?

Answer 68

Increase fibre and fluid intake