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Child Health > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

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

A

Tracheo-oesophageal fistula and oesophageal atresia

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2
Q

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

A

Down’s syndrome and Edward’s syndrome

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3
Q

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

A

Polyhydramnios

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4
Q

When is the diagnosis of oesophageal atresia made postnatally?

A

If an NG tube cannot be passed into the stomach

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5
Q

How is tracheo-oesophageal fistula and oesophageal atresia treated?

A

Nil by mouth until surgical anastamosis

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6
Q

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

A

Smoking and drug abuse in pregnancy

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7
Q

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

A

Young maternal age

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8
Q

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

A

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

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9
Q

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

A

Gastroschisis

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10
Q

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

A

Exomphalos

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11
Q

What is the typical presentation of Hirschsprung’s disease?

A

Failure to pass meconium within 48 hours of birth

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12
Q

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

A

Hirschsprung’s disease

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13
Q

How is the diagnosis of Hirschsprung’s disease made?

A

Rectal biopsy

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14
Q

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

A

Problems with continence and constipation

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15
Q

How does malrotation leading to volvulus typically present?

A

Bilious vomiting

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16
Q

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

A

Upper GI contrast studies

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17
Q

How and when does biliary atresia usually present?

A

In the first few weeks of life with prolonged jaundice

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18
Q

How is a diagnosis of biliary atresia confirmed?

A

Radioisotope scans

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19
Q

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

A

Down’s syndrome

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20
Q

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

A

Duodenal atresia

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21
Q

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

A

Gastro-oesophageal reflux

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22
Q

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

A

Poor weight gain

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23
Q

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

A

Overfeeding

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24
Q

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

A

1 year

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25
Q

At what age would pyloric stenosis typically present?

A

3-8 weeks

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26
Q

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

A

Pyloric stenosis

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27
Q

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

A

Hypokalaemic, hypochloraemic metabolic alkalosis

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28
Q

What investigation is used to diagnose pyloric stenosis?

A

Abdominal ultrasound

29
Q

How is pyloric stenosis treated?

A

Pyloromyotomy

30
Q

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

A

Appendicitis

31
Q

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

A

Inflammatory markers and abdominal ultrasound

32
Q

What is a condition that can mimic appendicitis?

A

Meckel’s diverticulum

33
Q

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

A

PR bleeding

34
Q

What is the most common site of intussusception?

A

Terminal ileum

35
Q

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

A

Intussusception

36
Q

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

A

Intussusception

37
Q

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

A

Intussusception

38
Q

What investigation can be used to diagnosis intussusception?

A

Abdominal ultrasound

39
Q

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

A

Air enema

40
Q

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

A

Mesenteric adenitis

41
Q

When is toddler’s diarrhoea diagnosed?

A

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

42
Q

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

A

Toddler’s diarrhoea

43
Q

What is the most common cause of gastroenteritis in children?

A

Rotavirus

44
Q

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

A

Lactase deficiency

45
Q

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

A

Anti-TTG antibody levels

46
Q

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

A

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

47
Q

What is the confirmatory test to diagnose coeliac disease?

A

Small bowel biopsy (showing villous atrophy)

48
Q

How can the diagnosis of IBD be confirmed?

A

Upper and lower GI endoscopies with samples taken for biopsy

49
Q

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

A

Barium follow through

50
Q

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

A

Exclusive enteral nutrition

51
Q

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

A

Corticosteroids

52
Q

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

A

Aminosalicylates, e.g. mesalazine

53
Q

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

A

Immunosuppressants, e.g. azathioprine or methotrexate

54
Q

For which children is vitamin D supplementation recommended?

A

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

55
Q

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

A

Rickets

56
Q

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

A

Vitamin D

57
Q

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

A

Zinc

58
Q

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

A

Night blindness

59
Q

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

A

Aspirin

60
Q

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

A

Anal fissure

61
Q

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

A

Overflow incontinence

62
Q

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

A

CF or Hirschsprung’s disease

63
Q

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

A

Mass in the left iliac fossa

64
Q

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

A

3 times per day

65
Q

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

A

Once per day

66
Q

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

A

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

67
Q

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

A

Add a stimulant laxative (i.e. Senna)

68
Q

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

A

Increase fibre and fluid intake

Child Health (10 decks)

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