paediatric GI

Question 1

why do babies get GORD?

Answer 1

-babies have immature lower oesophageal sphincter

Question 2

how does GORD present?

Answer 2

• regurgitation
• chronic hiccups
• presents in 1st 2 months of life and improves in first year

Question 3

investigations for GORD?

Answer 3

• clinical diagnoses
• older kids= 24 hour ambulatory oesophageal pH monitoring
• Suspect oesophagitis= endoscopy

Question 4

treatment for GORD?

Answer 4

• self resolves in 1 year
• avoid over feeding, feed in prone
• gaviscon immediately after feed

Question 5

how does pyloric stenosis occur?

Answer 5

progressive hypertrophy of pyloric sphincter muscle which leads to gastric obstruction

Question 6

how does pyloric stenosis present?

Answer 6

• projectile vomiting (roughly 30 mins after feed)
• child remains hungry and eager to feed
• weight loss
• dehydration + constipation

Question 7

what investigations are done for pyloric stenosis?

Answer 7

examination- olive shaped mass in RUQ
USS- hypertrophic pyloric muscle (DIAGNOSTIC)
Blood gas- hypochloraemia, hypokalaemia + metabolic alkalosis

Question 8

treatment for pyloric stenosis?

Answer 8

Ramstedt pyloromyotomy

Question 9

what is intussusception?

Answer 9

• telescoping of small bowel leading to obstruction
• usually involving the ileocecal valve
• can cause bowel necrosis if left untreated

Question 10

presentation of intussusception?

Answer 10

• child unwell/ floppy
• palpable ‘sausage’ mass
• red current jelly in stool
• vomit + episodic colicky abdo pain

Question 11

investigations for intussusception?

Answer 11

USS- kidney bean or target/ bulls eye sign

Question 12

treatment for intussusception?

Answer 12

conservative= air enema retraction

surgical= laparascopic surgery

Question 13

what causes malrotation with volvulus?

Answer 13

• absent mesentery attachments

- allows organs to wrap around eachother (leading to volvulus)

Question 14

presentation of malrotation with volvulus?

Answer 14

-green, bilious vomit is malrotation with volvulus until proven otherwise

Question 15

investigations for malrotation with volvulus?

Answer 15

1st= Abdo Xray

2nd= upper GI contrast

Question 16

treatment for malrotation with volvulus?

Answer 16

immediate referral to srugery

Question 17

what is Cow’s protein allergy?

Answer 17

-immune mediated response to casein + weigh

Question 18

how does Cow’s milk protein allergy present?

Answer 18

• Urticaria, atopic eczema
• colic, irritability, crying
• wheeze, cough

Question 19

investigations for Cow’s milk protein allergy?

Answer 19

• elimination diet

- skin prick or RAST (radioallergosorbent test)

Question 20

treatment for Cow’s milk protein allergy?

Answer 20

1st= use extensive hydrolysed formula (eHF)
severe= amino acid based formula

Question 21

presentation coeliac?

Answer 21

• pale stool
• abdo pain/ bloating
• failure to thrive
• crypt hyperplasia, villi flattening

Question 22

investigations for coeliac?

Answer 22

GOLD STANDARD= endoscopy with duodenal biopsy

IgA tissue transglutaminase (TTG)

Question 23

coeliac treatment?

Answer 23

Gluten free diet

Question 24

most common cause of gastroenteritis?

Answer 24

rotavirus

Question 25

presentation gastroenteritis?

Answer 25

- acute onset vomiting - followed by diarrhoea - post infection lactose intolerance

Question 26

treatment gastroenteritis?

Answer 26

- oral rehydration therapy (ORT) | - diaorylate

Question 27

treatment for dehydration?

Answer 27

``` 1st= encourage breast feeding 2nd= oral rehydration solution (ORS) over 4 hours severe= 0.9% NaCl (slow infusion over 48 hours) ```

Question 28

most common cause of lower GI bleed in new born?

Answer 28

- necrotising enterocolitis | - anal fissure

Question 29

most common cause of lower GI bleed in 1 month- 1 year?

Answer 29

Intussusception | Anal fissure

Question 30

most common cause of lower GI bleed in 1-2 years?

Answer 30

- polyps | - Meckel's diverticulum

Question 31

most common cause of lower GI bleed in >2 years>

Answer 31

- polyps - intussusception - IBD

Question 32

treatment for neonatal sepsis?

Answer 32

IV nezyl penicillin + gentamicing

Question 33

presentation of neonatal sepsis?

Answer 33

- fever, tachy or bradicardia, hypoxia - poor feeding, vomiting, hypoglycaemia - resp distress, grunting, apnoea - seizures RED FLAGS:-confirmed or suspected sepsis in mum-signs of shock (pyrexial or hypothermic)-resp distress starting >4 hours after birth-seizures

Question 34

what is biliary atresia?

Answer 34

- congenital condition - part of the biliary tract is narrowed/ absent leading to cholestasis cholestasis= liver disease that occurs when the flow of bile from liver is reduced or blocked

Question 35

what are the types of biliary atresia?

Answer 35

``` 3= left + right ducts at the level or porta hepatis are narrowed/ absent (>90%) 2= cystic duct + cystic structures are absent 3= proximal ducts are patent but the common duct is not ```

Question 36

how does biliary atresia present?

Answer 36

- prolonged jaundice (>14 days)= pale stool + dark urine - abnormal growth - hepatosplenomegaly

Question 37

investigations for biliary atresia?

Answer 37

abdominal USS liver biopsy

Question 38

treatment for biliary atresia?

Answer 38

-surgical dissection of abnormalities in ducts