Paediatric GI/ Surgery

Question 1

What are the typical blood gas findings for a baby with pyloric stenosis?

Answer 1

Hypochloraemic hypokalaemic metabolic alkalosis with base excess

Question 2

What does a double bubble appearance on X-Ray indicate?

Answer 2

Duodenal atresia

Question 3

What is the gold standard investigation for developmental dysplasia of the hip?

Answer 3

USS

Question 4

Wilm’s tumour is associated with defects on which chromsome?

Answer 4

11

Question 5

How does the presentation of Ig-E mediated cows milk protein allergy compare to non-IgE cows milk protein allergy?

Answer 5

IgE mediated: acute onset, more allergic symptoms e.g. urticaria, angio-oedema, sneezing, conjunctivitis as well as colicky abdo pain, vomiting and diarrhoea
Non-IgE mediated: slower onset, more GI symptoms e.g. diarrhoea, blood/ mucus in stool, colic, perinatal redness, constipation

Question 6

How is cows milk protein allergy managed?

Answer 6

Elimination of cows milk from diet for minimum 6/12, including mums diet if breastfeeding
If formula fed:
1st line: extensively hydrolysed formula
2nd line: amino acid formula
Reintroduce cows milk every 6-12 months to assess tolerance, 90% Sr fine by 3y/o

Question 7

When does pyloric stenosis usually present?

Answer 7

2-8 weeks (pyloric typically normal at birth, then will hypertrophy)

Question 8

What is the name of the surgery to treat pyloric stenosis?

Answer 8

Ramstedt’s pylorotomy

Divides the hypertrophied pylorus

Question 9

How can pyloric stenosis present?

Answer 9

Projectile non-bilious vomiting
Weight loss
Dehydration 
Constipation
Mass in RUQ with peristaltic waves visible
Palpable pylorus during feed

Question 10

Where does intussusception usually occur?

Answer 10

Terminal ileum into caecum

Question 11

In what age does intussuscpetion usually present?

Answer 11

2 months to 2 years old

Question 12

What is the typical presentation of intussusception?

Answer 12

Vomiting, abdominal distension, sever colicky abdominal pain

Red current jelly stools

Question 13

Target sign on an abdominal USS is suggestive of what?

Answer 13

Intussusception

Question 14

How is intussusception managed?

Answer 14

Air enema to force back the intussuscepting bowel
Fluid
IV abx (possibility of sepsis)
Surgery if perforation/ peritonitis

Question 15

For undesceded testes, when is orchidoplexy performed?

Answer 15

Age 6-18 months

Question 16

How may necrotising enterocolitis present?

Answer 16

Poor feeding, bilious vomiting, distended abdomen, bloody stool

Question 17

How is necrotising enterocolitis treated?

Answer 17

Bowel rest NBM, TPN feeds
NG tube to decompress 
IV fluid
IV Abx
Surgery if deteriorating or perforation
Restarts oral feed 7-10 days after gas in bowel disappears

Question 18

When would you refer to a paediatric surgeon for undescended testes?

Answer 18

If not descended by 6 months

Question 19

What is the treatment for Hirschsprung’s disease?

Answer 19

Rectal washouts initially

Surgical anorectal pullthrough procedure

Question 20

Kasai procedure is the surgery for which condition?

Answer 20

Biliary atresia

Question 21

Ground glass appearance on x Ray is seen in which condition?

Answer 21

Respiratory distress syndrome

Question 22

What is looked at in the coeliac screen?

Answer 22

IgA immunoglobulin
tTGA (tissue transglutaminase antibody)
EMA (endomysial antibody)

Question 23

What will an upper GI biopsy show if positive for coeliac screen?

Answer 23

Crypt hyperplasia
Villus atrophy
Lymphocytosis

Question 24

Henoch Schonlein purpura classically presents with what symptoms?

Answer 24

Purpuric rash (buttocks and legs)
Haematuria (Proteinuria)
GI symptoms/ abdominal pain
Arthralgia

Question 25

Why do inguinal hernia occur?

Answer 25

Due to a patient processus vaginalis

Question 26

What is a hydrocele?

Answer 26

Abnormal collection of fluid within a patent processus vaginalis

Question 27

How will a hydrocele present?

Answer 27

Often asymptomatic
Non tender scrotal mass
Can get above it, unlike herniae
Will transluminate

Question 28

On examination, how can retractile testes be differentiated from undescended testes?

Answer 28

By eliciting the cremasteric reflex (stroking the inside of the thigh to activate cremasteric muscle and pull the testes up)

Question 29

What investigation is done if necrotising enterocolitis is suspected?

Answer 29

Abdominal x ray
Will show bowl wall oedema and dilated bowel loops filled with gas
Pneumoperitoneum if perforation

Question 30

What complications can gastroenteritis give rise to?

Answer 30

Dehydration

E Coli gastroenteritis can lead to haemolytic uraemic syndrome

Question 31

How would you manage dehydration in a child?

Answer 31

Deficit + Maintenance + losses
- orally: rehydrate with dioralyte rehydration solution (P.O. or via NG) for 50ml/kg over 4 hours plus maintenance fluids

• IV if persistently vomiting or still deteriorating despite oral rehydration solution: weight x % dehydration x10 = over 48 hours (divide by 2 for daily needs)
• if child in shock: rapid 20ml/kg 0.9% saline bolts, repeat if necessary

Question 32

What fluid bolus would you supply to a child in shock?

Answer 32

Rapid 0.9% saline bolus of 20ml/kg, repeat if necessary