Paediatrics - GI

Question 1

What are the differentials of an abdominal mass in a child?

Answer 1

Wilm’s tumour, neuroblastoma, leukemia, sarcoma. hepatoblastoma
Constipation
Enlarged kidneys

Question 2

What are some ways to treat constipation?

Answer 2

Diet
Osmotic laxatives - movical, lactulose
Stimulant laxatives - sodium picosulfate, senna, bisacodyl

Question 3

What are some symptoms of oesophageal atrusion?

Answer 3

persisten salivation and drooling
coughing and choking on feeding
cyanotic episodes
aspiration

Question 4

What is the difference between gastroschisis and exomphalos?

Answer 4

gastroschisis - bowel protrudes through abdominal wall with no covering sac - these is greater risk of dehydration and hypothermia

Question 5

What do you do with umbilical hernias?

Answer 5

leave them alone!

95% resolve spontaneously

Question 6

How would you treat necrotizing enterocolitis?

Answer 6

stop oral feeds
broad spectrum antibiotics
abdo XR
surgery if bowel perforation - surgcial review

Question 7

How would you test for oesophagel atrusion?

Answer 7

insert wide-calibre feeding tube and see if in stomach on XR

Question 8

What are the symptoms of necrotizing enterocolitis?

Answer 8

feed intolerance
vomiting - bile stained
disended abdo
stool-fresh blood

Question 9

Name 2 causes of large bowel atresia

Answer 9

Hirschrung disease

rectal atresia

Question 10

Name 3 common causes of small bowel atresia

Answer 10

duodenal atresia/stenosis (esp Down)
Jujunual atresia/stenosis 
malnutrition with volvulus 
meconium ileus 
meconium plug

Question 11

How do you test for and treat Hirschprung?

Answer 11

rectal exam and suction rectal biopsy

treat - surgery, colostomy

Question 12

What is the VACTERL association?

Answer 12

vertebral, anorectal, cardiac, tracheo-oesophageal, renal, radial limb anomalies

Question 13

What increases the incidence of necrotizing enterocolitis?

Answer 13

Hisprungs

premature - vulnerable to ischaemic injury and bacterial invasion

Question 14

What are the symptoms of Hirschprung disease?

Answer 14

do not pass meconium in 24-48 hours
abdominal distension 
bile stained vomiting 
chronic constipation 
growth failure 
enterocolitis

Question 15

What is different with treating inguinal hernias in children?

Answer 15

Need more urgent repair
Neonates - within days
Infants - within weeks

Question 16

Name symptoms of small bowel atresia

Answer 16

persistent vomiting - bile stained
no normal stool +/- meconium
abdominal distension (esp when distal)

Question 17

What is the meconium ileus?

Answer 17

thick insipissated meconium, putty consistency becomes impacted in lower ileum - 10% of people with CF

Question 18

What is Hirschsprung disease?

Answer 18

absence of myenteric plexus of rectum and variable distance of colon

Question 19

How would you treat GORD?

Answer 19

anatacid, H2 blocker e.g. ranitide, PPI e.g. omeprazole

Question 20

What are the red flags for constipation?

Answer 20

no/delayed meconium, fever, vomiting, bloody stools, failure to thrive, tight, empty rectum and palpable mass, abnormal neuro exam

Question 21

Name 5 causes of diarrhoea

Answer 21

gastroenteritis, UTI, meningitis, food allergy, appendicitis, intussception, haemolytic uraemic syndrome

Question 22

What are red flags of abdo pain?

Answer 22

weight loss, decreased growth, GI blood loss, vomiting, diarrhoea, fever, family history, persistent right/upper or lower quadrant pain

Question 23

Name 5 differentials for constipation

Answer 23

Hirschprung, anorectal malformation, spina bifida, neuromuscular disease, coeliac, food allergy, CF, anal fissure, hypothyroid, sexual abuse, drugs, spinal tumours

Question 24

When does pyloric stenosis present?

Answer 24

2-8 weeks

Question 25

What would you see on bloods of a child with pyloric stenosis?

Answer 25

hypochoremic metabolic acidosis | low sodium and potassium

Question 26

Name symptoms of pyloric stenosis

Answer 26

vomiting - increased frequency and forcefullness eventually projectile hunger - until dehydration results in loss of feeding weight loss

Question 27

What is the cause of neonatal jaundice is urgent and needs to be treated ASAP?

Answer 27

extrahepatic obstruction to bile flow TEST - radioisotope, liver biopsy TREAT - hepatoporto and enterostomy Risk - liver cirrhosis

Question 28

What is a major complication of jaundice?

Answer 28

Kernictereus - bilirubin deposits in basal ganglia and brainstem nuceli due to unconjugated bilirubin being fat soluble so can cross blood-brain barrier

Question 29

When would you be concerned about jaundice?

Answer 29

< 1 days old dark urine pale stools failure to thrive

Question 30

What are some causes of jaundice?

Answer 30

congenital, infection, haemolytic, polycythaemia, physiological, breast milk, biliary atresia

Question 31

What is biliary atresia?

Answer 31

extrahepatic obstruction to bile flow = pale urine and dark stools

Question 32

What does bile stained vomit indicate?

Answer 32

Intestinal obstruction

Question 33

What does blood stained vomit indicate?

Answer 33

Peptic ulceration, gastritis, oesophageal varices

Question 34

What does projectile vomit indicate?

Answer 34

Pyloric stenosis

Question 35

What does blood in stool indicate?

Answer 35

intussusception, gastroenteritis

Question 36

How would you test for pyloric stenosis?

Answer 36

ABG - metabolic alkalosis, low potassium and chloride Test feed - NG tube and aspiration to empty stomach, give dioralyte - if an "olive" mass is palpable on liver edge = stenosed pylorus

Question 37

What is the treatment of pyloric stenosis?

Answer 37

normalise fluid and electrolytes | Ramstedt's pyloromytomy

Question 38

How would you treat Crohn's disease?

Answer 38

enteral nutrition, glucocorticoid | Maintainence - azathioprine

Question 39

How would you treat UC?

Answer 39

glucocorticoids, aminosalicylates (e.g. mesalazine) | Maintainence - aminosalicylates

Question 40

What are symptoms of intussusception?

Answer 40

sudden colicky pain, drawing legs up, pale, vomiting, redcurrent jelly stools Target sign on US

Question 41

What causes jaundice in firsts 24 hours?

Answer 41

haemolytic disease of the newborn, hereditary spherocytosis, G-6-PD deficiency, sepsis, TORCH infections

Question 42

What causes jaundice 2 weeks after birth?

Answer 42

Biliary atresia, hypothyroidism, galactosaemia, UTI, Gilbert syndrome

Question 43

What would high levels of conjugated or unconjugated bilirubin indicate?

Answer 43

Conjugated - hepatobiliary source | un-conjugated - extra-hepatic source

Question 44

What is wilson's disease?

Answer 44

Copper accumulating in liver, kidneys, eyes and brain | Kayser-Fleischer rings, parkinsonism, vit D resistant rickets, jaundice

Question 45

How do you test and treat for Wilson's disease?

Answer 45

24 hour urine copper assay, serum caeruloplasmin low | Treat - penicillamine, zinc, vit B6

Question 46

What is Kernicterus?

Answer 46

unconjugated bilirubin in basal ganglia = GI haem, athetosis, gaze disturbance, hearing loss, convulsions, cerebal palsy, usually in first month of life

Question 47

What is galactosaemia and some of its symptoms?

Answer 47

autosommal recessive where you lack the enzyme for galactose ingestion (in milk) ingestion of galactose = vomiting, hepatomegaly, failure to thrive, DM, cataracts, developmental delay transferase deficiency itself causes poor growth and problems with speech and mental development

Question 48

What is phenylketonuria?

Answer 48

they cannot digest phenylalamine (eggs, milk, meat) | leads to brain damage, epilepsy and learning difficulties

Question 49

When is phenylketonuria tested for?

Answer 49

Newborn heel prick test

Question 50

How would you manage intussception?

Answer 50

NBM IV fluids 75% reduced by air insuffiation rectally but this risks perforation so do in theatre

Question 51

What counts as prolonged jaundice?

Answer 51

Beyond day 14 in term babies | Beyond dy 21 in preterm neonates

Question 52

What are systemic symptoms of cow's milk allergy?

Answer 52

diarrhoea, dermatitis, rhinitis

Question 53

When does reflux start and how long does it last?

Answer 53

within first 8 weeks, peaks 3-4 months | 90% resolve in one year