Paeds gastro

Question 1

What is encopresis? What is it usually a sign of?

Answer 1

• Faecal incontinence
• Chronic constipation

Question 2

What is the first line laxative for constipation?

Answer 2

Movicol

Question 3

What is the main preventative medication for abdominal migraine? What drug is it?

Answer 3

Pizotifen - a serotonin agonist

Question 4

Management of more problematic GOR?

Answer 4

• Gaviscon with feeds
• Thickened milk/formula
• PPI when other methods are inadequate

Question 5

What is Sander’s Syndrome? What are the key features?

Answer 5

• When GOR is associated with brief episodes of abnormal movement
• Torticollis
• Dystonia

Question 6

What is pyloric stenosis?

Answer 6

Hypertrophy of the pylorus

Question 7

What are the key features of pyloric stenosis?

Answer 7

• Projectile vomiting
• Olive mass in abdomen
• Blood gas showing hypochloric metabolic alkalosis

Question 8

Pyloric stenosis:
1. Diagnostic Ix?
2. Rx?

Answer 8

1. Abdominal USS
2. Laparoscopic pyloromyotomy

Question 9

What are the 2 key antibodies in coeliac disease? What else should you measure? Why?

Answer 9

• Anti-tissue transglutaminase and anti-endomysial
• IgA as some patients have IgA deficiency and if so the coeliac test can be negative even though they have the condition

Question 10

What should you always screen new T1DM patients for? Why?

Answer 10

Coeliac disease, the conditions are often linked

Question 11

What will endoscopy and intestinal biopsy show in coeliac disease?

Answer 11

• Crypt hyperplasia
• Villous atrophy

Question 12

How does intussusception present?

Answer 12

• Abdo pain
• ‘Redcurrant jelly stool’
• ‘Sausage shaped’ mass (RUQ)
• Unwell child
• Intestinal obstruction

Question 13

What commonly precedes intussusception?

Answer 13

Viral illness

Question 14

Intussusception:
1) Diagnostic Ix?
2) Rx?

Answer 14

1) USS
2) Air/water enema, surgical resection if bowel becomes gangrenous or perforates

Question 15

What colour vomit do you get in bowel obstruction?

Answer 15

Green (bilious vomit)

Question 16

What will an abdo XR show in bowel obstruction?

Answer 16

Dilated loops of bowel proximal to the obstruction, the absence of air in the rectum

Question 17

What is the management of bowel obstruction?

Answer 17

• Admit to surgical unit
• Nil by mouth
• NG tube to drain stomach
• IV fluids
• Manage underlying cause

Question 18

Biliary atresia:
1) What is it?
2) What does it result in?
3) How does it present?
4) Ix?
5) Rx?

Answer 18

1) A congenital condition where a section of the bile duct is narrowed or absent
2) Results in cholestasis
3) Persistent jaundice
4) Unconjugated and conjugated bilirubin (conjugated will be high)
5) Surgery - ‘Kasai portoenterostomy’

Question 19

What signs on examination suggest peritonitis caused by a ruptured appendix?

Answer 19

• Rebound tenderness
• Percussion tenderness

Question 20

What is the classical finding on a blood gas of pyloric stenosis?

Answer 20

Hypochloraemic, hypokalaemia alkalosis

Question 21

What is condition coeliac commonly associated with?

Answer 21

T1DM

Question 22

What type of antibodies are anti-tissue transglutaminase and anti-endomysial?

Answer 22

IgA

Question 23

What genes is coeliac associated with?

Answer 23

HLA-DQ2 and HLA-DQ8

Question 24

What is the first line management of inducing remission for 1) Crohns and 2) Ulcerative colitis?

Answer 24

1. Steriods e.g. pred or IV hydrocortisone
2. Aminosalicylate e.g. mesalazine (if sever disease would be IV hydrocortisone)