paeds GI

Question 1

signs to look out for in GORD

Answer 1

Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain

Question 2

mx for GORD?

Answer 2

Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)

• Gaviscon mixed with feeds
• Thickened milk or formula
• Ranitidine
• Omeprazole where ranitidine is inadequate

Question 3

what is Sandifer’s syndrome?

Answer 3

GORD with abnormal movements- the baby is neurologically fine tho

torticollis: forceful contraction of the neck muscles causing twisting of the neck

Dystonia: abnormal muscle contractions causing twisting movements, arching of the back or unusual postures

resolves as reflux gets better

Question 4

Pyloric stenosis

Answer 4

hypertrophy of pyloric

failure to thrive
Projectile vomitting!!!!
firm round mass in upper abdomen- feels like a large olive

hypochloric (low CL) and metabolic alkalosis

dx: abdominal USS

Tx: laparoscopic pyloromyotomy (known as “Ramstedt’s operation“

Question 5

main concerns with gastroenenteritis in a child?

Answer 5

isolate- easily spread.

Dehydration

Question 6

Cystic fibrosis?

Answer 6

Steatorrhoea means greasy stools with excessive fat content.

Question 7

most common cause of viral gastroenteritis?

Answer 7

Rotavirus

Norovirus

Question 8

E.coli and gastroenteritis?

Answer 8

produces Shiga toxin:
bloody diarrhoea and vomitting
-> HUS

don’t use abs!!- increase risk of HUS

Question 9

travellers diarrhoea causes?

Answer 9

Campylobactor

Raw or improperly cooked poultry
Untreated water
Unpasteurised milk

Question 10

abx for campylobacter diarrhoea?

Answer 10

azithromycin or ciprofloxacin.

Question 11

Shigella diarrhoea?

Answer 11

1-2 day incubation

bloody diarrhoea and cramps

• can cause HUS
• > Azithromycin/ ciprofloxacin (like campylobacter)

Question 12

Bacillus ceros diarrhoea?

Answer 12

guy eats rice and

vomiting within 5 hours,

diarrhoea after 8 hours,

then resolution within 24 hours.

Question 13

gastroenteritis ccx?

Answer 13

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome

Question 14

Coeliac antibodies?

Answer 14

anti-tissue transglutaminase (anti-TTG) -raised

anti-endomysial (anti-EMA)

-> these 2 are IgA, need to test for TOTAL IgA

Question 15

coeliac presentation?

Answer 15

Failure to thrive 
Diarrhoea
Fatigue
Weight loss
Mouth ulcers

Anaemia secondary to iron, B12 or folate deficiency

!!!!Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen

Question 16

what disease associated with Coeliac?

Answer 16

test all patients with a new diagnosis of type 1 diabetes for coeliac disease, even if they don’t have symptom, because the conditions are often linked.

Question 17

how does Crohns present?

Answer 17

N – No blood or mucus (these are less common in Crohns.)

E – Entire GI tract

S – “Skip lesions” on endoscopy

T – Terminal ileum most affected and Transmural (full thickness) inflammation

S – Smoking is a risk factor (don’t set the nest on fire)

Question 18

UC presentation?

Answer 18

C – Continuous inflammation

L – Limited to colon and rectum

O – Only superficial mucosa affected

S – Smoking is protective

E – Excrete blood and mucus

U – Use aminosalicylates!!

P – Primary sclerosing cholangitis

Question 19

how to test for IBD?

Answer 19

Faecal calprotectin

endoscopy- gold standard!

Question 20

how to treat IBD?

Answer 20

steroids!!- Prednisalone/ IV hydrocortisone

Question 21

How does Biliary atresia present?

Answer 21

presents shortly after birth

-significat conjugated jaundice (dark pee, pale poo)

lasting more than 14 days in term babies and 21 days in premature babies.

Question 22

how to manage biliary atresia?

Answer 22

Surgery!!

Kasai portoenterostomy

Question 23

what can cause surgical obstruction?

Answer 23

Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia
Intussusception
Imperforate anus
Malrotation of the intestines with a volvulus
Strangulated hernia

Question 24

presentation of abdominal obstruction?

Answer 24

bilious vomitting

abdo pain and distention

failure to pass stool or wind

high pitched tinkling

Question 25

ix and management of abdominal obstruction?

Answer 25

abdo xray!- dilated loops of bowel

absnece of air in rectum

Surgery!! nil by mouth, IV fluids

Question 26

what is Hirshsprungs disease?

Answer 26

nerve cells in myenteric plexus in nervous system absent

Absence of parasympathetic ganglion cells

loss of movement of poo and obstruction of bowel-> listened and full

Question 27

genes and hirshsprungs?

Answer 27

FH!!

associated with: downs, neurofibromatosis, waadernburg syndrome

multiple endocrine neoplasia type II

Question 28

presentation of hurshprungs

Answer 28

acute intestinal obstruction shortly after birth

gradually developing symptoms

delay passing meconium

abdo pain and distention

vomitting

poor wight gain and FTT

Question 29

what is Hirschsprung-assosiated enterocolitis?

Answer 29

2-4 weeks of birth with fever, abdominal distention, diarrhoea (often with blood) and features of sepsis.

life threatening-> toxic megacolon and perforation of the bowel.

urgent antibiotics,
fluid resuscitation and decompression of the obstructed bowel.

Question 30

mx of hirshprungs?

Answer 30

abdo xray

rectal biopsy confirms diagnosis- there will be no ganglionic cells

need fluid rhesus, and mx of obstruction

definitive mx- surgical removal!!- but can be left with incontinence

Question 31

Intussesception?

Answer 31

associated with concurrent viral illness
HSP
Cystic fibrosis

presentation:
Recurrent Jelly stool!!!!!
RUQ mass- Sausage shaped!!!
-usually kid would of had URTI before and sx of bowel obstruction

Question 32

ix of choice for intussusception?

Answer 32

USS!!

Question 33

mx of intussusception?

Answer 33

therapeutic enemas

surgery