Gastroenterology

Question 1

Mesenteric (lymph)adenitis

• Definition
• Causes/ associations
• Presentation

Answer 1

Inflammation of the mesenteric lymph nodes, leading to their enlargement.

Association

• Post-URTI/ tonsilitis
• Appendicitis

Presentation

• Acute abdominal pain/ tenderness (periumbical, RIF, epigastrium)
• Anorexia
• Vomiting/ nausea
• Diarrhoea

Question 2

Pyloric stenosis epidemiologyP

Answer 2

Typically presents age 2-8 weeks
- More common in boys

First born male

Question 3

Presentation of pyloric stenosis

Answer 3

Vomiting after feeding
- Projectile vomiting

Failure to thrive/ poor weight gain

Dehydration

• Dry nappies and mucous membranes
• Depressed fontanelles

Signs

• Olive shaped mass in RUQ
• Visible peristaltic waves

Question 4

Investigations for pyloric stenosis

Answer 4

Bloods

• U+Es: hypochloraemia, low Na, low K+
• VBG: metabolic alkalosis

Imaging
- Abdominal US

Question 5

Management of pyloric stenosis

Answer 5

Manage acute electrolyte imbalance
- IV fluids

Immediate referral to surgery
- Pyloromyotomy

Question 6

Most common cause of gastroenteritis

Answer 6

Viral

• Rotavirus
• Norovirus
• Adenovirus

Bacterial

• Campylobacter jejuni
• Shigella
• E.coli O571
• Clostridium perfringens

Parasitic

• Giardia
• Cryptosporidum

Question 7

Complications of gastroenteritis

Answer 7

Dehydration + electrolyte imbalance
- Severe: shock, AKI

Reactive arthritis (shigella, campylobacter)

Haemolytic uraemic syndrome

Guillain-Barre

Question 8

Presentation of gastroenteritis

Answer 8

GI

• Vomiting, diarrhoea
• Campylobacter, shigella= blood in stool
• Viral= vomiting

Dehydration

• Dry mucous membranes
• Sunken eyes
• Depressed fontanelle
• Loss of skin turgor

Question 9

Features of campylobacter gastroenteritis

• presentation
• Incubation period

Answer 9

Abdominal pain/ cramps

Blood diarrhoea

Fever

Vomiting

2-5 days incubation

Question 10

Causes of baccillus cereus GE

Answer 10

Ingestion of poorly cooked food or food refrigerated after cookin

Question 11

Management of GE

- No clinical dehydration

Answer 11

Ensure hydration is mantained

• Breastfeeding/ milk
• Adequate oral intake

Question 12

Management of GE

- Clinical dehydration

Answer 12

Oral rehydration

• Fluid challenge every 5-10 mins
• Rehydration solution
• Fluid balance

Shock

• IV fluid resus
• Maintenance fluids over 24 hours

Question 13

Antibiotic indications in GE

Answer 13

Sepsis

Pathogens

• Salmonella in < 6 months
• Shigella
• Giardia
• Cholera
• C.difficile

Malnourised/ immunocompromised

Question 14

Cryptosporidiosis presentation

Answer 14

Profuse watery diarrhoea
- Lasts 1-2 weeks

Abdominal pain/ nausea, vomiting

• Fever
• Anorexia

Question 15

Hirschsprung’s disease

- Pathology

Answer 15

Congenital abscence of myenteric plexus in the distal bowel.

- Aganglionic portions of bowel become constricted, when can cause obstruction.

Question 16

Complication of Hirschsprung’s disease

Answer 16

Hirschsprung’s associated enterocolitis (HAE)
- Inflammation and obstruction

Presents

• Bloody diarrhoea
• Abdominal distension
• Fever
• Severe: sepsis

Question 17

Presentation of Hirschsrung’s disease

Answer 17

Failure to pass meconium

Weight loss/ failure to thrive

Chronic constipation/ bowel obstruction
- Distended abdomen

Vomiting

Question 18

Gold standard investigation for Hirschsprung’s disease

Answer 18

Rectal biopsy and histology

Question 19

Definite management of Hirschsprung’s disease

Answer 19

Resection of aganglionic bowel.

Question 20

Sandifer’s syndrome

- description

Answer 20

Spasmodic torsion dystonia

• Causes back/neck arch
• Predisposes to GORD

Question 21

Epidemiology of GORD in children

Answer 21

Typically started before 8 weeks

- 90% resolves by 1 year

Question 22

Presentation of GORD

Answer 22

Chronic cough
- Hoarse voice/ crying

Vomiting
- After feeding

Poor weight gain/ failure to thrive

Distress after feeding

Pneumonia

Question 23

Red flags in GORD (6)

Answer 23

Projectile vomiting
- Pyloric stenosis/ bowel obstruction

Neurological signs
- meningitis, raised ICP

Green/ bilous vomiting
- Bowel obstruction

Haematemesis/ malaena
- GI bleed

Blood in stools
- GE, cow milk protein allergy

Allergic features
- Cow milk protein allergy

Question 24

Investigations for GORD in children

Answer 24

Largely clinical diagnosis

If needed:

• Abdominal ultrasound
• Barium meal
• Endoscopy

Question 25

Management of GORD in children - Conservative - medical

Answer 25

Conservative - Avoid overfeeding - Feed small, frequent meals - Burping after eating - Avoid laying flat after eating Medical - OTC special reflux-preventing formula - Gaviscon in feeds - Ranitidine

Question 26

Epidemiology of intussusception

Answer 26

Most common in 3 months- 2 years

Question 27

Risk factors for intussusception

Answer 27

Viral illness Cystic fibrosis Henoch- Schonlein purpura Intestinal polyps Meckel diverticulum

Question 28

Presentation of intussusception

Answer 28

Acute bowel obstruction - Colicky abdominal pain - Distended abdominal - Vomiting Red currant/ jelly stools Pallor Sausage-shaped abdominal mass Shock

Question 29

Investigation findings for intussusception

Answer 29

FBC - may show anaemia U+E - low Na and K+ if vomiting AXR - Distended small bowel - No gas in distal colon/rectum

Question 30

After appropriate resuscitation, what is first line management of intussuception

Answer 30

If non-peritonic - Rectal air insufflation Second line/ in peritonitis - Surgical resection