Paediatrics & Child Health: Gastroenterology

Presentations

• Abdominal pain:
  
  • acute
  • chronic
  • recurrent
• Constipation and encopresis
• Diarrhoea, acute and chronic
• Vomiting:
  
  • acute
    
    • pyloric stenosis
    • urinary tract infection
  • cyclical

Conditions

• Cows’ milk protein intolerance
• Eosinophilic oesophagitis
• Gastroenteritis
• Gastro-oesophageal reflux (GOR, reflux)
• Hepatitis, acute and chronic
• Inflammatory bowel disease:
  
  • Crohn disease
  • ulcerative colitis
• Liver disease:
  
  • neonatal jaundice, such as neonatal hepatitis, biliary atresia, and inherited cholestasis syndromes
  • chronic liver disease
• Liver failure, acute
• Malabsorption syndromes, such as:
  
  • those secondary to infections and parasitic infestations
  • coeliac disease
• Meckel diverticulum

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

Presentations

• Abdominal masses
• Bleeding:
  
  • lower gastrointestinal (GI)
  • upper GI
• Dysphagia and food impaction
• GI manifestations of systemic and chronic disease, such as cystic fibrosis
• Intestinal failure and malnutrition

Conditions

• Acute pancreatitis
• Chronic recurrent pancreatitis
• Congenital malformations:
  
  • anorectal malformations
  • duodenal atresia
  • gastroschisis
  • Hirschsprung disease
  • malrotation
  • oesophageal atresia
• Delayed gastric emptying
• GI malignancies:
  
  • inherited GI cancers and polyposis
  • liver tumours, such as hepatoblastoma, hepatocellular cancer, and haemangioendothelioma
• Hepatitis B and C
• Inflammatory bowel disease
• Intestinal failure:
  
  • dysmotility
  • inherited enteropathies
  • short bowel syndrome
• Intestinal failure-associated liver disease
• Irritable bowel syndrome
• Peptic ulcer disease, including Helicobacter pylori infection
• Peritonitis
• Portal hypertension:
  
  • non-cirrhotic portal hypertension
  • secondary to liver disease
• Protein-losing enteropathy

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

• Bilirubin metabolism
• Embryology, anatomy, and physiology of the GI and hepatobiliary system
• Laboratory markers of hepatic and pancreatic function and malabsorption
• Macro- and micronutrient absorption
• Nutrition and fluid balance

Investigations

• Abdominal imaging:
  
  • CT scan
  • MRI, including MR enterography and MRCP
  • ultrasound
  • X-ray
• Barium contrast studies
• Laboratory tests, such as:
  
  • coeliac serology
  • culture and toxin testing
  • faecal calprotectin
  • faecal microscopy
  • Helicobacter pylori testing
  • investigations of acute and chronic liver disease
  • liver function test (LFT)
  • malabsorption tests
  • viral hepatitis serology
• Liver biopsy
• Manometry:
  
  • oesophageal
  • rectal
• Oesophageal pH monitoring and impedance

Procedures

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Upper and lower endoscopy

Clinical assessment tools

• Rectal examination

• Decision making when requesting endoscopy in children with reflux or vomiting
• Distinction between GOR, reflux and gastro-oesophageal reflux disease (GORD)
• Distinction between irritable bowel syndrome and other causes of abdominal pain, diarrhoea, and constipation
• Exclusion diets in:
  
  • children
  • mothers who are breastfeeding
• Indications and technique for appropriate rectal examination
• Indications for liver transplant and principles of post-transplant care
• Indications for the use of parenteral intravenous nutrition
• Role of endoscopy in the investigation and management of common GI presentations and conditions
• Role of radiolabelled scintigraphy in occult GI protein or blood loss
• Selection and appropriate use of enteral formulae
• Use of hydrolysed or elemental formulae