Pediatric Gastroenterology, Hepatology and Nutrition
Core concepts
Know the approach to failure to thrive (caloric intake, absorption, increased losses, increased needs), the differential for chronic diarrhea (celiac disease, cow's milk protein allergy, IBD, infection), and the evaluation of vomiting (GER versus pyloric stenosis versus malrotation). Understand jaundice in the older child (hepatitis, biliary obstruction, metabolic), the interpretation of liver enzymes, and the recognition of cholestasis in infancy. Master nutritional assessment, the refeeding syndrome, and the indications for enteral versus parenteral nutrition.
Traps
Questions test whether you can distinguish physiologic reflux from GERD and pyloric stenosis (projectile, nonbilious, palpable olive, hypochloremic hypokalemic metabolic alkalosis). Bilious vomiting in a neonate is malrotation until proven otherwise. Another trap is attributing poor growth to a behavioral cause before excluding organic disease, or vice versa.
Worked example
A 6-week-old with projectile nonbilious vomiting, weight loss, and a hypochloremic metabolic alkalosis has pyloric stenosis; the next step is ultrasonography, and correction of electrolytes precedes surgery. The trap is treating the alkalosis as the primary problem or delaying surgery without correcting fluids.
Rule of thumb
Bilious vomiting in any infant is a surgical emergency until malrotation with volvulus is excluded.