4th Year GI

Question 1

viral causes of gastroenteritis

Answer 1

norovirus
adenovirus
rotavirus

Question 2

bacterial causes of gastroenteritis

Answer 2

e. coli 0157
c. diff
campylobacter
salmonella
cryptosporidium

Question 3

parasitic cause of gastroenteritis

Answer 3

giardia

Question 4

management of gastroenteritis

Answer 4

rehydration with dioralyte
water
ondansetron

loose stools can continue for a couple of weeks

Question 5

define diarrhoea

Answer 5

more than 3 stools a day

Question 6

what is toddler’s diarrhoea?

Answer 6

a benign condition due to colonic immaturity

Question 7

what age does toddler’s diarrhoea improve?

Answer 7

5-6

Question 8

presentation of toddler’s diarrhoea

Answer 8

up to 10 stools a day

thriving child

Question 9

management of toddler’s diarrhoea

Answer 9

reduce excessive fruit juice
increase fat if on low fat diet
keep fibre normal
may need loperamide

Question 10

causes of abdominal pain

Answer 10

colic
intussusception
mesenteric adenitis
appendicitis
constipation
IBD
Coeliac's
testicular torsion
obstruction

Question 11

constipation criteria

Answer 11

at least 2 and present for 1 month:

• <3 defecations a week
• one episode of faecal incontinence after toileting skills
• history of excessive retention, painful/hard bowel movements
• obstruction to toilet/ large mass

Question 12

RF for constipation

Answer 12

low fibre
low fluid
excessive dairy
lack of exercise
obesity

Question 13

examples of softeners for constipation

Answer 13

magrocol (laxicod, movicol)

Question 14

when might laxido be needed?

Answer 14

faecal impaction +/- soiling

Question 15

how to wean off laxatives

Answer 15

aim for type 5 on Bristol stool chart for fortnight, then aim for type 4 for at least 6 months slowly weaning dose

Question 16

examples of stimulants

Answer 16

docusate or senna

Question 17

define infant dyschezia

Answer 17

problem in learning to defaecate with poor coordination of straining on stool and opening of external anal sphincter

Question 18

management of infant dyschezia

Answer 18

usually resolves after 2-4 weeks

Question 19

why do most babies get GORD?

Answer 19

milk all day + lying flat

Question 20

management of GORD

Answer 20

thickening feed e.g. gaviscon or carobel
reduce stomach acid (PPI/H2A)
empty stomach faster e.g. domperidone
assess for overfeeding
consider CMPA and trial of hydrolysed formula

Question 21

management of eosinophilic oesophagitis

Answer 21

dietary with 6 food elimination = seafood, nuts, dairy, eggs, wheat, soya

2nd line is topical viscous budesonide

Question 22

complication of eosinophilic oesphagitis

Answer 22

oesophageal stricture

Question 23

management of pyloric stenosis

Answer 23

pyloromyotomy

Question 24

GOLD standard to diagnosis coeliac

Answer 24

endoscopy with duodenal biopsy

Question 25

associations with coeliac's

Answer 25

``` T1DM AI thyroid juvenile chronic arthritis Down's Turner's William's ```

Question 26

complications of coeliac's

Answer 26

``` OP anaemia short stature delayed puberty female infertility intestinal malignancy (T cell lymphoma) ```

Question 27

what is the wPCDAI score?

Answer 27

weighted paediatric Crohn's activity index

Question 28

MILD UC

Answer 28

``` distal colon only <3 stools/day little blood no fever no weight loss ```

Question 29

moderate UC

Answer 29

``` 3-5 stools/day bloody abdominal pain/cramp low grade fever mild anaemia weight loss ```

Question 30

severe UC

Answer 30

``` >5 stools a day frank blood fever anaemia leucocytosis hypoalbuminaemia pain ```

Question 31

complications of UC

Answer 31

``` colon cancer growth failure arthropathy episcleritis erythema nodosum/ pyoderma gangrenosum PSC AI hepatitis ```

Question 32

diagnosis of UC

Answer 32

3 stool cultures stool calprotectin endoscopy/ colonoscopy

Question 33

typical histology of UC

Answer 33

polymorph nuclear leucocytes near base of crypts crypt abscesses no granulomas

Question 34

acute management of UC

Answer 34

steroids

Question 35

maintenance of UC

Answer 35

``` MILD= mesalazine MODERATE-SEVERE= mesalazine + azathioprine NON-RESPONDERS= mesalazine + azathioprine + infliximab or adalimumab ``` cure= colectomy

Question 36

what is toxic megacolon?

Answer 36

transverse colon diameter >5cm in adults on AXR

Question 37

is toxic megacolon a surgical emergency?

Answer 37

yes as risks perforation

Question 38

management of toxic megacolon

Answer 38

drip and suck IV antibiotics early surgical review

Question 39

what is hypernatraemic dehydration?

Answer 39

sodium level is very high and is seen in the first few weeks when breast feeding is difficult profuse watery diarrhoea and drowsy baby

Question 40

colic in neonates

Answer 40

paroxysmal crying with pulling of legs for more than 3 hours more than 3 days a week can give lactase if lactose intolerance but REASSURE

Question 41

what is biliary atresia?

Answer 41

jaundice as bile is not secreted from gall bladder as ducts are small or absent bilirubin not broken down fat soluble vitamins not absorbed