Common Gastroenterology Problems

Question 1

What is the definition of vomiting

Answer 1

Physical act that results in the gastric contents forcefully brought up to and out of the stomach aided by the sustained contraction of abdominal muscles and diaphragm at a time when the cardia of the stomach is raised and the pylorus is contracted

Question 2

What is regurgitation

Answer 2

Effortless expulsion of gastric contents

Question 3

What is rumination

Answer 3

Frequent regurgitation of ingested food largely behavioural

Question 4

What is possetting?

Answer 4

Small volume vomits during or in between feeds in otherwise healthy children

Question 5

What are the 5 key receptors in the vomiting centre

Answer 5

Muscarinic M1 
Dopaminergic D2
Histaminergic H1 
5-hydroxytriptamine or 5-HT 3 serotonin 
Neurokinin NK 1 substance P

Question 6

What are the five precipitants to the vomiting centre

Answer 6

Toxic material in the lumen of the GI tract
Visceral pathology
Vestibular disturbance
Central nervous system stimulation 
Toxins in the blood or CSF

Question 7

What kind of history do you want to take with GI problems

Answer 7

Bilious or non bilious 
Bloody or non bloody
Projectile or non projectile 
Age of presentation 
Febrile or afebrile 
Nausea, abdo pain, distension, diarrhoea and constipation 
Headache, changes in vision, polyuria, polydipsia, weight loss, to rule out increased intracranial pressure 
Hydration status

Question 8

What are the red flags for a GI history?

Answer 8

Meningism
Costovertebral tenderness
Abdominal pain
Signs of raised intracranial pressure

Question 9

What is meningism?

Answer 9

clinical syndrome of headache, neck stiffness, and photophobia, often with nausea and vomiting

Question 10

What are the signs of increased intracranial pressure?

Answer 10

Headache
Blurred vision
Feeling less alert than usual
Vomiting
Changes in your behavior
Weakness or problems with moving or talking
Lack of energy or sleepiness

Question 11

What examinations do you do for GI

Answer 11

General: Hydration, temperature, observations, weight loss, jaundice and pallor
Abdo: distension, scars, tenderness, rigidity, bowel sounds
Neurological: GCS, meningism, neurological deficit
Plot growth
Hydration
Infection
Presence of dysmorphic features, ambiguous genitalia or unusual odours

Question 12

GI differential diagnosis of vomiting in infants and children

Answer 12

Gastrointestinal obstruction: pyloric stenosis, malrotation, intestinal duplication, Hirschsprung’s disease, antral/duodenal web, foreign body and incarcerated hernia

Other GI disorders:
Achalasia - Achalasia occurs when nerves in the esophagus become damaged. As a result, the esophagus becomes paralyzed and dilated over time and eventually loses the ability to squeeze food down into the stomach
Gastroparesis, gastroenteritis, peptic ulcer, food allergy, IBD, pancreatitis, appendicitis

Question 13

Non GI differential diagnosis of vomiting in infants and children

Answer 13

Neurologic: hydrocephalus, subdural hematoma, intracranial hemorrhage, intracranial mass, infant migraine
Infectious: sepsis, meningitis, UTI, pneumonia, otitis media, hepatitis
Metabolic/endocrine: galactosemia, hereditary fructose intolerance, urea cycle defects, amino and organic acidemias, congenital adrenal hyperplasia
Renal: obstructive uropathy, renal insufficiency
Toxic: lead, iron, vit A & D, medications ipecac and digoxin
Cardiac: congestive heart failure, vascular ring
Psychiatric: Münchausen syndrome by proxy, child neglect or abuse, self induced

Question 14

Presentation of malrotation

Answer 14

Bilious vomiting, abdominal distension

Question 15

Management of malrotation

Answer 15

Contrast study

Urgent surgical referral

Question 16

What is the presentation of Hirschsprung’s disease

Answer 16

Delayed passage of meconium, abdominal distension, bilious vomiting

Question 17

What is the management of Hirschsprung’s disease

Answer 17

Surgical referral

Question 18

Presentation of necrotising enterocolitis

Answer 18

Usually pre term infant, abdominal distension, bilious vomiting

Question 19

Management of necrotising enterocolitis

Answer 19

Antibiotics, enteral rest, surgical referral if severe

Question 20

Necrotising enterocolitis

Answer 20

Necrotising enterocolitis (NEC) is a serious illness in which tissues in the intestine (gut) become inflamed and start to die. This can lead to a perforation (hole) developing, which allows the contents of the intestine to leak into the abdomen (tummy).

Question 21

What is the presentation of infection?

Answer 21

May be non-specific or point

to source of infection

Question 22

What is the management of infection?

Answer 22

Investigations to establish cause
May require fluid resuscitation
and empirical antibiotic treatment

Question 23

What is the presentation of Gastro-oesophageal reflux disease?

Answer 23

Vomiting associated with feeds

Question 24

What is the management of Gastro-oesophageal reflux disease?

Answer 24

Step-wise approach

Question 25

What is the presentation of Food intolerance?

Answer 25

Vomiting, loose stools or constipation, eczema

Question 26

What is the management of Food intolerance?

Answer 26

Elimination

Question 27

Important causes of vomiting in neonates

Answer 27

Malrotation, Hirschsprung’s, necrotising enterocolitis, and infection

Question 28

Important causes of vomiting in infants

Answer 28

GORD
food intolerance 
Pyloric stenosis 
Intussusception 
Strangulated hernia 
Raised ICP
Infection

Question 29

What is the presentation of pyloric stenosis?

Answer 29

Progressive projectile vomiting

Hypokalaemic, hypochloraemic metabolic alkalosis

Question 30

What is the management of pyloric stenosis?

Answer 30

Fluid and electrolyte replacement prior to surgery

Question 31

What is the presentation of intussusception?

Answer 31

Usually 3 to 36 months age, colicky abdominal

pain, bilious vomiting, red-currant jelly stools

Question 32

What is the management of intussusception?

Answer 32

Air or barium enema for reduction

Question 33

What is the presentation of Strangulated hernia/adhesion obstruction?

Answer 33

Bilious vomiting, abdominal pain

Question 34

What is the management of Strangulated hernia/adhesion obstruction?

Answer 34

Surgical referral