Gastro

Question 1

Constipation management

Answer 1

Polyethylene glycol (Movicol) 
\+/- stimulant (eg Senna)

Question 2

Hirschsprung disease define

Answer 2

absence of ganglion cells from the myenteric and submucosal plexuses

• > lack of parasympathetic innervation
• > narrow contracted segment, no coordinated peristalsis
• > constipation

Question 3

Hirschsprung disease diagnosis

Answer 3

DRE: digit withdraws -> liquid stool/flatus release
Rectal biopsy- no ganglion cells in submucosa
staining for acetylcholinesterase- positive nerve excess

Question 4

Hirschsprung disease management

Answer 4

defunctioning colostomy
pull through procedure
closure of colonoscopy

Question 5

Dehydration classification

Answer 5

Mild <5%
Moderate 5-10% clinical signs present
Severe >10% shock

Question 6

What is the danger with hypernatraemic dehydration

Answer 6

rehydration may cause cerebral oedema

-> rehydrate over 48 hrs

Question 7

Fluid loss deficit calculation

Answer 7

%dehydration x weight x 10 = … ml

Question 8

Gastroenteritis causes

Answer 8

rotavirus

campylobacter jejuni

Question 9

Posseting define

Answer 9

non-forceful return of small amounts of milk that often accompany the return of swallowed air

Question 10

Regurgitation define

Answer 10

non forceful return of larger amoutnts of feeds and more frequent return. May indicate presence of more significant gastro-oesophageal reflex

Question 11

Pyloric stenosis: age at presentation

Answer 11

2-8 wks

Question 12

Pyloric stenosis rx

Answer 12

pyloromyotomy

Question 13

Gastro-oesophageal reflux cause

Answer 13

inappropriate relaxation of the lower sphincter as a result of functional immaturity (physiological)

Question 14

Gastro-oesophageal reflux investigations

Answer 14

not normally required
24hts oesophageal pH monitoring
24hrs impedance monitoring (identifies weekly acidic or non-acidic reflux)

Question 15

Gastro-oesophageal reflux management

Answer 15

inert thickening agents
smaller more frequent feeds
ranitidine, omeprazole
fundoplication if severe

Question 16

Coeliac disease define

Answer 16

enteropathy 
protamines cause immunological response 
- villus atrophy 
- increased intraepithelial WBC 
- crypt hyperplasia

Question 17

Coeliac disease diagnosis

Answer 17

anti-transglutaminase antibody

endomysial antibodies

Question 18

Crohn’s disease induction meds

Answer 18

nutritional therapy (whole protein modular feeds)
\+/- steroids

Question 19

Crohn’s disease maintenance meds

Answer 19

azathioprine

Question 20

UC induction meds

Answer 20

5-ASA +/- steroids

Question 21

UC maintenance meds

Answer 21

azathioprine +/- steroids

Question 22

How long does physiological jaundice take to resolve?

Answer 22

2-3 wks