Gastroenterology

Question 1

List some of the common causes of vomiting in all age groups

Answer 1

Infection:
- gastroenteritis
Functional:
- physiologic reflux, GERD
- post-tussive
Obstructive:
- pyloric stenosis
- intussusception 
- volvulus
- incarcerated hernia
Metabolic:
- adrenal crisis
Hepatobiliary

Question 2

List some complicated causes of vomiting by age group

Answer 2

Neonate:
- Hirschsprung’s 
- necrotizing enterocolitis 
Infancy:
- Hirschsprung’s
- toxin ingestion
- increased ICP: subdural hematoma, hydrocephalus
- renal disease: obstructive, insufficiency
Children:
- diabetic ketoacidosis
- toxin ingestion
- increased ICP: subdural hematoma, hydrocephalus, tumour
Adolescence:
- suicide attempt
- diabetic ketoacidosis
- increased ICP

Question 3

List some of the red flags for vomiting

Answer 3

Prolonged vomiting: >12 hours in children <2, >24 hours in children <2, >48 hours in adolescence

Question 4

Divide causes of abdominal pain by quadrants

Answer 4

RUQ:
- liver
- gallbladder
- duodenum
- hepatic flexor 
- right kidney
RLQ:
- terminal ileum and caecum
- appendix
- ovary
LUQ:
- spleen
- tail of pancreas
- left splenic flexure 
- left kidney
LLQ:
- sigmoid colon
- ovary

Question 5

List some common causes of abdominal pain in children >2 years old

Answer 5

GI:
- constipation
- gastroenteritis
- appendicitis
- obstruction
- inflammatory bowel disease
GU:
- urinary tract infection
- testicular or ovarian torsion
- calculi
Respiratory:
- pneumonia
Metabolic:
- diabetic ketoacidosis
Hematologic:
- sickle cell
Female:
- ectopic pregnancy
- dysmenorrhea
- endometriosis

Question 6

List some of the common causes of chronic abdominal pain in children

Answer 6

GI:
- functional dyspepsia 
- IBS
- GERD
- peptic ulcer
- carbohydrate absorption 
- IBD
- Celiac
OBGYN:
- dysmenorrhea
- PID
GU:
- UTI

Question 7

List some of the red flags for chronic abdominal pain

Answer 7

• involuntary weight loss
• back pain
• significant vomiting or diarrhea, dysphagia
• dysuria, flank pain
• family history of IBD or Celiac

Question 8

List the common abdominal masses by location

Answer 8

Epigastric
- pyloric stenosis
- pancreatic pseudocyst 
Flank:
- hydronephrosis
- polycystic kidney disease
- Wilms tumour 
LUQ:
- splenomegaly
RUQ:
- hepatomegaly
- hepatoblastoma
- hepatocellular carcinoma
LLQ/RLQ
- ovarian cyst or tumour
- fecal impaction
- lymphoma (LLQ)

Question 9

List the concerning liver size features on exam for hepatomegaly

Answer 9

Newborns:
- >3.5cm below costal margin and >5cm up the costal margin
Infants:
- > 2cm below costal margin and >6.5 in females or >8cm in males along costal margin

Question 10

List some of the acute causes of diarrhea

Answer 10

GI Infection:

• rotavirus, Norwalk virus, enteric adenovirus
• Salmonella, campylobacter, shigella, e. Coli (all can cause bloody diarrhea)

Question 11

List some of the chronic causes of diarrhea

Answer 11

• IBS
• infection
• celiac disease
• carbohydrate malabsorption
• hyperthyroidism
• ulcerative colitis
• chron’s disease

Question 12

List the investigations and interpretations of chronic diarrhea

Answer 12

Stool osmotic gap:

• normal (<50) in secretory suggesting infection, medication, hyperthyroidism or microscopic colitis
• abnormally high (>125) is osmotic suggesting carbohydrate malabsorption, laxative or celiac
• inflammatory with high WBC and blood suggest IBD
• steatorrhea suggest celiac, carbohydrate malabsorption, pancreatic insufficiency or small bowel overgrowth

Question 13

List some of the common pathogens for gastroenteritis

Answer 13

Viral (75-90%): 
- rotavirus
- calicivirus 
- norovirus
Bacterial (10-20%):
- e. Coli
- campylobacter
- salmonella
- shigella
- C. difficile
Parasitic (<5%)
- giardia
- cryptosporidium