Gastroenterology

Question 1

What dose vomiting of undigested food indicated?

Answer 1

Achlasia
Delayed gastric emptying
Rumination

Question 2

What does bilious vomiting suggest?

Answer 2

GI obstruction beyond duodenum eg malrotation

Question 3

What is cyclic vomiting?

Answer 3

Paroxysms of vomiting followed by intervals of complete health
Assoc. with migraine headaches
Normal exam

Question 4

The finding of red current jelly suggests what?

Answer 4

Intussusception

Question 5

What is the most common cause of abdominal pain in children?

Answer 5

Functional abdominal pain

Question 6

What clues are useful in diagnosing functional abdominal pan?

Answer 6

Periumbilical
Normal growth
Better on weekends / vacation
Worse before school / before bed

Question 7

What clues suggest an organic cause for abdominal pain?

Answer 7

Abdo pain AND:

• vomiting
• weight loss
• hematochezia
• diarrhoea
• night-time awakening from pain
• fever, rash, oral ulcers or joint pain
• melena

Question 8

Most common cause of diarrhoea in children?

Answer 8

Infectious agent - most common rotavirus

Question 9

Indications for IV therapy in diarrhoea child?

Answer 9

Shock
Stool output >10ml/kg/hr
Ileus
Monosaccharide intolerance

Question 10

When is diarrhoea considered chronic?

Answer 10

3x/day for >14 days

Question 11

Treatment for infant dyschezia?

Answer 11

Reassurance, no treatment

Question 12

Most common cause of constipation in children?

Answer 12

Functional constipation

Question 13

How do 90% of tracheoesophageal abnormalities present?

Answer 13

Blind upper EA with fistula between lower oesophageal segment and the lower portion of the trachea near the carina.
(EA + distal TOF)

Question 14

What does VACTERL stand for?

Answer 14

Vertebral
Anal atresia
Cardiac
Tracheo-oesophageal fistula
Renal 
Limb abnormalities

Question 15

How do you diagnose eosophageal atresia with distal tracheoesophageal fistula?

Answer 15

NG tube, blind pouch prevents its passage

Question 16

What is achalasia?

Answer 16

Incomplete relaxation of the LES and lac of normal oesophageal peristalsis
- motor problem, not anatomic problem

Question 17

True or false? Achalasia in infancy can be due to a congenital disorder?

Answer 17

May be a congenital disorder

Question 18

Is GE reflux a normal process for many infants?

Answer 18

Yes

Question 19

Which children are at risk of having infection of the oesophagus?

Answer 19

HIV, diabetes, cancer, long term high dose steroid use

Question 20

What is the initial treatment for reflux in infants?

Answer 20

Reassurance

Question 21

How long after ingestion of a caustic substance should upper endoscopy be performed?

Answer 21

12 - 24 hours

Question 22

What disorders is spontaneous eosophageal perforation increased in frequency?

Answer 22

Ehlers-Danlos

Marfan

Question 23

What type of acid-base disorder is seen with pyloric stenosis?

Answer 23

Hypochloremic metabolic alkalosis

Hypokalaemia (exchange of hydrogen/potassium ions in kidney)

Question 24

What causes stress gastropathy?

Answer 24

Severe physiologic stress
- shock, metabolic acidosis, sepsis, burns, head injury

(think sick ICU patient with GI bleed)

Question 25

What is the most common identifiable cause of gastritis in children?

Answer 25

H.pylori infection

Question 26

What usually causes Menetrier disease?

Answer 26

CMV infection

Protein losing gastropathy

Question 27

Which organism is responsible for most PUD in children?

Answer 27

H.pylori

Then NSAIDs

Question 28

When and how do you diagnose H.pylori infection?

Answer 28

Upper endoscopy - gastritis, biopsy

No not perform breath test first

Question 29

Are antibody tests useful in diagnosing active PUD?

Answer 29

Useful in PAST exposure, not for active

Question 30

What is the treatment for H.pylori infection?

Answer 30

2 weeks

PPI + clarithromycin + amoxicillin (or metro)

Question 31

What is Zollinger Ellison Syndrome?

Answer 31

Excessive stomach acid production from gastrin secreting tumour in pancreas / duodenal wall

Gastrinomas assoc with MEN1

Question 32

How does pyloric stenosis present?

Answer 32

3wk-2mo of age
Worsening non bilious vomiting
Babe hungry and eager to feed

RF - erythromycin <2wk old

Question 33

At what age do infants with malrotation present?

Answer 33

1st month of life - bilious emesis

Question 34

What does an upper GI series show in an infant with malrotation?

Answer 34

Bird beak of the 2nd and 3rd part of duodenum

Question 35

What age does intussusception occur?

Answer 35

2mo and 5yo (peak 4-10mo)

Question 36

Describe presenting symptoms of intussusception

Answer 36

Repeated episodes of severe abdominal pain with asymptomatic intervals
Vomiting and hematochezia