GI

Question 1

duodenal atresia

Answer 1

Polyhydramnios
Distended abdomen
Bilious vomiting

Question 2

oesophageal atresia

Answer 2

blind-ended oesophagus, while a tracheo-oesophageal fistula involves an abnormal connection between the trachea and oesophagus.

Antenatally- polyhydramnios

postnatally- respiratory distress, distended abdomen, choking or problems with swallowing may be observed.

Difficulty in passing NG tubes

surgery to correct anatomy soon after birth

Question 3

pyloric stenosis

Answer 3

babies 4-12 weeks
projectile non bilious vomiting
weight loss
dehydration and shock
metabolic alkalosis, hypochloraemia, hypokalaemia

• Fluid resuscitation (to correct metabolic alkalosis and dehydration)
• Nasogastric tube for drainage (if obstruction)
• Ramstedt’s pyloromyotomy (for obstruction)

Question 4

investigations for bilious vomiting

Answer 4

• Abdominal X-Ray
• Ultrasound
• Contrast Meal

Question 5

causes of bilious vomiting

Answer 5

intestinal atresia
malrotation
intussusception
necrotising enterocolitis
ileus
crohns disease with strictures

Question 6

necrotising enterocolitis presentation

Answer 6

• Bloody stools
• Bilious vomiting
• Abdominal distension

Question 7

GORD management in kids

Answer 7

nutrional support and feeding advice
optimal volume 150ml/kg/day
feed thickeners
acid suppressing drugs- PPIs, H2 receptors
prokinetic drugs
Nissen Fundoplication if persistent despite treatment and - Failure to thrive
- Aspiration
- Oesophagitis

Question 8

treatment of IBD

Answer 8

antinflammatory- glucocorticoids, 5ASA
immunosuppression- azathioprine, 6- mercaptopurine, methotrexate
biologicals- infliximab, adalimumab

• Pouch surgery e.g. ileostomy in Ulcerative colitis
• Bowel resection in Crohn’s disease

Question 9

intussusception

Answer 9

condition where the bowel “invaginates” or “telescopes” into itself leading to bowel obstruction and a palpable mass in the abdomen

• 6-18 months
• Few days of viral illness
• Palpable mass
• Intermittent colic
• Dying spells (crying then completely floppy and white for 10-15 seconds then they’ll take a big breath and start crying)
• Bilious vomiting
• Bloody and mucous stool ‘’redcurrant jelly stool’’
• Abdominal examination: sausage-shaped mass
• Target sign on ultrasound (Gold standard)

pneumostatic reduction- air pumped into the gut to blow the intussuseptum
laparotomy if doesnt work

Question 10

volvulus

Answer 10

complication of malrotation where the bowel twists around itself and themesentery that it is attached to leading to a closed-loop bowel obstruction

days 1—3, colicky pain, bilious vomiting, abdominal distension, absolute constipation

upper GI contrast x ray study
right sided duodenum

laparotomy

Question 11

gastroschisis

Answer 11

birth defect where there is a hole in the abdominal wall beside the belly button allowing the intestines to exit through it

Question 12

short gut syndrome

Answer 12

conditions that result in malabsorption of nutrients due to small intestine resection secondary to atresias, fistulas, gastroschisis, necrotising enterocolitis

Question 13

exomphalos

Answer 13

umbilical defect with covered viscera with many associated anomalies including cardiac chromsomal and renal

the baby’s intestine develops inside the umbilical cord. It usually moves inside the abdomen a few weeks later. this case there is no abdominal wall fully developed

Question 14

managment of gastroschisis

Answer 14

fluid and heat management
Delayed closure with a silo chimney
Total Parenteral Nutrition (TPN)

Question 15

management of exomphalos

Answer 15

• Fluid and Heat management
• Primary or Delayed closure with a silo chimney

Question 16

umbilical hernia

Answer 16

• Onset: days after birth
• Umbilical swelling
• Worse with crying
• Easily reducible
• Usually self-limiting

operate if persists more than 4 years
large defect or aesthetic reasons

paraumbilical hernia, which usually points towards the feet, while umbilical hernia points straight up the air

Question 17

hirschsprungs disease

Answer 17

nerve cells of myenteric plexus are absent in distal bowel and rectum
Without this stimulation the bowel looses it’s motility and stops being able to pass food along its length.
Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive

abdo x ray
rectal biopsy- absense of gangionic cells
iv fluids
iv antibiotics if enterocolitis due to hirschsprungs
surgical removal of aganglionic section of bowel

Question 18

diseases associated with hirschsprungs

Answer 18

Downs syndrome
Neurofibromatosis
Waardenburg syndrome (a genetic condition causing pale blue eyes, hearing loss and patches of white skin and hair)
Multiple endocrine neoplasia type II