GI Disorders

Question 1

What are GERD investigations?

Answer 1

Barium swallow
24 hr esophageal ph monitoring
Impedance monitoring (manometry)
Esophageal endoscopy :erosive esophagitis

Question 2

GERD management

Answer 2

• not compicated : lifestyle modifications
• complicated: pro kinetics, H2 blockers( ranitidine), PPI
• surgical

Question 3

What is the peak age for Functional childhood Abdominal pain?

Answer 3

8-9 years

Question 4

What is the diagnostic investigation of IBD in children?

Answer 4

Endoscopy and Biopsy

Question 5

What is the management of crohns disease?

Answer 5

First line : enteral nutrition(polymeric diet), 5asa, prednisolone
Second line: AZAthioprine ; MTX
Third line: infliximab ; surgery

Question 6

What is the pathological finding of a biopsy of celiac disease

Answer 6

Villous atrophy on a jujenal biopsy

Question 7

What is the serology test to do in celiac disease

Answer 7

Anti-tissue transglutaminase IgA
Endomesial antibodies
Anti gliadin

Question 8

When should infants regain birth weight after losing it?

Answer 8

By 2 weeks

Question 9

What are the energy needs of infants?

Answer 9

Ø0 – 3 months 115Kcal/kg/day.

Ø1 – 3 years 95 Kcal/kg/day

Question 10

Dysphagia associated with achalasia is for what type of food?

Answer 10

Solids & liquids

Question 11

Investigations of Achalasia

Answer 11

CXR: air fluid level in dilated esophagus
Barium swallow: bird peak appearance
Manometry: increased intra esophageal pressure
Upper endoscopy

Question 12

Treatment of Achalasia

Answer 12

Endoscopy pneumatic dilatation
Myotomy: laparoscopic, endoscopic, surgical
Botulinum toxin injection (temporary)

Question 13

What is the peal age for foreign body ingestion in children

Answer 13

6 months - 3yrs

Question 14

Treatment of Foreign Body ingestion

Answer 14

Fortunately, most ingested FBs pass
spontaneously. Only 10 – 20% require endoscopic
removal, and < 1% require surgical intervention.

Question 15

What is the role of upper GI series (barium or gastrograffin) swallow) in corrosive injuries

Answer 15

Not valuable in the initial stages of evaluation, only if clinical
suspicion of perforation (use water-soluble contrast not barium).
§ 2-3 weeks post-ingestion, even if the patient is asymptomatic to
evaluate stricture.

Question 16

Investigations of caustic ingestion

Answer 16

CXR
Endoscopy to all symptomatic pts within 24 hrs (not<6 hrs)
Upper GI series (no major role before 2 weeks)

Question 17

Treatment of caustic ingestion

Answer 17

Hospital admission & IV Fluids: till evaluation.
v Feeding:
Ø Nasogastric tube: extensive circumferential burns.
Ø Gastrostomy tube: severe extensive esophageal burns.
Ø Jujenostomy tube
v Medications:
Ø Antibiotics: If infection suspected or as prophylasis.
Ø Acid suppression: PPIs.
Ø Corticosteroids: may reduce risk of stricture (Controversial).
v Treatment of complications:
Ø Esophageal dilatation: for strictures 3-6 wks after injury.
Ø Surgical: for perforation and reconstruction of esophagus (If
needed).

Question 18

What is Rumination syndrome

Answer 18

people repeatedly & unintentionally
regurgitate undigested or partially digested food from the stomach, re-
Swallow it or spit it out,
it most often occurs in infants and very young
children (3-12 months), and in children with intellectual disabilities.

Question 19

If projectile vomiting presents at 2–7 weeks of age, what disease should be excluded?

Answer 19

Pyloric stenosis

Question 20

Cl/p of CHPS

Answer 20

§ Non-bilious projectile vomiting, then child is hungry.
§ Olive-shaped palpable mass in Rt upper abd. quadrant.
§ Gastric peristaltic waves (Lt to Rt) in baby’s abdomen.

Question 21

What is the finding of a barium meal in a baby with pyloric stenosis?

Answer 21

String sign

Question 22

Investigations of CHPS

Answer 22

§ Hypochloremic metabolic alkalosis with a low Na & K as
result of vomiting.
§ Abd. Ultrasound: Pylorus: ► > 4mm wall thickness.
► > 15mm length.
§ Barium meal ± (in doubtful cases): Narrow pyloric canal
(String sign).

Question 23

Management of CHPS

Answer 23

§ The initial priority: correct any fluid and
electrolyte disturbance with IV fluids (0.9% saline
and 5% dextrose with K supplements).
§ Definitive treatment by pyloromyotomy:
ØDivision of the hypertrophied muscle down to, but
not including, the mucosa.
ØEither by open procedure or laparoscopically.
§ Postoperatively, the child can usually be fed within
6 hrs and discharged within 2 days of surgery

Question 24

What is sandifer syndrome?

Answer 24

Dystonic head and neck. Movements

A complication of GERD

Question 25

Investigations of GERD

Answer 25

24 h esophageal PH monitoring (gold standard)
24 h impedance monitoring
Barium study
Upper GI endoscopy

Question 26

Management of GERD

Answer 26

ØIf CMPA suspected → Trial of hypoallergenic
formula)
q Acid Suppression:
ØReduce volume of gastric contents.
ØTreat acid-related esophagitis.
§ H2 blockers (Ranitidine). 
§ Proton-pump inhibitors (Omeprazole).
q Prokinetics:
Ø Enhance gastric emptying.
§ Metoclopramide 
§ Domperidone

Surgical management:
§ Nissen fundoplication (abdominal or
laparoscopic procedure): The fundus of stomach
is wrapped around the intra-abdominal
esophagus

Question 27

Rome III Diagnostic criteria for childhood FAP

Answer 27

Episodic or continuous abdominal pain.
2. Insufficient criteria for other FGIDs.
3. No evidence of an inflammatory, anatomic,
metabolic, or neoplastic process that explains the
symptom.
*Criteria fulfilled at least once per week for  2 months
before diagnosis

Question 28

Pathology of crohns disease

Answer 28

▪ Skip lesions.
▪ Transmural.
▪ Granulomas

Question 29

Pathology of Ulcerative Colitis

Answer 29

Diffuse.
▪ Mucosal.
▪ Crypt abscesses

Question 30

Treatment of Ulcerative Colitis

Answer 30

Induction:• Prednisolone
• Sulphasalazine/5-ASA

Maintenance: Sulphasalazine/5-ASA
Second line:
• Systemic steroids (exacerbation)
• Azathioprine

Fulminant disease: Surgery + Cyclosporine
• Surgery
• ?? Infliximab

Question 31

Rome Diagnostic criteria for pediatric constipation

Answer 31

❖ Gold standard definition
▪ → A patient must have  2 of the following
symptoms over the preceding 3 months:
➢< 3 spontaneous bowel movements / week.
➢Straining for > 25% of defecation attempts.
➢Lumpy or hard stools for  25% of defecation attempts.
➢Sensation of anorectal obstruction or blockage  25%…
➢Sensation of incomplete defecation for  25%…
➢Manual maneuvering required to defecate for  25%

Question 32

Medical management of constipation

Answer 32

▪ Enemas or manual
evacuation (if severe).
▪ Movicol (PEG).
▪ Lactulose (Osmotic).
▪ Stimulant laxatives:
➢Senna.
➢Sodium picosulphate.

Question 33

Diagnosis of Esinophiloc esophagitis

Answer 33

Esophageal biopsy: inflamation + peak value of ≥15 eosinophils /HPF (or 60/mm2).
Increased serum IgE and peripheral eosinophilia
Endoscopy : Stacked circular rings (appearance of a tracheal (trachealisation)

Question 34

What is the first line management of eosinophilic esophagitis

Answer 34

Dietary therapy: Avoidance of allerge

Question 35

Management of ana acute attack of Cow milk protein allergy

Answer 35

ØMild reaction (no Cardiorespiratory symptoms):
►► Antihistamines.
ØSevere reaction:
►►I.M. Epinephrine (adrenaline) by auto-injector (Epipen)
Child/parent should carry at all times.

Question 36

Most common cause of infectious gastroenteritis in children

Answer 36

Rota virus

Question 37

What is the cutoff duration for chronic abdominal pain

Answer 37

2 months