GI disorders part 1

Question 1

with a patient complaining of dysphagia what is the most appropriate first test ?

Answer 1

barium swallow

followed by manometry if further investigations are needed

Question 2

what is achalasia a result of ?

Answer 2

degeneration of neurons in the esophageal wall leading to failure of relaxation of the LES
loss of peristalsis in the distal oesophagus

Question 3

what aret the types of achalasia ?

Answer 3

primary or idiopathic

secondary ( diseases affecting the intramural ganglion cells)

Question 4

what is the primary and earliest clinical feature of achalasia ?

Answer 4

dysphagia for solids and liquids

Question 5

besides dysphagia what are the other symptoms of achalasia ?

Answer 5

regurgitation
vomiting
chest pain or heart burn not responsive to PPI
weight loss

Question 6

what would a contrast swallow show to confirm achalasia ?

Answer 6

1. dilatation of the proximal oesophagus

2. followed by a narrow esophagogastric junction or what is called a bird beak appearance

Question 7

what would an esophageal manometry show in achalasia ?

Answer 7

incomplete relaxation of the LES

aperistalsis in the lower two-thirds of the oesophagus

Question 8

what would an upper endoscopy show in achalasia ?

Answer 8

retained food in the oesophagus

resistance to passage of the endoscope through the esophagogastric sphincter

Question 9

what is the treatment for achalasia ?

Answer 9

temporarily - botox
pneumatic dilatation
myotomy

Question 10

what age group is foriegn body ingestion most common in ?

Answer 10

6 months to 3 years

Question 11

how can a fistula be caused due to foreign body ingestion ?

Answer 11

leakage of corrosive material such as with batteries

should be removed within 4 hours

Question 12

what are the clinical manifestations of caustic ingestion ?

Answer 12

dysphagia
drooling
oral burns
hematemesis

Question 13

what are the clinical manifestations associated with upper airway injury in caustic ingestion ?

Answer 13

chemical epiglottitis
stridor
hoarseness of voice

Question 14

what are the required investigations for caustic ingestion ?

Answer 14

chest radio
Upper GI imaging ( using water soluble and not barium)
endoscopic evaluation

Question 15

when his upper GI imaging preferable in caustic ingestion ?

Answer 15

not really valuable in the early stages

only valuable if there is suspicion of perforation

Question 16

what are the contraindications to performing an endoscope in a caustic ingestion case ?

Answer 16

respiratory compromise
hemodynamically unstable
evidence of perforation

Question 17

what is the time window in which an endoscopy should be performed in caustic ingestion ?

Answer 17

within 24 hours and not before 6 hours

Question 18

what management pathway should be avoided with caustic ingestion ?

Answer 18

induction of vomiting
gastric lavage
administration of gastric lavage
attempts to neutralize the causative agent

Question 19

what is the most appropriate method of treatment in caustic ingestion ?

Answer 19

hospital admission and stabilization and supportive care

if there is significant airway compromise then sent to IC and consider endotracheal intubation

Question 20

what is the association of proximal and distal in intestinal obstruction in relation to vomiting ?

Answer 20

the more proximal the obstruction the more prominent the vomiting

Question 21

what do each of these red flags indicate ?
bile stained vomit 
hematemesis 
projectile vomiting in first weeks of life 
vomiting at the end of paroxysmal cough 
abdominal tenderness
abdominal distention 
hepatosplenomegaly
blood in stool 
severe dehydr - shock 
bulging fontanelle / seizures 
failure to thrive

Answer 21

• intestinal obstruction
• esophagitis, peptic ulceration, oral/nasal bleeding
• pyloric stenosis
• whooping cough
• surgical abdomen
• intestinal obstruction , strangulated inguinal hernia
• chronic liver disease
• intussusception ( associated with henoch)
• severe GE
• raised intracranial pressure
• GER

Question 22

what is the triad for henoch schonlein purpra ?

Answer 22

arthritis
renal affection
skin / rash
usually post infectious

Question 23

what are the three stages of whooping cough ?

Answer 23

pertussis :
catarrhal stage
paroxysmal stage
convalescent stage

treated with macrolide
prophylactic : DPT VACCINE , RIFAMPCIN FOR CONTACTS

Question 24

what must be excluded in a 2-7 week old infant presenting with projectile vomiting ?

Answer 24

pyloric stenosis

Question 25

what must be excluded in a child with bile stained vomiting ?

Answer 25

intestinal obstruction
intussusception
malrotation
strangulated inguinal hernia

Question 26

if we have transient vomiting with other symptoms what should be considered ?

Answer 26

gastroenteritis
resp tract infection
UTI and meningitis should also be considered

Question 27

what is the clinical picture of pyloric stenosis ?

Answer 27

1 week - 5 month old 
projectile vomiting then immediately hungry after 
olive shaped palpable mass
visible gastric peristalsis
mostly in boys , first borns

Question 28

what would be the metabolic status of a child with pyloric stenosis ?

Answer 28

hypochloremic metabolic alkalosis

low Na and K

Question 29

how can a diagnosis of pyloric stenosis be confirmed ?

Answer 29

ultrasound

Question 30

what is the management for pyloric stenosis ?

Answer 30

first correct any electrolyte imbalance and the metabolic alkalosis
then surgically :
pyloromyotomy ( definitive treatment )

Question 31

how can CMPA be tested ?

Answer 31

elimination diet and a stool test
could do a skin test
reducing substance may be found in stool

Question 32

what must be done for a baby with CMPA ?

Answer 32

hydrolyzed formula milk

if it is very severe then amino acid formula ( with GERD)

Question 33

difference between GER and GERD ?

Answer 33

GER is a normal physiological process whilst GERD IS NOT

Question 34

which movement disorder is associated with GERD ?

Answer 34

SANDIFER SYNDROME

Question 35

what is the surgical management of GERD ?

Answer 35

nissen fundoplication