GIT

Question 1

Some abbreviations and their meaning

Answer 1

(GE) - Gastroesophageal reflux

(GER) - Uncomplicated gastroesophageal reflux

(ALTEs) - Apparent life-threatening events

(EoE) - Eosinophilic esophagitis

(APFED) - American Partnership for Eosinophilic Disorders

(POEM) - Per-oral endoscopic myotomy

(CrD) - Crohn disease

(ALF) Acute Liver Failure

Question 2

What is Uncomplicated gastroesophageal reflux (GER) ?

Answer 2

GER) refers to recurrent postprandial spitting and vomiting in healthy infants that resolves spontaneously

Question 3

When does infant GER usually resolve?

Answer 3

By 12-18 months

Question 4

What is important to determine regarding vomited material in GER?

Answer 4

Does it contain bile.
If it does, this is important as it may be a symptom of intestinal obstruction

Question 5

Symptoms of GER in infants

Answer 5

heartburn, regurgitation, mucosal complications

less common:
include failure to thrive, food refusal, pain behavior, GI bleeding, upper or lower airway-associated respiratory symptoms, or Sandifer syndrome.

Question 6

Children with what diseases (5) are at increased risk of GERD and esophagitis?

Answer 6

asthma
cystic fibrosis
developmental handicaps
hiatal hernia
repaired trachoesophageal fistula

Question 7

Some extra esophageal manifestations of GERD are (3)?

Answer 7

GERD has been linked to the occurrence of apnea or apparent life-threatening events (ALTEs),

although the majority of pathologic cases are not reflux associate

lower airway symptoms (asthma, pneumonnia, cough), dental erosions, Sandifer syndrome

Question 8

Treatment of GERD (4)

Answer 8

85% spontaneously resolves

small feedings

PPIs and histamine-2 receptor antagonists

Antireflux surgery, if meds fail

Question 9

Complications of GERD (3)

Answer 9

feeding dysfunction
esophageal stricture
anemia

Question 10

Eosinophilic esophagitis (EoE)

Answer 10

a chronic immune-mediated inflammatory disorder of the esophagus, characterized by infiltration of eosinophils into the esophageal tissue

Question 11

EoE symptoms

Answer 11

feeding dysfunction, dysphagia, esophageal food impaction, heartburn

Question 12

EoE lab findings (4)

Answer 12

peripheral eosinophilia may or may not be present

mucosa is usually thickened or with fissures

esophagus is often sprinkled with pinpoint exudates that look like candida (but are eosinophils)

IgE may be elevated, but this is not diagnostic

Question 13

EoE treatment (3)

Answer 13

dietary exclusion of allergens

steroids from inhaler

esophaheal dilation

Question 14

Achalasia

Answer 14

distal esophageal obstruction and high resting pressure on the lower esophageal spinchter

Question 15

Symptoms of achalasia

Answer 15

dysphagia, esophageal food impaction, weight loss, chronic cough and chronic pulmonary aspiration

Question 16

Achalasia diagnosis

Answer 16

barium esophagram shows a dilated esophagus with a tapeerd beak at the GE junction

Question 17

Caustic burns of the esophagus

Answer 17

after ingestion of lye or battery acid

Question 18

Are esophageal injuries worse with acid or basic solutions?

Answer 18

Acidic substances typically lead to limited injury because of the small volume ingested due to the sour taste.
Conversely, the more benign taste of alkali ingestions may allow for larger volume ingestions, subsequent liquefactive necrosis that can lead to deeper mucosal penetration.

Question 19

Treatment for caustic burns (2)

Answer 19

IV corticosteroids
3rd gen cephalosporins

Question 20

Regarding foreign bodies, what needs to be removed immediately?

Answer 20

Esophageal button batteries must be removed emergently because of their ability to cause lethal injury.

Question 21

Most common symptoms of ingestion of foreign body

Answer 21

dysphagia, odynophagia, drooling, regurgitation, and chest or abdominal pain

Question 22

With larger batteries ________ and in younger children __________endoscopic evaluation with gastric batteries may still be considered in order to evaluate the esophagus for signs of injury and risk of aortoesophageal fistula.

Answer 22

> 20mm
< 5 years

Question 23

Presence of a _________ on upper GI has been found to be associated with hiatal hernia in 96% of children and should increase the index of suspicion.

Answer 23

Schatzki ring

Question 24

What is pyloric stenosis and what are its symptoms

Answer 24

Postnatal muscular hypertrophy of the pylorus

Progressive gastric outlet obstruction, nonbilious vomiting, dehydration, and alkalosis in infants younger than 12 weeks.

Question 25

Pyloric stenosis

Answer 25

Postnatal muscular hypertrophy of the pylorus.

Question 26

Classic lab finding of pyloric stenosis

Answer 26

hypochloremic alkalosis with potassium depletion

Question 27

treatment of pyloric stenosis

Answer 27

Ramstedt pyloromyotomy - incision down to the mucosa alon the pyloric length

alternative is pyloromyotomy

Treatment of dehydration and electrolyte imbalance is mandatory before surgical treatment, even if it takes 24–48 hours.

Question 28

most common causes of gastric and duodenal ulcer

Answer 28

Underlying severe illness, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common causes.

Question 29

The first attack of acute H pylori gastritis may be accompanied by

Answer 29

vomiting and hematemesis.

Question 30

gastric/duodenal ulcer diagnostics

Answer 30

Upper GI endoscopy is the most accurate diagnostic examination.
The typical endoscopic appearance of an ulcer is a white exudative base with erythematous margins

Question 31

treatment of ulcer

and H pylori

Answer 31

H2 receptor antagonist and PPIs
adjunct therapy sucralfate

triple combination of amoxicillin, clarithromycin, and PPI.

Question 32

Inflammatory bowel disease (IBD), a chronic relapsing inflammatory disease, is most commonly differentiated into _______ and _______.

Answer 32

Crohn disease and ulcerative colitis

Question 33

Treatment of IBD

Answer 33

1. Diet
2. Aminosalicylates (ASA)
3. Corticosteroids
4. Immunomodulators: azathioprine (AZA),
5. Antibiotics
6. Biologicals
7. Other agents
8. Surveillance

Question 34

Clinical findings of acute liver failure

Answer 34

Acute hepatitis with deepening jaundice.
Extreme elevation of AST and ALT.
Prolonged PT and INR.
Encephalopathy and cerebral edema.
Asterixis and fetor hepaticus.

Question 35

In acute liver hepatitis, Without liver transplantation, mortality is approximately ___ in children.

Answer 35

50%

Question 36

Acute liver hepatitis LAB

Answer 36

elevated serum bilirubin levels (usually > 15–20 mg/dL), sustained elevations of AST and ALT (> 3000 U/L), low serum albumin, hypoglycemia, and prolonged PT and INR. Blood ammonia levels become elevated, whereas blood urea nitrogen is often very low.

Question 37

major prognostic factors in acute liver failure

Answer 37

The development of renal failure and depth of hepatic coma are major prognostic factors

Question 38

Illnesses predisposing to secondary ulcers include…

Answer 38

central nervous system (CNS) disease,
burns,
sepsis,
multiorgan system failure,
chronic lung disease,
Crohn disease (CrD),
cirrhosis, and
rheumatoid arthritis.

Question 39

For severe or recurrent ulcerations not caused by H pylori, stress, or medications, a serum gastrin level may be considered to evaluate for…

Answer 39

a gastrin- secreting tumor (Zollinger-Ellison syndrome), though mild to moderate elevation in gastrin levels can be seen with use of PPI drugs.

Question 40

Some complications of Crohn disease

Answer 40

Nutritional complications from chronic active disease, malabsorption, anorexia, protein-losing enteropathy, bile salt malabsorption, or secondary lactose intolerance include failure to thrive, short stature, decreased bone mineralization, and specific nutrient deficiencies, including iron, calcium, zinc, vitamin B12, and vitamin D.

Question 41

Growth failure is more common in CrD than UC : True or False

Answer 41

True

Question 42

Acute Liver Failure (ALF) is defined as …

Answer 42

Acute Liver Failure (ALF) is defined as acute liver dysfunction associated with significant hepatic synthetic dysfunction evidenced by a vitamin K–resistant coagulopathy (INR > 2.0) within 8 weeks after the onset of liver injury.

Question 43

____________and _________are seen before the onset of encephalopathy.

Answer 43

Hyper-reflexia and positive extensor plantar responses are seen before the onset of encephalopathy.

Question 43

_and _________are seen before the onset of encephalopathy.

Question 44

signs and symptoms of acute liver failure

Answer 44

Children may present with flu-like symptoms, including malaise, myalgias, jaundice, nausea, and vomiting. Tender hepatomegaly is common, which may be followed by progressive shrinking of the liver, often with worsening hepatic function.

Question 45

Treatment of acute liver failure

Answer 45

Excellent critical care is paramount, including careful management of hypoglycemia, bleeding and coagulopathy, hyperammonemia, cerebral edema, and fluid balance, while systematically investigating for potentially treatable causes.

Spontaneous survival may occur in up to 50% of patients.

Liver transplant may be lifesaving in patients without signs of spontaneous recovery

Corticosteroids may be harmful, except in autoimmune hepatitis for which steroids may reverse ALF.

Acyclovir is essential in herpes simplex or varicella-zoster virus infection.

For hyperammonemia, oral antibiotics are used to reduce blood ammonia levels and trap ammonia in the colon.