GIT

Question 1

Esophageal atresia

Answer 1

1. Only atresia - coiling of NG tube on cxr
2. +Tracheo-oesophageal fistula - +gas shadow in the stomach

Rx: SX repair

Question 2

GERD in newborn

Answer 2

1. Small amount - normal
   Large - failure to thrive, blood reflux, esophagitis etc
2. No inv needed, refer to pediatrician who might do barium test, eso ph test etc
3. Spontaneous resolution in 18 months
4. Thicker food (gaviscon food thickener) , elevate bed, small freq feeds
5. PPI - omeprazole (last resort)

Question 3

**Pyloric stenosis

Answer 3

1. Non-bilious projectile vomiting, soon after feed
2. Still hungry - wants more food
3. Small palpable (olive shaped) mass in abd
4. 2-6wks of age
5. Hypo K, CL, met alkalosis
6. Inv:
   Initial: VENOUS BLOOD GAS BEST - ABD USG
7. RX: IV FLUIDS - 0.9%NaCl, 5% glucose
   Sx correction - pyloromyotomy

Question 4

Duodenal atresia`

Answer 4

1. Bilious vomiting, 1st day of life
2. No abd distension (present in jejunal/ileal atresia)
3. Premature/Downs baby
4. Xray - DOUBLE BUBBLE SIGN with no distal gas shadow
5. Nasogastric decompression
   Electrolite balance
   Sx correction

Question 5

*Intususception

Answer 5

1. 3mo to 6yrs
2. Telescoping of intestine
3. Leading point - meckle diverticulum, polyp, hematoma, neurofibroma etc
4. Post adeno/rota virus, HSP cases
5. Colicky pain - knee to chest, clenching of fist, fever, lethargy, Bile stained vomitings
6. Black currant jelly stools @ rectum
   SAUSAGE SHAPED MASS @abd

Question 6

Intususception dxt

Answer 6

USG

Question 7

Intususception mx

Answer 7

NBM, IV fluids, Analgesics..
1. Unstable - IV fluids
2. Stable- check for clinical signs of obstruction/perforation
Yes = Xray No = USG
Shows intusucception

Rx: IV fluids, antibiotics
Main - Gas enema