GIT

Question 1

Meconium ileus mainly due to….

Answer 1

pancreatic insufficiency, the distal ileum becomes impacted with thick, viscous meconium. This is associated with cystic fibrosis in most cases, with 20% of newly diagnosed children developing meconium ileus

Question 2

Most common site of Duplication cysts

Answer 2

the ileocecal region

Question 3

Presentation of Duplication cysts

Answer 3

Presentation may be with an abdominal mass, or obstruction

Question 4

What is most common defect in midgut rotation

Answer 4

duodenum lying to the right of the vertebral column instead of the left, with the caecum lying in the upper abdomen to the left of the duodenum

Question 5

Ix of choice of Midgut malrotation

Answer 5

A barium meal is then the investigation of choice as it can show the position of the duodenal–jejunal flexure.

Question 6

Incidence of Meckel’s diverticulum?

Answer 6

(2–4% of newborn infants)

Question 7

Cause of Meckel’s diverticulum?

Answer 7

when the remnant of the omphalomesenteric duct does not fully regress and remains attached to the ileal mucosa (F

Question 8

Ix of choice in Meckel’s diverticulum

Answer 8

technetium-99m scan (the sensitivity of this is 85% in children with a specificity of 95%).

Question 9

Incidence of Gasrtoschesis

Answer 9

4 per 10,000 births

Question 10

Risk factors of Gastroschesis

Answer 10

low maternal age,
drug misuse,
low socioeconomic status,
smoking
ethnic origin.

Question 11

Site of herniation in Gastroschesis

Answer 11

through the anterior abdominal wall on the right-hand side of the umbilicus

Question 12

What is the cause of Gastroschesis

Answer 12

spontaneous herniation of the intraabdominal wall in utero (possibly at the site of the right omphalomesenteric artery) or

from incomplete reduction of the abdominal contents following rotation during the first weeks of fetal life.

Question 13

معلومة

Answer 13

In Gastroschesis

There is a high risk of intrauterine death (15%) due to ischaemia and thus serial antenatal ultrasound scans are recommended

Question 14

Type of surgery in Gastroschesis

Answer 14

primary closure, or secondary

if the defect is too large to replace all the contents in one stage without causing respiratory compromise from splinting of the diaphragm.

In this case, a silo may be used to preserve the intestinal contents while complete closure is awaited.

Question 15

Incidence of Hirschsprung’s disease

Answer 15

1 in 5000 live births

Question 16

Cause of Hirschsprung’s disease

Answer 16

absence of ganglion cells in a variable segment of bowel (aganglionosis).

Question 17

Most common affected site in Hirschsprung’s disease

Answer 17

sigmoid and rectum

Question 18

Type of Intestinal obstruction in Hirschsprung’s disease and why?

Answer 18

functional bowel obstruction.

Due to lack of ganglion cells causes an inability of the bowel to relax.

Question 19

‘explosive diarrhoea’. ?

Answer 19

Occurs in Hirschsprung’s disease as Dramatic decompression occurs on digital examination

Question 20

Dx of Hirschsprung’s disease

Answer 20

rectal suction biopsy to confirm the absence of ganglion cells (in older children, a strip rectal biopsy)

Question 21

Major post op complication in Hirschsprung’s disease

Answer 21

Enterocolitis

Question 22

Post op complication of Hirschsprung’s disease

Answer 22

malaise, fever, diarrhoea and generalized sepsis.

Question 23

The most common site in intussusception

Answer 23

ileocaecal junction

Question 24

Sx of intussusception

Answer 24

acute onset abdominal pain, drawing up of the legs and pallor.

Question 25

What is a late sign in intussusception

Answer 25

have ‘redcurrant jelly’ stool

Question 26

Dx of intussusception

Answer 26

ultrasound scan, which shows a target-shaped mass

Question 27

Intussusception Mx

Answer 27

Treatment aim is to reduce the intussusceptions with an air enema, but surgical reduction may be necessary.

Question 28

swallowing centre in…..

Answer 28

cerebral medulla

Question 29

Swallowing is under control of which nerve?

Answer 29

cranial nerves V, IX and X.

Question 30

Antral peristalsisemptying

Answer 30

3 per minute

Question 31

Which part is responsible for the mixing of food.

Answer 31

The antral peristaltic contractions

Question 32

What is the amount of gastric fluid in well hydrated child

Answer 32

10 and 20 mL/kg of gastric fluid per day

Question 33

Gastric ph at birth

Answer 33

6-8

Question 34

1 day infant Gastric PH

Answer 34

1-3

Question 35

معلومة

Answer 35

Only by age 3 years does the production of acidity reach adult capacity.

Question 36

Aspirin and gastric ph

Answer 36

at low pH aspirin is absorbed from the stomach almost as rapidly as water, but, as the pH of the stomach rises, aspirin is absorbed more slowly.

Question 37

What contents delay gastric empting

Answer 37

fats

Question 38

cotransport Na +including:

Answer 38

• Amino acids (e.g. glycine)

• Dipeptides

• Tripeptides

.Glucose

Question 39

Why there is watery secretory diarrhea in cholera or Ecoli infections?

Answer 39

Cholera toxin and E.coli cause an increase in the levels of cAMP, so driving chloride flow across the brush border into the lumen, and hence the net movement of water with it. This results in watery, secretory diarrhoea.

Question 40

The maximal absorptive capacity of the adult large bowel is……

Answer 40

2–3 L/day

Question 41

Input into small intestine……

Answer 41

9 L/day (diet: 1.8 L; e enous secretions: 7.2 L)

Question 42

Output of fluid in faeces

Answer 42

100–200 mL/day

Question 43

Pancreatic exocrine secretions are controlled by……

Answer 43

secretin and cholecystokinin. Secretin is produced in response to the presence of acidic chyme in the duodenum. Cholecystokinin is produced when fat is present in the duodenum.

Question 44

secrete bicarbonate and mucus. The latter provides a protective barrier against damage from mechanical trauma from peristalsis, autodigestion and acid.

Answer 44

Mucous neck cells

Question 45

produce pepsinogen. Pepsinogen is a ally a precursor of pepsin, and must be converted to pepsin in order to allow protein digestion to amino acids.

Answer 45

Chief cells

Question 46

produce hydrochloric acid and i sic factor. Hydrochloric acid activates pepsinogen to its active form, pepsin, and helps break down connective tissue fibres within food contents whilst destroying microorganisms within the food. Intrinsic factor is important for the absorption of vitamin B 12 in the terminal ileum.

Answer 46

Parietal cells

Question 47

found in the pyloric area and secrete the hormone gastrin, which is integral in stimulation of the parietal and chief cells to produce their enzymes.

Answer 47

G cells

Question 48

cells produce histamine, which in turn stimulates gastric acid secretion by the parietal cells.

Answer 48

Enterochromaffin-like cells

Question 49

produce somatostatin, whose functions include the inhibition of acid secretion.

Answer 49

S cells

Question 50

histological findings of coeliac disease include:

Answer 50

• Flattened duodenal mucosa with loss of crypt architecture

• Intraepithelial lymphocytosis

• Glandular hyperplasia