GIT

Question 1

clinical picture of corrosive injuries

Answer 1

1. Severe burning pain, drooling, vomiting, dysphagia
2. Respiratory: Dyspnea, stridor, cyanosis
3. Oral lesions may be absent
4. Odynophagia is prominent at the onset
5. Dysphagia (especially to solids) and vomiting: two weeks after later (strictures)

Question 1

Etiology of Dysphagia

Answer 1

1. Oropharyngeal dysphagia:
   a. Neuromuscular Disorders: e.g.
   = Cerebral palsy, brain tumors, cerebrovascular accidents,
   = Myositis, dermatomyositis, myasthenia gravis or muscular dystrophies.
   b. Infectious Disease: e.g.
   = Meningitis, botulism, diphtheria
   = Viral infections (polio, Coxsackievirus, herpes, cytomegalovirus).
   c. Structural lesions: e.g.
   = Inflammatory: abscess, pharyngitis
   “ Congenital web, Zenker diverticulum or extrinsic compression (lymph nodes,
   thyroid swelling).
   d. Metabolic and autoimmune Disorders: e.g.
   = SLE, sarcoidosis or amyloidosis.
   e. Others: e.g.
   “ Corrosive injury, side effects of medications, after surgery or radiotherapy.
2. Esophageal dysphagia
   a. Neuromuscular Disorders: e.g
   =achalasia of the cardia, diffuse esophageal spasm or scleroderma.
   b. Mechanical :
   = Intrinsic Lesions: e.g.
   o Foreign bodies (including pills)
   o Esophagitis (GERD, eosinophilic esophagitis), stricture (corrosive injury, pill induced, peptic), esophageal webs, rings or diverticula.
   = Extrinsic Lesions: e.g.
   o Vascular compression, Mediastinal lesion or vertebral abnormalities.

Question 2

Complications of corrosive injuries

Answer 2

1. Esophageal perforation and mediastinitis-related death
2. Malnutrition and weight loss.
3. Aspiration and recurrent chest infections.

Question 3

Treatment of corrosive injuries

Answer 3

1- Hospital admission: for IV fluids until endoscopy
2- Broad-spectrum antibiotics: if infection is suspected
3- Systemic steroids reduce the risk of stricture
4- Endoscopic dilation: for esophageal strictures (usually develop within 1-2 months)
5- Surgical reconstruction of the esophagus: using stomach or intestine may be necessary.

Hospital IV-antibiotics-steroids-2 surgical (endoscope-reconstriction)

Question 4

Contraindications in corrosives treatment

Answer 4

= Emesis—aspiration
=Stomach wash—no nasogastric tube
= Neutralization—evaporates gases
= Activated charcoal
= rigid endoscope

Question 5

Parrot-beak appear in

Answer 5

Barium fluoroscopy in achalasia of cardia

Question 6

IQ

Causes of Neonatal vomiting

Answer 6

a. Vomiting in doing well baby
Amniotic gastritis (vomiting of mucoid material)
Hemorrhagic disease of the newborn (blood stained vomitus)
Swallowed maternal blood (blood stained vomitus)
Overfeeding
Gastroesophageal reflux
b. Vomiting in sick baby
1. Medical conditions
= Infections (septicemia, meningitis)
“Increased intracranial pressure (intracranial hemorrhage, hypoxic encephalopathy)
= Metabolic: Galactosemia
2. Surgical conditions
= Esophageal atresia with tracheo-esophageal fistula (with the first feed)
= Congenital hypertrophic pyloric stenosis (vomiting after 2-3 weeks)
® Intestinal obstruction (bile stained vomitus), which may be due to:
o Small gut lesion: e.g. atresia, stenosis or volvulus.
o Large gut lesion: e.g. Hirschsprung disease

Question 7

Causes of Vomiting in infacy and childhood

Answer 7

a. Medical
1- Dietetic: overfeeding, irregular feeding or inappropriate foods
2- Infections
= GIT: Gastroenteritis, hepatitis.
= Respiratory infections: Pneumonia, bronchitis, pertussis, otitis media
= Other infections: UTI
= CNS infections: Meningitis, encephalitis or brain abscess (increased ICP)
3- Metabolic
=” Hypervitaminosis D
® Diabetic ketoacidosis
® Chronic kidney disease
® Disorders of amino acid metabolism (aminocidopathy)
b. Surgical (intestinal obstruction)
1- Intussusception
2- Volvulus
3- Strangulated inguinal hernia

Question 8

treatment of vomiting

Answer 8

1- Treatment of the cause
2- Antiemetic medications:
- Metoclopramide
- Domperidone
- Ondansetrone:

Question 9

incidence of Congenital Hypertrophic Pyloric Stenosis

Answer 9

m to f 4:1

Question 10

C/P of Congenital Hypertrophic Pyloric Stenosis

Answer 10

1. Onset of symptoms: 2-7 weeks after birth
2. Repeated, progressive, nonbilious, projectile vomiting immediately after feeds
3. The infant is hungry after vomiting
4. Weight loss & Dehydration
5. Olive-shaped, firm epigastric mass
6. Gastric peristalsis can be seen as a wave from left to right

Question 11

Olive-shaped, firm epigastric mass appear in

Answer 11

Congenital Hypertrophic Pyloric Stenosis

Question 12

treatment of Congenital Hypertrophic pyloric stenosis

Answer 12

1- Correction of fluid & electrolyte disturbance
2- Pyloromyotomy (Ramstedt)

Question 13

(Ramstedt) is used to treat

Answer 13

Congenital Hypertrophic Pyloric Stenosis

Question 14

Etiology of GERD

Answer 14

1. Transient relaxation of the (LES)
2. Short intra-abdominal length of the esophagus
3. Gastric distension

Question 15

Complications of GERD

Answer 15

1. GIT: esophagitis, peptic stricture, bleeding, iron deficiency, anemia
2. Respiratory: Apnea, aspiration, pneumonia
3. CNC: Sandifer syndrome (Dystonic movements of head and neck)
4. Sudden infant death syndrome (SIDS):

Question 16

Treatment of GERD

Answer 16

Treatment
A) Mild cases
1. Reassurance
2. Positioning: 30° head-up prone position after meals
3. Feeding practice: Avoid too frequent & large volume feeds
B) More severe cases
1. Drugs enhancing gastric emptying:e.g., domperidone
2. Proton pump inhibitor: e.g., omeprazole
C) Surgery (fundoplication)
1. Failure of response to intensive medical treatment
2. Esophageal stricture
3. Recurrent aspiration

Question 17

Diarrhea is more serious in infants

Answer 17

o Greater surface area to weight leading to increases insensible water loss
o Inability to gain access to fluids when thirsty
o Immature renal tubular reabsorption function

Question 18

discuss clinical diagnosis of infective diarrhea

Answer 18

239

Question 19

Complications of severe gastroenteritis

Answer 19

1. Dehydration
   = Cause: Loss of extracellular fluid (ECF)
   = C/P: Sunken eyes, depressed anterior fontanel, dry tongue, lost skin turgor
2. Shock
   = Cause: Hypovolemic shock (Loss of ECF), septic shock may also occur
   = C/P: Tachycardia, hypotension, poor peripheral perfusion
3. Acute renal failure
   = Cause: Decreased renal perfusion (Prerenal failure)
   = C/P: Oliguria or anuria
4. Metabolic acidosis
   = Cause: Lactic acidosis (Tissue hypoperfusion) & Renal failure
   = C/P: Deep rapid respiration (Acidotic breathing)
5. Hypokalemia
   = Cause: VW Intake & 4% Intestinal loss
   “ Manifestations: Abdominal distension & paralytic ileus
6. Hypocalcemia
   = Cause: Vv Intake & 4% Intestinal loss
   = Manifestations: Tetany (Carpo-pedal spasm) & convulsions
7. Bleeding
   = Cause: Hypoprothrombinemia (WwW Vitamin K) & Disseminated
   intravascular coagulation (DIC)
   = Manifestations: Bleeding
8. Convulsions
   = Cause: Febrile, ICH, Metabolic () Ca, LI Na, ST Na), Toxic
   (Salmonella, Shigella)
   C/P: Variable types of convulsions (Focal, generalized…)
9. Persistent diarrhea
   = Cause: Lactose intolerance, persistent infection, cow’ milk protein allergy, bacterial
   overgrowth
   = C/P: Diarrhea 2 14 days
10. Malnutrition
    = Cause: Vw Calories (Marasmus), wrong feeding with excess CHO
    (Kwashiorkor)
    = C/P: Wasting (Marasmus), Edema (Kwashiorkor)