upper and lower GI disorders

Question 1

what are the different types of vomiting ?

Answer 1

vomiting with retching
projectile vomiting
bilious vomiting
effortless vomiting

Question 2

what can stimulate the vomiting centre ?

Answer 2

enteric pathogens
intestinal inflammation
metabolic derangement
infection
head injury
visual stimuli
middle ear stimuli

Question 3

what are features of pyloric stenosis ?

Answer 3

babies 4-12 weeks
M>F

projectile non-bilious vomiting
weight loss
dehydration and shock

electrolytes
alkalosis
hypochloraemia
hypokalaemia

Question 4

how do you manage pyloric stenosis ?

Answer 4

fluid resuscitation

Ramstedts pyloromyotomy

Question 5

what causes bilious vomiting ?

Answer 5

intestinal atresia - newborns only
malrotation +/- volvulus
intussusception - telescopes inside
ileus - no movement
Crohn's with stricture

Question 6

what is the investigation for bilious vomiting ?

Answer 6

abdominal Xray
contrast meal
exploratory laparotomy

Question 7

what are features of effortless vomiting ?

Answer 7

almost always reflux
very common
self-limiting in vast majority

Question 8

what are some serious causes of effortless vomiting ?

Answer 8

cerebral palsy
progressive neurological problems
oesophageal atresia +/- TOF operated
generalised GI motility problem

Question 9

what is Sandifer’s syndrome ?

Answer 9

reflux

spastic and dystonic body movements

Question 10

what problems can be identified with a barium swallow ?

Answer 10

dysmotility 
hiatus hernia
reflux
gastric emptying
strictures

Question 11

what are potential problems with barium swallows ?

Answer 11

aspiration

inadequate contrast taken

Question 12

what are different aspects of feeding advice ?

Answer 12

thickeners for liquids
appropriateness for foods - textures, amounts
behavioural programme - oral stimulation, remove aversive stimuli
feeding position

Question 13

what are options for nutritional support ?

Answer 13

calorie supplements
exclusion diet - milk free
NG tube
gastrotomy

Question 14

what are options for medical treatment ?

Answer 14

feed thickener - gaviscon
prokinetic drugs
acid suppressing drugs - H2 receptor blockers, PPI

Question 15

what are indications for surgery ?

Answer 15

persistent;
failure to thrive
aspiration
oesophagitis

Question 16

what is the definition of chronic diarrhoea ?

Answer 16

4 or more stools per day
more than 4 weeks

<1 week - acute diarrhoea
2-4 weeks - persistent diarrhoea
>4 weeks - chronic diarrhoea

Question 17

what are causes of diarrhoea ?

Answer 17

motility disturbance - toddler diarrhoea, IBS

active secretion - acute infective, IBD

malabsorption of nutrients - food allergy, coeliac, CF

Question 18

what are features of osmotic diarrhoea ?

Answer 18

generally accompanied by macroscopic and microscopic intestinal injury
remission with removal of causative agent

usually enzyme/transport defects

Question 19

how do you differentiate osmotic and secretory diarrhoea ?

Answer 19

osmotic - small volume
secretory - large volume > 200 ml

Os - stops when fasting
Se - continues in fasting

Question 20

what are symptoms of coeliac disease ?

Answer 20

abdo bloatedness
diarrhoea
failure to thrive
short stature
constipation
tiredness
dermatitis herpatifromis

Question 21

how do you screen for coeliac disease ?

Answer 21

serology
anti-tissue transglutaminase
anti-endomysial
anti-gliadin
IgA deficiency

duodenal biopsy
genetic HLA DQ2, DQ8

Question 22

what is seen on duodenal biopsy in coeliac disease ?

Answer 22

lymphocytic infiltration of surface epithelium
partial/ total villous atrophy
crypt hyperplasia

Question 23

what is the ESPGHAN guidelines for diagnosing coeliac without a biopsy ?

Answer 23

symptomatic
anti-TTG >10x upper limit
positive anti-endomysial Abs
HLA DQ2, DQ8 positive

Question 24

how do you treat coeliac disease ?

Answer 24

gluten-free for life
cannot removes gluten prior to diagnosis

rechallenge warranted if <2

increased risk of small bowel lymphoma in untreated