Upper GI

Question 1

What are the different types of vomiting?

Answer 1

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
Haematemesis

Question 2

What symptoms are seen in the pre-ejection phase of vomiting?

Answer 2

Pallor
Nausea
Tachycardia

Question 3

Upon a blood gas, what would be seen in a patient with pyloric stensosi?

Answer 3

Metabolic alkalosis

Question 4

If you suspect pyloric stenosis, what should be done?

Answer 4

Refer to surgeons, they will carry out Ramstedt’s pyloromyotomy

Question 5

In which age group does pyloric stenosis occur in?

Answer 5

Babies 4-12wks

Question 6

What type of vomiting is seen in pyloric stenosis?

Answer 6

Projectile non-bilious vomiting

Question 7

What symptoms are seen in pyloric stenosis?

Answer 7

Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock

Question 8

What is the characteristic electrolyte disturbance seen in pyloric stenosis?

Answer 8

Metabolic alkalosis
Hypochloraemia
Hypokalaemia

Question 9

Bilious vomiting should always ring alarm bells.

What is bilious vomiting until proved otherwise?

Answer 9

Intestinal obstruction

Question 10

What are some of the causes of intestinal obstruction, and therefore bilious vomiting?

Answer 10

Intestinal atresia
Malrotation
Intussusception
Crohns disease with structures

Question 11

Investigations for bilious vomiting to rule out intestinal obstruction?

Answer 11

Abdominal x-ray
Consider contrast meal
Surgical opinion e.g. exploratory laparotomy

Question 12

What is effortless vomiting almost always caused by?

Answer 12

Gastro-oesophageal reflux

Question 13

What is the treatment for gastro-oesophageal reflux and effortless vomiting?

Answer 13

Resolves on its own in most cases

Question 14

What are the situations where gastro-oesophageal reflux will not resolve by itself?

Answer 14

Cerebral palsy
Progressive neurological problems
Oesophageal atresia
Generalised GI motility problem

Question 15

How long after birth does gastro-oesophageal reflux tend to occur?

Answer 15

2 weeks after birth

->can get worse for four to six months

Question 16

Investigations for gastro-oesophageal reflux?

Answer 16

History and examination usually sufficient

Can do barium swallow, pH studies. oesophageal impedance monitoring, endoscopy

Question 17

What is done in terms of feeding for infants with gastro-oesophageal reflux?

Answer 17

Thickeners for liquids
Feeding position- propped up after feeds

->bigger teat in bottle required

Question 18

What is done in terms of nutrional support for infants with gastro-oesophageal reflux?

Answer 18

Calorie supplements
Exclusion diet- milk
NG tube
Gastrotomy

Question 19

Medical treatment of GORD?

Answer 19

Feed thickener
Prokinetic drugs
Acid suppressing drugs e.g. PPI

Question 20

What are some of the indications for surgery in GORD?

Answer 20

Failure of medical treatment
Persistent failure to thrive, aspiration, oesophagitis

Question 21

What colour will the vomit be if it is bilious?

Answer 21

Green

->not yellow. Green.

Question 22

What is meant by chronic diarrhoea?

Answer 22

4 or more stools per day for 4wks

Question 23

What is meant by osmotic diarrhoea?

Answer 23

Movement of water into the bowel to equilibrate osmotic gradient

->usually a feature of malabsorption

Question 24

What is osmotic diarrhoea generally accompanied by?

Answer 24

Macroscopic and microscopic intestinal injury

Question 25

What is secretory diarrhoea associated with?

Answer 25

Toxin production from Virbio cholerae and E.Coli

Question 26

Which type of diarrhoea is always pathological?

Answer 26

Nocturnal diarrhoea

Question 27

If there is fat malabsorption, and fat is appearing in stools, what may be the cause?

Answer 27

Hepatobiliary disease-chronic liver disease, cholestasis Pancreatic disease-diarrhoea due to lack of lipase, cystic fibrosis

Question 28

Which genes mean there is genetic susceptibility to coeliac disease?

Answer 28

HLA DQ2, DQ4

Question 28

Symptoms of coeliac disease in children?

Answer 28

Bloating Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis

Question 29

Okay to check you were paying attention... Which skin change can be observed in coeliac disease?

Answer 29

Dermatitis herpatiformis

Question 30

If a child has coeliac disease, which condition are they screened for every two years?

Answer 30

Type 1 diabetes

Question 31

Gold standard investigation to diagnose coeliac disease?

Answer 31

Duodenal biopsy ->but not done in everyone, if the anti TTG is more than ten times the upper limit of normal and the anti-endomysial is positive, diagnosis is made without the biopsy

Question 32

Which other tests are useful in the diagnosis of coeliac disease?

Answer 32

Anti-tissue transglutaminase Serum IgA Anti-endomysial Genetic testing for HLA DQ2, DQ4

Question 33

Histological findings of coeliac disease?

Answer 33

Villous atrophy Crypt hyperplasia

Question 34

Treatment of coeliac disease?

Answer 34

Gluten free diet for life