Upper GI

Question 1

4 types of vomiting

Answer 1

vomiting with retching
projectile vomiting
bilious vomiting
effortless vomiting

Question 2

phases of vomiting with retching

Answer 2

pre-ejection - pale, nausea
ejection - retch and vomit
post ejection

Question 3

Stimulation of vomiting centre

Answer 3

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

Question 4

What can you see and palpate on a test feed?

Answer 4

olive tumour

visible gastric peristalsis

Question 5

managing pyloric stenosis

Answer 5

fluid resuscitation

pyloromyotomy

Question 6

Typical presentation of pyloric stenosis

Answer 6

4-12 week old boy
projectile non bilious vomit
weight loss, dehydration

Question 7

typical electrolyte disturbance of pyloric stenosis

Answer 7

metabolic alkalosis
hypochloraemia
hypokalaemia

Question 8

investigating pyloric stenosis

Answer 8

test feed
USS
blood gas

Question 9

type of vomiting associated with GORD

Answer 9

effortless

Question 10

presenting symptoms of GORD

Answer 10

GI - vomit, haematemesis
Nutritional - FTT, feeding
resp = apnoea, cough, wheeze, chest infections
neurological - sandifers

Question 11

Investigating GORD

Answer 11

history and exam
video fluoroscopy - swallowing problems
barium study 
pH study 
oesophageal impedance
endoscopy

Question 12

Barium swallow can detect what?

Answer 12

dysmotility
reflux
gastric emptying
strictures

Question 13

4 broad treatments of reflux

Answer 13

feeding advice
nutritional support
medial
surgical;

Question 14

feeding advice - reflux

Answer 14

carobel - feed thickener
appropriateness of food
behaviour programme
feeding position

Question 15

nutritional support - reflux

Answer 15

calorie supplement
exclusion diet - milk free
NG tube
gastrostomy

Question 16

medical treatment - reflux

Answer 16

feed thickener - Gaviscon
prokinetic drugs
H2 receptor blockers
PPI

Question 17

indications for surgery reflux

Answer 17

persistent FTT, aspiration, oesophagitis

Question 18

surgery for reflux

Answer 18

fundoplication

Question 19

Causes of bilious vomiting

Answer 19

INTESTINE OBSTRUCTION 
intestinal atresia 
malrotation/volvulus 
intussusception 
ileus 
crohns with strictures

Question 20

Investigating bilious vomiting

Answer 20

abdominal x-ray
contrast meal
surgery

Question 21

chronic diarrhoea

Answer 21

4 or more stools per day for 4 weeks

Question 22

causes of diarrhoea

Answer 22

motility - toddlers, IBS
active secretion - cholera
malabsorption - CF, coleliac

Question 23

Osmotic diarrhoea

Answer 23

malabsorption - enzyme, transporter defect

mechanism of lactulose

Question 24

nocturnal defaecation

Answer 24

organic pathology

Question 25

osmotic or secretory diarrhoea stop with fasting?

Answer 25

osmotic

Question 26

Appearance of baby with coeliac

Answer 26

bloated stomach 
diarrhoea 
FTT/short 
constipation 
tired 
dermatitis herpatiformis

Question 27

susceptible groups - coeliac

Answer 27

type 1 DM
autoimmune thyroid disease
downs
HLA DQ8, DQ2

Question 28

testing for coeliac

Answer 28

anti ttg and anti endomysial
duodenal biopsy
genetic testing

Question 29

coeliac histology

Answer 29

total vilious atrophy
crypt hyperplasia
lymphocytes

Question 30

Criteria for coeliac diagnosis with no biopsy

Answer 30

anti ttg >10 times normal limit
anti endomysial ab +ve
HLA Q2/8 positive

Question 31

treatment for coeliac

Answer 31

strict gluten free diet