Upper GI Disorders

Question 1

what are the four types of vomiting ?

Answer 1

bilious
projectile
effortless
vomiting with retching

Question 2

what is bilious vomiting associated with?

Answer 2

bowel obstruction

- RED FLAG

Question 3

what does bilious vomiting require?

Answer 3

surgical opinion

Question 4

state some causes of bilious vomiting ?

Answer 4

intestinal atresia
malrotation
intussusception

Question 5

what is inturssesception?

Answer 5

part of the intestine folds into the section next to it

-more common in small intestine

Question 6

what investigations should be done for bilious vomiting ?

Answer 6

abdo X-ray

contrast meal

Question 7

what is projectile vomiting associated with?

Answer 7

pyloric stenosis

Question 8

what are the three phases of vomiting ?

Answer 8

pre ejection
ejection
post ejection

Question 9

what symptoms are felt in the pre ejaction phase of vomiting ?

Answer 9

pallor nausea tachycardia

Question 10

what symptoms are felt in the post ejaction phase of vomiting ?

Answer 10

pale shivering limp

Question 11

state some triggers of the vomiting centre?

Answer 11

enteric pathogens 
intestinal inflammation 
metabolic derangement 
head injury (raised ICP)
middle ear stimuli

Question 12

what is effortless vomiting associated with?

Answer 12

gastro-oesophageal reflux

Question 13

what are the symptoms of pyloric stenosis ?

Answer 13

projectile non bilious vomiting
FTT
dehydrated

alkalosis

Question 14

what does pyloric stenosis look like on US?

Answer 14

longer and thickened

Question 15

what test should be done for pyloric stenosis ?

Answer 15

test feed to see visible gastric peristalsis

Question 16

what does the pH, Cl and K look like in pyloric stenosis ?

Answer 16

metabolic alkalosis
hypochloraemia
hypokalaemia

Question 17

what test is done to check pH of blood?

Answer 17

blood gases

Question 18

what gender are more affected by pyloric stenosis ?

Answer 18

boys (first born)

Question 19

is there bile present in pyloric stenosis vomit?

Answer 19

no

Question 20

is gastro-oesophageal reflux common?

Answer 20

yes

Question 21

state some symptoms of gastro-oesophageal reflux?

Answer 21

effortless vomiting 
feeding problems 
FTT
haematamesis 
aspirations can cause chest infections

Question 22

what investigations should be done for gastro-oesophageal reflux?

Answer 22

barium swallow 
SALT 
pH study 
endoscopy 
oesophageal impedance monitoring

Question 23

how is a pH study of the oesophagus conducted?

Answer 23

place the monitor 5cm from the LOS

Question 24

what is the treatment for gastro-oesophageal reflux?

Answer 24

usually self limiting

• feeding advice
• nutritional support (NG tube, supplements)
• medical treatment (PPI, H2RA, gaviscon)

Question 25

what surgical option is there for gastro-oesophageal reflux?

Answer 25

nissen fundoplication

- lots of side effects so not done commonly

Question 26

is coeliac disease an autoimmune disease?

Answer 26

yes

Question 27

state the presentation of coeliac disease ?

Answer 27

bloated 
diarrhoea 
FTT
growth retardation 
tiredness
dermatitis herpetiformis

Question 28

what investigations should be done for coeliac ?

Answer 28

anti-tissue transglutaminase
anti-endomysial
duodenal biopsy
genetic testing - HLA DQ2/8

Question 29

what should the biopsy of the coeliac duodenum look like?

Answer 29

partial/total villous atrophy
lymphocytic infiltration
crypt hyperplasia

Question 30

what groups are at risk of coeliac ?

Answer 30

people with other autoimmune disorders
downs syndrome
FHx