Gastroenterology

Question 1

Red flags of abdominal pain

Answer 1

Persistent or bilious vomiting
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss
Dysphagia
Night time pain
Abdominal tenderness

Question 2

History of constipation

Answer 2

Less than 3 stools a week
Hard stool thats difficult to pass
Rabbit dropping stools
Straining and painful passage
Abdominal pain
Abnormal posture - retentive posturing
Rectal bleeding
Faecal impaction - overflow soiling
Incontinence of loose smelly stools
Hard stools palpable
Loss of the sensation of needing to open bowels

Question 3

Red flags of constipation

Answer 3

Not passing meconium
Neurological signs
Vomiting
Ribbon stool
Abnormal anus
Abnormal lower back or buttocks
Failure to thrive
Acute severe abdominal pain and bloating

Question 4

Management of constipation

Answer 4

Lifestyle management
Reverse contributing factors
Laxatives - movicol!
Encourage appropriate toilet behaviour

Question 5

Define gastro oesophageal refulx disorder

Answer 5

Where contents of the stomach reflux through the lower oesophageal spincter into the oesophagus throat or mouth

Question 6

Presentation of reflux

Answer 6

Normal after large feeds
Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain

Question 7

Red flags of reflux

Answer 7

Not keeping anything down
Projectile or forceful vomiting
Bile stained
Haematemesis
Abdominal distension
Reduced consciousness, bulging fontanelle or neuro signs
Respiratory symptoms
Blood in stool
Signs of infection
Rash, angioedema
Apnoeas

Question 8

Management of reflux

Answer 8

Small frequent meals
Burping regularly
Not overfeeding
Keep upright after feed

Gaviscon
Thickened milk
PPIs

Question 9

Define pyloric stenosis

Answer 9

Hypertrophy and narrowing of the pylorus - preventing food traveling from the stomach to duodenum as normal

Question 10

Presentation of pyloric stenosis

Answer 10

Failure to thrive
Projectile vomiting
Firm round mass in upper abdomen - large olive
Metabolic alkalosis - hypochloric

Question 11

Management of pyloric stenosis

Answer 11

Abdominal ultra sound
Laparoscopic pyloromyotomy

Question 12

Define gastroenteritis

Answer 12

Inflammation of the stomach leading to nausea vomiting and diarrhoea

Question 13

Causative organism in gastroenteritis

Answer 13

Rotavirus
Norovirus

E. coli - shiga toxin
Campylobacter
Salmonella
Bacillus cereus

Question 14

Management of gastroenteritis

Answer 14

Barrier nursing
Prevent dehydration

Anti-diarrhoeals - loperamide
Abx

Question 15

Define coeliac disease

Answer 15

Autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine

Question 16

Presentation of coeliac disease

Answer 16

Failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia - iron, B12 or folate
Dermatitis herpetiformis
Neurological symptoms

Question 17

Investigations in coeliac disease

Answer 17

Auto antibodies - anti-TTH, anti-EMA
Endoscopy and biopsy - crypt hypertrophy, villous atrophy

Question 18

What conditions are associated with coeliac disease

Answer 18

Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down’s

Question 19

Management of coeliac disease

Answer 19

Life-long gluten free diet

Question 20

Define inflammatory bowel disease

Answer 20

Umbrella term for conditions causing chronic inflammation in the bowel

Question 21

Features of Crohns

Answer 21

Crows NESTS
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum
Smoking is a risk factor

Question 22

Features of ulcerative colitis

Answer 22

UC CLOSEUP
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking protective
Excrete blood and mucis
Use aminosalicylates
Primary sclerosing cholangitis

Question 23

Presentation of IBD

Answer 23

Perfuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Systemically unwell
Fevers
Malaise
Dehydration

Question 24

Extraintestinal manifestations of IBD

Answer 24

Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis

Question 25

Investigations in IBD

Answer 25

Faecal calprotectin Endoscopy Imaging - CT

Question 26

Management of Crohns

Answer 26

Induce remission - steroids (azathioprine, mercaptopurine, infliximab) Maintain remission - Azathioprine (methotrexate, infliximab) Surgery -

Question 27

Management of ulcerative colitis

Answer 27

Inducing remission - mesalazine (corticosteroids, ciclosporin) Maintaining remission - mesalazine, azathioprine, mercaptopurine Surgery - ileostomy

Question 28

Define biliary atresia

Answer 28

A congenital condition where a section of the bile duct is either narrowed or absent - results in cholestasis and jaundice.

Question 29

Managment of biliary atresia

Answer 29

Kasai portoenterostomy

Question 30

Define intestinal obstruction

Answer 30

A physical obstruction preventing the flow of faeces through the bowel.

Question 31

Causes of intestinal obstrucction

Answer 31

Meconium ileus Hirschsprung's disease Oesophageal atresia Duodenal atresia Intussusception Imperforate anus Malrotation Strangulated hernia

Question 32

Presentation of bowel obstruction

Answer 32

Vomiting - bilious? Abdo pain Failure to pass stool or wind Bowel sounds - absent or tinkling

Question 33

Define hirschsprungs disese

Answer 33

A congenital condition where the nerve cells of the myenteric plexus are absent in the distal bowel and rectum - Bowel looses its motility and stops passing food along its length There is an absence of parasympathetic ganglion` cells

Question 34

Genetic associations with Hirschsprung's disease

Answer 34

Down's Neurofibromatosis Waardenburg syndrome MEN II

Question 35

Presentation of Hirschsprungs disease

Answer 35

Acute obstruction at birth or gradual development of symptoms Delayed meconium passing Chronic constipation Abdominal pain Vomiting Poor weight gain and failure to thrive

Question 36

Investigation in Hirschsprung's disease

Answer 36

Abdo xray Rectal biopsy

Question 37

Management of Hirschsprung's disease

Answer 37

Fluids Manage obstruction Surgical removal of affected bowel

Question 38

Define intussusception

Answer 38

Where a portion of bowel invaginates into itself - telescoping of the bowel.

Question 39

Associations with intussusception

Answer 39

Concurrent viral illness Henoch-Schonlein purpuraa Cystic fibrosis Intestinal polyps Meckel diverticulum

Question 40

Presentation of intussusception

Answer 40

Severe colicky pain Pale lethargic unwell Redcurrant jelly stool Mass on palpation - sausage shapped Vomiting Obstruction

Question 41

Management of intussusception

Answer 41

Ultrasound Therapeutic enemas - air or water Surgical reduction

Question 42

Define appendicitis

Answer 42

Inflammation of the appendix

Question 43

PResentation of appendicitis

Answer 43

Central abdominal pain Moves to right iliac fossa Tenderness in McBurney's point Loss of appetitis Nausea and vomiting Rovsings signs - pain on palaption of left Guarding Rebound tenderness Percussion tenderness

Question 44

Management of appendicitis

Answer 44

Appendicetomy Laparoscopic exploration