Gastroenterology

Question 1

how much is overfeeding?

Answer 1

> 200ml/kg/day

Question 2

how to mgx regurgitation

Answer 2

most likely overfeeding

• normal in babies (reassure)
• divide to more feeds
• food thickeners
• lie in lateral position

if aspiration or bleeding: do 24h pH probe, barium swallow +
domperidone or omeprazole

if fails, oesophagoscopy

Question 3

Investigations for GERD

Answer 3

clinical diagnosis
if severe, consider:
- barium swallow
- 24 esophageal ph monitoring
- endoscopy

Question 4

how to mgx GERD

Answer 4

depends on simple or severe:

Simple:

• thicken feeds
• nurse in upright position
• wind baby well after feeds

Severe:

• domperidone or ompeprazole
• if recurrent aspiration, surgical fundoplication

Prognosis:
usually resolve when weaned to more solid diet

Question 5

what investigation must be done in neonates with bilous vomitting

Answer 5

contrast upper GI study.

barium swallow through to rule out intestinal malrotation (DJ junction or IC junction)

Question 6

What is the mgx for intestinal malrotation

Answer 6

malrotation with volvulus is a surgical emergency - esp if there is systemic decompensation, impending perforation, bleeding (NG aspirate or PR) - resus and rush to theatre

else, elective sx

SX: Ladd Procedure

Question 7

Causes of intestinal obstruction in infants

Answer 7

• anal atresia
• imperforate anus
• hirshsprung (colonic aganglionosis), intussusception, meconium ileus (cystic fibrosis)

Question 8

Broad approach to vomitting

Answer 8

determine if bilous, bloody, nature (pulsatile? post tussive?), postural, and relation to feeding

• GI: infection GE, intestinal obstruction, GERD, intra abdominal inflammation (e.g. appendicitis, cholecystitits)
• neuro: migraine, raised ICP, meningitis
• metabolic: DKA, uremia, hypogly, adrenal insuff
• ENT: labyrinthitis, vestibular neuronitis, BPPV
• psych: buliemia
• others: toxins, pregnancy

Question 9

Causes of acute diarrhoea

Answer 9

Osmotic
o	Food intolerance
Secretory
o	Toxins
Inflammatory
o	Bacterial
o	Viral
o	Fungal
Altered motility
o	Thyrotoxicosis
o	Pseudo-obstruction

Question 10

Causes of chronic diarrhoea

Answer 10

• Malabsorption syndromes
• Pancreatic insufficiency
• Cholestasis
• Cystic fibrosis
• Intestinal
  o Short gut syndrome
  o Celiac sprue
  o IBD

Question 11

How to prescribe ORS

Answer 11

< 5%: 10ml/kg/motion

5% - 10%: 50ml/kg/motion
10%: 100ml/kg/motion
for first 4 hours, then convert to 10ml/kg/motion

Question 12

Causes of painful defecation

Answer 12

• Toilet training
• Changes in routine or diet
• Stressful events
• Intercurrent illness
• Unavailability of toilets
• Child’s postponing defecation

Question 13

Constipation mimics

Answer 13

• Short segment Hirschsprung’s disease
• Hypothyroidism
• Anal stenosis
• Intestinal pseudo-obstruction syndrome

Question 14

Special investigations in constipation

Answer 14

• stool test for occult blood (if constipation + ab pain, failure to thrive, diarrhoea, family hx of colon cancer or polyp)
• rectal biopsy with histopathologic exam and rectal manometry (hirschsprung)
• measurement of transit time with radio-opaque markers

Question 15

Mgx for LT constipation

Answer 15

daily low dose PEG solution ( Polyethylene glycol electrolyte solution)