GI

Question 1

GORD presentation

Answer 1

regurgitation
distress after feeding
apnoea
pneumonia
anaemia

Question 2

GORD management

Answer 2

reassurance, avoid over feeding
antacid and sodium/magnesium alginate
consider domperidone (increases stomach and bowel contractions) +/- omeprazole
most resolve 6-9months
fundoplication if failure to thrive

Question 3

pyloric stenosis presentation

Answer 3

projectile vomiting after feeding
vomit contains no bile
no diarrhoea
constipation likely
2-8 weeks of life

Question 4

pyloric stenosis diagnosis

Answer 4

hypochloraemic, hypokalaemic metabolic alkalosis

visable LUQ peristalsis when feeding`

Question 5

pyloric stenosis management

Answer 5

ramstedts pyloromyotomy

Question 6

intussuception presentation

Answer 6

epsodic (colicky) pain - may present with epsodic crying or drawing of legs up (an interception)
vomiting
PR blood (red current jam)
sausage shape mass in abdomen

Question 7

intussuception investigations

Answer 7

abdominal US with reduction by air enema

Question 8

ulcerative colitis definition

Answer 8

recurrent inflammatory and ulcerating disease involving mucosa of colon and or rectum

Question 9

ulcerative colitis symptoms

Answer 9

colicky pain

diarrhoea +/- blood and mucus

Question 10

ulcerative colitis diagnosis and features

Answer 10

faecal calprotectin and colonoscopy
mucosal / submucosal inflammation
continuous lesions
crypts

Question 11

ulcerative colitis management

Answer 11

mild - mesalazine (5 aminosalicylate)
moderate - add oral prednisolone
severe - IV hydrocortisone

Question 12

crohns disease definition

Answer 12

transmural granulomatous inflammation affecting any part of the gut from mouth to anus. commonly terminal ileum

Question 13

crohns disease symptoms

Answer 13

abdominal pain
diarrhoea
weight loss

Question 14

crohns disease diagnosis and features

Answer 14

faecal calprotectin and endo/colon oscopy
transmural inflammation
granulomas
skip lesions

Question 15

crohns disease managment

Answer 15

mild/moderate - prednisolone

Question 16

gastroenteritis cause

Answer 16

rotavirus commonest in children

Question 17

gastroenteritis presentation

Answer 17

sudden onset diarrhoea +/- vomiting

Question 18

IBS definition

Answer 18

abdominal symptoms with no organic cause

Question 19

IBS diagnosis

Answer 19

recurrent abdominal pain with at least 2 of:
relief by defication
altered stool form
altered bowel frequency

Question 20

appendicitis presentation

Answer 20

periumbical pain that moves to RIF
rovsings sign (pain in RIF when press LIF)
fever and guarding

Question 21

coeliac disease definition

Answer 21

T cell response to gluten in small intestine causes villous atrophy and malabsorption
associated with human leukocytes antigen HLA DQ2

Question 22

coeliac disease presentation

Answer 22

malabsorption after induction of wheat containing foods
stinking stools
diarrhoea
weight loss
anaemia

Question 23

coeliac disease diagnosis

Answer 23

raised IgA anti tissue transglutaminase

biopsy - small intestine villous atrophy

Question 24

coeliac disease management

Answer 24

gluten free diet

Question 25

failure to thrive causes

Answer 25

organic - impaired suck/swallow (cleft palate) non organic - inadequate food inadequate absorption - coeliac excessive calories loss - vomiting (GORD) excessive calorie requirements - malignancy

Question 26

failure to thrive definition

Answer 26

poor weight gain falling across centile lines | head circumference preserved relative to height

Question 27

marasmus definition

Answer 27

lack of calories and discrepency between height and weight - HIV associated

Question 28

marasmus signs

Answer 28

distended abdomen diarrhoea / constipation hypoalbuminaemia

Question 29

kwashiorkor cause

Answer 29

due to low intake of protein and essential amino acids

Question 30

kwashiorkor signs

Answer 30

``` poor growth diarrhoea anorexia odema distended abdomen ```

Question 31

lactose intolernace presentation

Answer 31

Explosive watery stools, abdominal distension, flatulence, audible bowel sounds

Question 32

hirschprungs disease presentation

Answer 32

meconium ileus vomiting (bilious green) abdominal distension constipation

Question 33

hirschprungs disease definition

Answer 33

absence of ganglia in segment of colon

Question 34

hirschprungs disease management

Answer 34

bowel washouts / irrigation | surgical excision of anganglionic section

Question 35

parasitic cause of acute diarrhoea

Answer 35

Giardia

Question 36

toddlers diarrhoea presentation

Answer 36

chronic, non specific diarrhoea | well and thriving

Question 37

toddlers diarrhoea management

Answer 37

adequate fat and fibre

Question 38

cows milk protein allergy

Answer 38

``` Associated with atopy IgA deficiency and IgG subclass abnormalities ```

Question 39

cows milk protein allergy diagnosis and management

Answer 39

Diagnosis – elimination diet | Management – Hydrolysed or AA feeds

Question 40

neonatal jaundice after 24hrs of birth causes

Answer 40

caused by hyperbilirubinaemia breastfeeding physiological: increased bilirubin production due to shorter RBC lifespan decreased bilirubin conjugation due to hepatic immaturity absence of gut flora impedes elimination of bile pigment

Question 41

neonatal jaundice within 24hrs of birth causes

Answer 41

abnormal sepsis rheus haemolytic disease ABO incompatibility

Question 42

prolonged neonatal jaundice >14 days causes

Answer 42

sepsis hypothyroidism breastfeeding

Question 43

neonatal jaundice complications

Answer 43

kernicterus - acute bilirubin encephalopathy (unconjugated bilirubin can be deposited in basal ganglia)

Question 44

neonatal jaundice management

Answer 44

phototherapy

Question 45

necrotising enterocolitis definition

Answer 45

inflammatory bowel necrosis (Bacterial invasion of ischaemic bowel wall) major risk factor in prematurity More common in premature baby’s fed with cow’s milk

Question 46

necrotising enterocolitis signs

Answer 46

abdominal distension in premature baby billious vomiting Fresh blood in stool

Question 47

necrotising enterocolitis management

Answer 47

stop oral feeding | cefotaxime and vancomycin

Question 48

intestinal malrotation what is it

Answer 48

Obstruction of small bowel – congenital anomaly of rotation of midgut

Question 49

intestinal malrotation presentation

Answer 49

billious vomiting Abdo pain Tenderness (peritonitis/ischaemic bowel) Bile stained vomit in 1st week of life = Malrotation until proven otherwise!

Question 50

intestinal malrotation investigations and management

Answer 50

Upper GI Contrast Study (diagnostic) | Surgical correction - Ladd’s procedure