GIT

Question 1

Definition of acute diarrhea

Answer 1

Passage of liquid/ watery stool
3 or more in 12 hours
or single soft or watery stool
contain blood, mucus, &pus

Question 2

Etiology and complication of acute diarrhea

Answer 2

1. Etiology
   - rota virus
   - e.coli
   - shigella
   - camphylobacter
   - food, drug, laxative
2. Complication
   - dehydration: shock
   - electrolyte disturbance: hypo/hyper Na, K
   - ph disturbance: acidosis
   - PEM
   - convulsion

Question 3

Management of acute diarrhea

Answer 3

1. Prophylactic
   - promote BF
   - improve weaning
   - rota virus immunization
   - improve hygeine
2. Ttt
   - ORS
   - diet selection: lactose free
   - zinc supplement
   - drug:
   a) antimicrobial
   > trimethoprim 10-50mg/kg
   > metronidazole

b) antidiarrhea
> constipating drug
> antimotility drug

Question 4

Composition of ORS

Answer 4

1. NaCl 3.5g/L
   - correct Na loss
   - facilities water solution
2. KCl 1.5g/L
   - correct potassium loss
   - prevent hypokalemia
3. Trisodium citrate 2.9g/L
   - correct the acidosis
4. Glucose 20g/L
   - facilitate Na absorption by glucose sodium co- transport

Question 5

Vomiting with diarrhea, why and how to deal?

Answer 5

• vomit due to acidosis, hypokalemia, hypovolemia
• anti emetic not effective (due it act peripheral)
• vomiting may stop by:
  > spontaneously
  > after correct of dehydration with ORS
  > if persistent give ORS by nasogastric tube

Question 6

Risk factor of persistent diarrhea.

Answer 6

• young age
• artificial feeding
• malnutrition
• low immunity
• abuse of drug

Question 7

Clinical picture of severe dehydration

Answer 7

• lethergy, unconsciousness
• deep sunken eyes
• absent tear
• deep breath
• unable to drink
• mouth & tougue pearched (kering)
• tachycardia
• skin recoil more then 2 sec
• pulse: weak
• prolonged capillary refill
• cold extremities
• minimal urine output

Question 8

Management of severe dehydration

Answer 8

1. admission to hospital
2. close monitor for IV fluid
   -type of fluid,
   > polyelectrolyte solution
   > ringer lactate

• amount: 100ml/kg
• rate:
  > shock therapy: 30ml/kg for 30 min
  > deficit : 70ml/kg for 2.5 hourj

3. Observation
   - pulse for sign of shock
   - consciousness
   - other sign: weight, skin, urine

Question 9

Clinical picture of some dehydration

Answer 9

• fatigue
• slightly sunken eye
• tear decrease
• fast breathing
• eager to drink
• mouth and tongue dry
• increase HR
• skin recoil less than 2 sec
• pulse: decrese
• prolonged capillary refill
• cool extremities
• decrease urine output

Question 10

Management of some dehydration

Answer 10

1. Under observation at hospital
2. Duration: 4hours and reasses
3. Fluid: ORS
   - amount: 75ml/kg
   - method: cup/ spoon
   - rate : one spoon (5ml) every 2 min
4. Observe:
   - if vomiting: wait 10 minute, slower the rate
   - if refusal: if persistent, start NGT
   - if sign dehydration persistent, start IV fluid

Question 11

Definition of diarrhea

Answer 11

Excessive loss of fluid and electrolyte in stool

Question 12

Type of diarrhea

Answer 12

1. Acute water diarrhea
   - watery stool
   - 3 or more time in 12 hours
2. Dysentry
   - small volume
   - frequent bloody stool
   - with mucus, tenesmus, urgency
3. Persistent diarrhea
   - episodic
   - began acutely
   - last at least 14 days
4. Chronic diarrhea
   - prolonge course
   - start gradually

Question 13

Mechanism of diarrhea

Answer 13

1. Secretory
   - caused by secretagogue ( cholera toxin)
   - watery
   - large amount
   - persist even no feeding
2. Osmotic
   - poorly absorb solute
   - lesser volume
   - stop after fasting
3. Motility disorder
   - slow motility
   - cause bacteria overgrowth the diarrhea

Question 14

Management diarrhea without dehydration

Answer 14

1. Home management
2. Fluid
   - 1/4- 1/2 cup ( baby lower 2 years)
   - 1/2- 1 cup ( baby more 2 years)
3. Other:
   - plain water
   - helba, anise
   - avoid sugar contain
4. Food:
   - breast feed continue
   - formula
   - easily digestible food
5. Follow up
   - diarrhea no better in 3 days
   - vomit appear
   - fever more than 2 days
   - dehydration appear
   - food, drink refusal

Question 15

DD of vomiting

Answer 15

• systemic infection
• GERD
• gastroenteritis
• otitis media
• over feeding
• gasteritis

Question 16

Definition GERD

Answer 16

Retrograde movement of gastric content across the lower esophegeal sphicter into esophagus

Question 17

CP in GERD

Answer 17

1. Infant
   - regurgitation
   - esophagitis
   > irritability
   > choking
   > gagging
   > feeding refusal

• FTT
• stridor

2. Child
   - regurgitation
   - chest pain
   - abdominal pain
   - ENT disease
   - laryngitis
   - asthma

Question 18

Investigate of GERD

Answer 18

• barium radiography
• esophageal pH monitoring
• endoscopy
• bronchoscopy

Question 19

Treatment of GERD

Answer 19

1. Diet
   a) infant
   - normalize feeding technique
   - thickning of formula
   - short trial at hypoallergic diet

b) child
- avoid acidic food
- avoid beverages
- reduce weight

2. Position: head elevation, prone position
3. Pharmaco:
   - antacid
   - histamine 2 receptor antagonist
   - PPI 0.7-3.3mg/kg/day
4. FUN duplication

Question 20

Organic and functional abdominal pain

Answer 20

1. Functional
   - age: school age
   - severity: not severe
   - site: periumbilical
   - other symptom: no
   - organomegally: no
   - general condition: good
2. Organic
   - age: any age
   - severity: severe
   - site: away umbilicus
   - other symptom: ass. Fever, diarrhea, vomit
   - organomegally: present
   - general condition: bad

Question 21

Causes of bleeding per rectum

Answer 21

1. Newborn
   - bacterial enteritis
   - ingest meternal blood
   - hemorrhage disease
2. Infant
   - gatroenteritis
   - ulcer
   - anal fissure
3. Child
   - gastroenteritis
   - esophagitis
   - drug

Question 22

Complication of gastroenteritis

Answer 22

• dehydration
• electrolyte inbalance
• neonatal sepsis
• athritis
• meningitis
• pneumonia
• abscess