Upper and Lower GI Disorders

Question 1

What is included in the pre-ejection phase of vomiting ?

Answer 1

Pallor
Nausea
Tachycardia

Question 2

What is included in the ejection phase of vomiting?

Answer 2

Retch

Vomit

Question 3

What is included in the post ejection phase of vomiting ?

Answer 3

Phase of weakness, shivering and lethargy.

Question 4

What are some examples of stimulants to the vomiting centre?

Answer 4

Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli

Question 5

What is the age bracket for pyloric stenosis?

Answer 5

Babies ~4-12 weeks

Question 6

What are the signs and symptoms of pyloric stenosis?

Answer 6

Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock
Electrolyte disturbance

Question 7

What kind of electrolyte disturbance would you expect in pyloric stenosis?

Answer 7

Metabolic alkalossis (Increased Ph)
Hypochloraemia (Decreased Cl)
Hypokalaemia (Decreased K)

Question 8

What is the common cause of Bilious Vomiting in the new born ?

Answer 8

Intestinal obstruction

Question 9

What are the causes of intestinal obstruction in the new born/infants ?

Answer 9

Intestinal atresia (New borns only)
Malrotation
Ileus
Crohn’s disease with strictures

Question 10

What investigations would you carry out to diagnose an intestinal obstruction ?

Answer 10

Abdo x-ray
Consider contrast meal
Surgical exploration

Question 11

What is commonly diagnosed in a child who has effortless vomiting?

Answer 11

Gastro-oesophageal reflux

Question 12

What is the treatment for a child who has effortless vomitting ?

Answer 12

Self-limiting and resolves spontaneously in the majority of cases.

Exceptions:
Cerebral palsy
Oesophageal atresia
Generalised GI motility problem

Question 13

What is Sandifer’s syndrome ?

Answer 13

The association of gastro-oesophageal reflux disease with spastic terticollius and dystonic body movements.

Question 14

What kind of medical assessments would you carry out if a child has gastro-osaephageal reflux ?

Answer 14

Radiological investigations i.e. Video fluroscopy
Barium swallow

pH study
Endoscopy

Question 15

What type of conditions would be shown by a Barium Swallow ?

Answer 15

Dysmotility
Hiatus hernia
Reflux
Gastric emptying
Strictures

Question 16

What is the treatment for gastro-osaephageal reflux in children?

Answer 16

Feeding advice
Nutritional support
Medical treatment
Surgery

Question 17

What would be the feeding advice given for children with gastro-oasophageal reflux ?

Answer 17

Thickeners for liquids
Appropriateness of foods (texture and amount)
Feeding position

Question 18

What kind of nutritional support would be suggested for children who suffer from GOR ?

Answer 18

Calories supplements
Exclusion diet (milk free)
NG tube
Gastrostomy

Question 19

What would be the chosen medical treatment for those with GOR ?

Answer 19

Gaviscon
Prokinetic drugs
Acid suppressing drugs (H2 receptor blockers and PPIs)

Question 20

What are the indications for surgery in children with GOR ?

Answer 20

Failure to thrive
Aspiration
Oesophagitis

Question 21

Children with cerebral palsy are more likely to have what kind of symptoms after surgery ?

Answer 21

Complications of bloat, dumping and retching after surgery

Question 22

What is the surgical procedure which is suggested for GOR ?

Answer 22

Nissen Fundoplication

Question 23

What is the definition of chronic diarrhoea ?

Answer 23

4 or more stools per day.

For more than 4 weeks.

Question 24

<1 week of diarrhoea is defined as what ?

Answer 24

Acute diarrhoea

Question 25

2-4 weeks of diarrhoea is defined as what ?

Answer 25

Persistant diarrhoea

Question 26

What type of motility disturbance causes diarrhoea ?

Answer 26

Toddler diarrhoea | IBS

Question 27

What kind of active secretion disorders causes diarrhoea ?

Answer 27

Acute infective diarrhoea | IBS

Question 28

What kind of malabsorption conditions cause diarrhoea ?

Answer 28

Food allergies Coeliac disease CF

Question 29

Define osmotic diarrhoea

Answer 29

Movement of water into the bowel to equilibrate osmotic gradient.

Question 30

What is osmotic diarrhoea a feature of ?

Answer 30

Malabsorption (Enzymatic defect or transport defect)

Question 31

How is osmotic diarrhoea resolved ?

Answer 31

Clinical remission with removal of causative agent

Question 32

Define secretory diarrhoea

Answer 32

Intestinal fluid secretion predominantly driven by active Cl secretion via CFTR

Question 33

What is secretory diarrhoea commonly associated with ?

Answer 33

Toxin production from Vibrio cholerae and enterotoxigenic Escherichia coli

Question 34

Define motility diarrhoea

Answer 34

Classically called toddlers diarrhoea ?

Question 35

Causes of motility diarrhoea ?

Answer 35

IBS Congenital hyperthyroidism Chronic intestinal pseudo-obstruction

Question 36

Define inflammatory diarrhoea

Answer 36

Malabsorption due to intestinal damage, accelerated transit time in response to inflamation.

Question 37

What are the pancreatic causes of fat malabsorption ?

Answer 37

Diarrhoea due to lack of lipase and resultant steatorrhoea. CF

Question 38

What are the hepatobilliary causes of of fat malabsorption ?

Answer 38

CLD | Cholestasis

Question 39

Define coeliac disease

Answer 39

Gluten sensitive eneteropathy

Question 40

What are the signs and symptoms of coeliac disease?

Answer 40

``` Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis ```

Question 41

What are the screening tests for coeliac disease ?

Answer 41

Serological screens Duodenal biopsy Genetic testing

Question 42

What is the treatment for coeliac disease ?

Answer 42

Gluten-free diet for life Gluten must not be removed prior to diagnosis as serological and histological features will resolve In very young <2yrs, re-challenge and re-biopsy may be warranted

Question 43

What is the risk to children if coeliac is left untreated ?

Answer 43

Increased risk of rare small bowel lymphoma if untreated