GIT --- Best Answer

.A 14-year-old girl presents with vomiting, worst in the mornings. She has previously been healthy Menarche was at 11 years. Her last period was eight weeks ago. She had a full term normal delivery with
no neonatal complications. Her immunisations are up to date. There is no FH/SH of note, except that she
has a new boyfriend.
On examination she is apyrexial and well. There are no abnormalities to find, except a slight fullness in the
lower abdomen.
What is the most likely diagnosis?
(Please select 1 option)
Classical migraine
Cyclical vomiting
Diabetic ketoacidosis
Intermittent maple syrup urine disease
Pregnancy
The diagnosis of early pregnancy can be confirmed by an appropriate urine test.
She should be referred to the obstetricians for further management.
.A 13-year-old boy presents with haematemesis and hepatomegaly The haematemesis began suddenly, and consisted of 500-1000 ml of fresh red blood with clots.
Full term normal delivery, no neonatal problems. Immunisations up to date. No family or social history of
note.
On examination:
Temperature

36.4C

Respiratory rate

14/min

Pulse

110/min

Blood Pressure

135/75

He looks unwell and a little pale. He has 3 cm firm nodular liver and 2 cm spleen.
What is the most likely diagnosis?
(Please select 1 option)
Adult polycystic disease
Alpha 1 antitrypsin deficiency
Autoimmune hepatitis
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GIT --- Best Answer

Hepatitis B infection
Hepatitis D infection
The history suggests cirrhosis with oesophageal varices, which have bled.
Among causes to consider are iron and copper overload, Indian childhood cirrhosis, and autoimmune
diseases.
Wilson's disease and alpha-1 antitrypsin deficiency are the commonest congenital causes.
Definitive treatment is of the underlying cause +/- liver transplant.
.A 6-month-old infant is admitted with vomiting His parents report that he 'possets' frequently, and may bring up the whole bottle up to 'two hours' after a
feed. His full blood count reveals a microcytic anaemia.
What is the most likely diagnosis?
(Please select 1 option)
Alpha 1-antitrypsin deficiency
Cystic fibrosis
Duodenal atresia
Hiatus hernia
Pyloric stenosis
This child's frequent vomiting and microcytic anaemia suggest a hiatus hernia with reflux.
Cystic fibrosis would be associated with chest infections and iron deficiency but not the vomiting.
A male child weighing 4.2 kg is admitted at age four weeks with a one week history of forceful vomiting .after feeds
He is alert and eager for food but exhibits a loss of skin elasticity and has apparent distension in the left
hypochondrium.
Which of the following statements is correct for this patient?
(Please select 1 option)
He has hyperosmolar dehydration
He should be started on an anticholinergic drug, e.g. atropine methylnitrate (Eumydrin), before feeds
Initial fluid replacement should comprise normal saline 10-20 ml/kg in one hour
Metabolic acidosis would be anticipated
The most likely diagnosis is hiatus hernia

GIT --- Best Answer

The most likely diagnosis is pyloric stenosis, which is more common in males (4:1 M:F ratio)and
characteristically presents 3-6 weeks after birth. This situation will cause a proportionate loss of fluid and
electrolytes.
Characteristically he will have hypokalaemic, hypochloraemic metabolic alkalosis.
Initial resuscitation should be with normal saline, at twice the maintenance volume. This will ensure he is
volume replete and prevent secondary activation of the renin/aldosterone system, which would cause more
alkalosis and hypokalaemia.
Once volume replete, the fluid can be changed to half strength saline with added potassium.
Although there are a few emerging reports showing satisfactory short term and long term outcome with
medical treatment, the preferred treatment is currently pylorotomy.
This should be performed after successful resuscitation and electrolyte correction.
?Which one of the following statements is true concerning subjects with untreated coeliac disease (Please select 1 option)
Are usually hungry
May have abdominal distension
May safely resume a normal diet in adult life
They are likely to have normal jejunal villi
Usually absorb glucose normally
They are likely to have subtotal or total villous atrophy.
Glucose absorption and hydrolysis of lactose and sucrose is impaired in florid coeliac disease.
Anorexia and weight loss are common.
The gluten free diet is required lifelong in this condition.
Abdominal distension may develop, but it is not characteristic.
A neonate does not pass meconium for 48 hours after birth. A fortnight later his mother states that he is not.passing stool regularly. He has been bottle fed since discharge
Investigations reveal massive dilatation of the colon proximal to the rectum and manometry shows
increased internal anal pressure on rectal distension with a balloon.
Where is the developmental abnormality responsible for this child's presentation?
(Please select 1 option)
Ectoderm
Endoderm
Neural crest
Neural ectoderm
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GIT --- Best Answer

Splanchnic mesoderm
This is Hirschsprung's disease which is due to absence of the ganglion cells supplying the colonic smooth
muscle.
Neural crest contributes to the formation of the postganglionic neurones of the autonomic nervous system
and the sensory neurones of the peripheral nervous system.
.A 17-year-old male student attends clinic complaining of right knee pain and left ankle pain These pains have deteriorated over the last two months and are associated with episodic diarrhoea.
What is the most likely diagnosis?
(Please select 1 option)
Amoebic dysentery
Coeliac disease
Chronic appendicitis
Ulcerative colitis
Whipple's disease
This patient has oligoarthropathy associated with episodic diarrhoea which suggests a diagnosis of
inflammatory bowel disease.
A 5-year-old girl presents with pallor and lethargy. This has been worsening over the last few weeks. Apart .from occasional abdominal pain with dark stools from time to time, she has otherwise been well
She was born at 40+5/40 weighing 3.5 kg and there were no neonatal problems.
On examination she has pale conjunctivae, but looks generally well. Her height and weight are on the 25%.
Temperature is 36.5C, HR is 95/min and RR 15/min. She has a 2/6 ejection murmur at the left sternal
edge. Abdominal examination is unremarkable.
What is the most likely diagnosis?
(Please select 1 option)
Dietary iron deficiency
Haemaglobinopathies, for example, sickle, thalassaemia
Malignancy
Marrow failure
Occult blood loss
The history suggests isolated anaemia, progressing over several months.
The dark stools and abdominal pain suggest an occult source of bleeding from the upper gastrointestinal
(GI) tract.
Potential sources include
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GIT --- Best Answer

Oesophagitis

Peptic ulcer

Meckel's diverticulum

Non-steroidal anti-inflammatories.

Investigation may include

Full blood count and film

Meckel's scan

Upper GI endoscopy.

A 10-month-old girl presents with abdominal pain and diarrhoea, which has recently had pink staining. She was well until 12 hours ago, when she had some loose stools and episodes of crying and holding her
.abdomen
She was a full term normal delivery and there were no neonatal problems.
On examination she looks intermittently uncomfortable. Her heart rate is 110/ min and respiratory rate
20/min. She has a temperature of 37.4C and is well perfused. Her abdomen is slightly distended and she
has a curved firm mass 10 cm long extending from the right iliac fossa towards the hepatic flexure.
What is the most likely diagnosis?
(Please select 1 option)
Constipation/encopresis
Inborn errors of metabolism
Intussusception
Malignancy, for example, neuroblastoma, Wilm's, lymphoma
Renal anomalies
The history suggests an intussusception in the typical ileo-colic location, associated with intermittent colic.
At this stage air enemas are usually successful in reducing them completely.
?Which one of the following suggests a diagnosis of Hirschsprung's disease (Please select 1 option)
A contrast study showing dilatation of the aganglionic bowel segment
Early presentation with vomiting
Neonatal large bowel obstruction
Presentation after one year of age
Red current jelly stools
Hirschsprung's disease is a common cause of neonatal large bowel obstruction.
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GIT --- Best Answer

It results from failure of migration of ganglion cells to the affected segment of bowel. This always involves
the distal colon but the proximal extent of the involvement is variable and in rare cases may involve the
whole of the large bowel.
Histologically, the affected segment has absent ganglion cells in the Meissner's and Auerbach's plexus but
immunohistochemical evidence of increased angiotensin-converting enzyme (ACE) activity.
Eighty percent of cases present in the neonatal period.
Contrast studies show the affected segment to be tonically contracted.
Rectal irrigation or an emergency colostomy may be required before a definitive 'pull-through' procedure.
Patients present typically with constipation and present late with vomiting and obstruction.
A 7-year-old girl presents with crampy lower abdominal pain, loose stools and anorexia of three days .duration. The stools contain blood and slime and occur 20 times a day
There is no history of foreign travel. She was born at 38+4/40 weighing 3.2 kg and there were no neonatal
problems.
On examination she appears lethargic and pale. She has dry mucous membranes but no jaundice. Her
temperature is 37.6C (tympanic), HR 100/min, RR 15/min. She has a few purpuric spots on her legs.
What is the most likely diagnosis?
(Please select 1 option)
Haemoglobinopathies for example, sickle, thalassaemia
Haemolytic uraemic syndrome
Iron deficiency
Malignancy
Marrow failure
The history suggests a dysenteric illness followed by haemolytic uraemic syndrome.
This is now the commonest cause of acquired acute renal failure in childhood.
The likely organism is Escherichia coli 0157:H7 in the United Kingdom,
although Shigella, Campylobacter and a variety of viruses have also been described.
These trigger the triad of

Microangiopathic haemolytic anaemia

Thrombocytopenia and

Acute renal failure.

A FBC showed Hb 6.8 g/dl, WC 16.8 x 109, platelets of 36. Blood film showed schistocytes, spherocytes,
helmet cells and polychromasia.
Careful attention to fluid balance is essential to avoid fluid and electrolyte-related complications.
.A 17-year-old male is admitted to casualty after a night out with friends at a nightclub 6

GIT --- Best Answer

After drinking eight pints of beer, he felt nauseated and vomited. Vomitus was seen to contain streaks of
bright red blood after vomiting a second time.
His pulse rate is 70/min with warm peripheries, and he is passing copious quantities of urine.
Investigations revealed:
Haemoglobin

13.2 g/dL (13.0-18.0)

White cell count

10.7 x109/L (4-11 x109)

Platelets

377 x109/L (150-400 x109)

Prothrombin time

12.0 s (11.5-15.5)

Activated Partial Thromboplastin Time

27 secs (30-40)

Blood alcohol

83 mg/dL

What is the next step in his management?

(Please select 1 option)
Coeliac axis angiography
Discharge the patient and arrange an endoscopy in one month
Discharge the patient from hospital
Prescribe a proton pump inhibitor and admit the patient overnight for observation
Refer to the surgeons for review
The history is compatible with a Mallory-Weiss tear.
His investigations are normal, with a moderate blood alcohol level.
No additional treatment or follow-up is required and the patient can be discharged from hospital.
A 6-week-old male is diagnosed with congenital hypertrophic pyloric stenosis. He is found to have .hypokalaemia
Which of the following is the cause of the hypokalaemia in this condition?
(Please select 1 option)
Associated type IV renal tubular acidosis
Intracellular potassium shift
Metabolic alkalosis producing a paradoxical renal loss of potassium ions
Paradoxical metabolic renal tubular acidosis
Upper gastrointestinal losses
The hypokalaemia in pyloric stenosis is due to gastrointestinal losses as generally there is renal
conservation of potassium.
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GIT --- Best Answer

Also, the alkalosis is associated with loss of H+ ions again through vomiting and the effort to conserve these
with the production of an alkaline urine.
.A 1-year-old child has recurrent episodes of diarrhoea and bronchopneumonia His full blood count shows a normal haemoglobin concentration, normal white cell count but low lymphocyte
count. His total immunoglobulin concentration is also low.
What is the likely diagnosis?
(Please select 1 option)
AIDS
Alpha1 antitrypsin deficiency
Cystic fibrosis
Hypogammaglobulinaemia
Severe combined immunodeficiency (SCID) syndrome
The combination of low lymphocyte count and low immunoglobulin concentration suggests SCID.
The defining feature of SCID, commonly known as "bubble boy" disease, is a defect in the specialised white
blood cells (B- and T-lymphocytes) that defend us from infection by viruses, bacteria and fungi.
Without a functional immune system, SCID patients are susceptible to recurrent infections such as
pneumonia, meningitis and chicken pox, and can die before the first year of life.
Though invasive, new treatments such as bone marrow and stem-cell transplantation save as many as 80%
of SCID patients.
It appears to be X linked in as many as 50% of cases.
.A 2-year-old child is admitted with a two day history of diarrhoea Which of the following statements correctly applies to his condition?
(Please select 1 option)
Adenovirus is the commonest pathogen isolated
Dehydration is best assessed clinically rather than biochemical
He should be treated with anti-diarrhoeal agents
He should be treated with boiled water alone for 24 hours
Hyponatraemia is expected
Hypernatraemic and hyponatraemic dehydration are both infrequent complications of childhood
gastroenteritis.
Rotavirus is the commonest pathogen.
Anti-diarrhoeal agents are not recommended in the treatment, as they may cause complications such as
respiratory depression, bowel obstruction and bacterial overgrowth.
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GIT --- Best Answer

Biochemical tests may not be abnormal till the dehydration is advanced.
Clinical signs such as decreased urine output, dry mucous membranes and sunken fontanelle may appear
when the child is more than 5% dehydrated.
Oral rehydration with a glucose electrolyte solution (sodium, glucose, chloride, potassium) is recommended.
?Which one of the following is a typical feature of toddler's diarrhoea (Please select 1 option)
Abdominal cramps
Failure to thrive
Pale stools
Poor growth
Undigested food in the stools
Toddler's diarrhoea affects children between the age of 1-5 years.
It is not serious, the child is well and grows normally.
It is characterised by three or more watery motions per day. Bits of undigested vegetable matter are usually
present in the stool, which is offensive.
Abdominal pain is unusual.
Pale stools suggest malabsorption and more serious underlying pathology.
.A 6-week-old infant presents with vomiting and failure to thrive A diagnosis of pyloric stenosis is considered.
Which one of the following statements is correct regarding congenital hypertrophic pyloric stenosis?
(Please select 1 option)
A "double bubble" is likely to be seen on abdominal x ray
A hyperchloraemic alkalosis would be expected
Refusal of feeds is a feature
Vomiting would have typically started between 2 to 4 weeks
Vomitus is typically bile stained
The characteristic radiological feature is the 'string sign', which comprises a thin contracted pyloric canal,
containing a central streak of barium.
The clinical symptoms commonly appear in the time frame of two to four weeks.
The vomiting is not bile stained but consists of large volumes of curdled milk. Appetite and feeding are
normal or increased.
The characteristic metabolic abnormality is hypochloraemic hypokalaemic alkalosis.
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GIT --- Best Answer

A neonate does not pass meconium for 48 hours after birth. A fortnight later his mother states that he is .not passing stool regularly. He has been bottle fed since discharge
Investigations reveal massive dilatation of the colon proximal to the rectum and manometry shows
increased internal anal pressure on rectal distension with a balloon.
What is the most likely diagnosis?
(Please select 1 option)
Cow's milk allergy
Cystic fibrosis
Hirschsprung's disease
Hypothyroidism
Idiopathic constipation
The child has Hirschsprung's disease characterised by the early constipation and radiology.
The disorder is due to an absence of the ganglion cells in the wall of the colon.
Treatment is through resection of the atonic segment.
?Which of the following statements regarding kernicterus is incorrect (Please select 1 option)
Is associated with gastrointestinal haemorrhage
May cause a chronic syndrome of athetosis, gaze disturbance and hearing loss
May cause convulsions
The diagnosis of kernicterus requires the histological confirmation of yellow staining of brain tissue on
autopsy caused by fat soluble unconjugated hyperbilirubinaemia
Usually occurs in the first month of life
Intracellular crystals are noted in intestinal mucosa of affected infants. This may be related to
gastrointestinal haemorrhage.
The chronic syndrome of neurologic sequelae observed following marked hyperbilirubinaemia includes
athetosis, gaze disturbance, and hearing loss.
If the affected infant survives the neonatal period and subsequently dies, the yellow staining of neural tissue
may no longer be present, but the basal ganglia will display microscopic evidence of cell injury, neuronal
loss, and glial replacement.
?Compared with bottle feeding, breast feeding is relatively protective against which of the following (Please select 1 option)
Late haemorrhagic disease of the newborn
Late onset diabetes
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GIT --- Best Answer

Maternal breast cancer
Prolonged jaundice
Under-feeding
Breast fed infants have a reduced risk of infection, though the effect is less in industrialised societies.
The protective effect is increased for low birth weight infants.
There may also be

Improved cognitive and psychological development

Reduced risk of juvenile onset diabetes, and

Reduced risk of maternal breast cancer.

Disadvantages of breast feeding include

Social limitations

Unrecognised under-feeding (rare)

Late haemorrhagic disease of the newborn

Breast milk jaundice.

?Which one of the following statements concerning biliary atresia is correct (Please select 1 option)
Can be confused with breast milk jaundice
Normal excretion of isotope into duodenum in HIDA scan
Occurs in 1 in 15000 babies
Stools are of normal colour initially
Unconjugated hyperbilirubinaemia occurs

Colourless stools

Dark urine

Weight loss

Jaundice and

Abdominal distension

are characteristic.
Conjugated hyperbilirubinaemia occurs.
Breast milk jaundice is a benign self limiting condition. Biliary atresia causes prolonged obstructive
jaundice.
If the isotope passes from the liver into the duodenum the bile ducts would be patent, unlike in biliary
atresia.
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GIT --- Best Answer

Osteoporosis and octeomalacia are potential consequences.
The frequency is 1 in 15000.
.A 5-year-old boy presents with fever, rash and hepatomegaly He was well until seven days before, when he developed malaise, headache and fever. Subsequently a
maculopapular rash had appeared over the trunk. An enlarged liver was noted by the family doctor. He had
a full term normal delivery with no neonatal problems. His immunisations are up to date. There is no family
or social history of note.
On examination:
Temperature

38.2C

Respiratory rate

20/min

Pulse

100/min

He has marked cervical lymphadenopathy, a 2 cm tender hepatomegaly and 3 cm spleen. Full blood count
shows occasional atypical lymphocytes, and his AST is slightly elevated.
What is the most likely diagnosis?
(Please select 1 option)
CMV infection
Glandular fever
Hepatitis A infection
Kawasaki disease
Toxoplasmosis
The history of fever, rash, lymphadenopathy and hepatosplenomegaly is in keeping with a mononucleosislike illness. This suspicion is supported by the atypical lymphocytes and elevated liver enzymes, which
suggest a mild hepatitis is present.
Epstein-Barr virus (EBV), cytomegalovirus (CMV) and toxoplasmosis can cause this picture, the latter two
of which may cause teratogenicity in pregnant mothers.
EBV is the most common of these.
A 10-month-old boy presents with a three month history of diarrhoea. He was well until 6 months of age, when he developed vomiting and diarrhoea. The vomiting settled within 24 hours, but the diarrhoea has
.persisted three to four times a day, loose and watery. He has become thinner
He was born at term weighing 3.45 kg, is fully immunised, and there is no FH/SH of note.
On examination he looks thin and wasted, with loose buttock skin folds. He is below the 3% for weight and
on the 25% for height. He looks pale but is not clubbed. Cardiac and respiratory examination is normal. His
abdomen is distended and tympanic and he has perianal excoriation.
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GIT --- Best Answer

What is the most likely diagnosis?
(Please select 1 option)
Autoimmune enteropathy
Coeliac disease
Post-enteritis enteropathy
Toddler diarrhea
Ulcerative colitis
The history suggests acute gastroenteritis, followed by malabsorption with acidic stools causing perianal
excoriation.
The likely diagnosis is post-enteritis enteropathy (post-infectious secondary lactase deficiency). In this
condition there is delayed recovery of the intestinal villi.
Since only mature enterocytes are fully competent to digest food, this results in diarrhoea due to
maldigestion.
Stools may contain excess carbohydrate (more than 2+ on Clinitest) and pH less than 5.6.
A 3-year-old boy is referred because of an abdominal mass. He otherwise is well apart from sluggish bowel movements and sleep disturbance, which is causing stress in the family. He was a full term normal
.delivery weighing 3.4 kg. He had gastroenteritis at 13 months of age
On examination he is on the 75% for height and the 90th for weight. He has tympanic abdominal distension
with no enlarged liver, spleen or kidneys. He has large non-tender irregular indentable masses in the left
iliac fossa and suprapubic region.
What is the most likely diagnosis?
(Please select 1 option)
Congenital adrenal hyperplasia
Constipation
Duplex ureter
Dysplastic kidney
Neuroblastoma
The history suggests chronic idiopathic constipation.
Often this begins following gastroenteritis, when poor fluid intake results in hard stools.
When these are passed they can tear the delicate anal mucosa, causing a fissure.
There is then voluntary stool retention, completing the vicious circle.
As in this case, psychological stresses are common.

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GIT --- Best Answer

A 6-week-old male infant presents with projectile vomiting following feeds. He has been perfectly well until .now
Examination reveals that he is constipated and dehydrated.
Which of the following is the most likely diagnosis?
(Please select 1 option)
Diaphragmatic hernia
Duodenal atresia
Hirschsprung's disease
Hypertrophic pyloric stenosis
Staphylococcus food poisoning
The history of projectile vomiting suggests pyloric stenosis.
This is due to thickening of the muscle at the pylorus and is treated by pyloroplasty.
The incidence is approximately 1 in 4000 live births and is commoner in males than females.
A 2-year-old child presents with a long history of poor development, offensive diarrhoea and vague .abdominal pains
Examination reveals that he is on the tenth centile for height and third centile for weight and has a
protuberant abdomen.
What is the most likely diagnosis?
(Please select 1 option)
Coeliac disease
Cows' milk protein allergy
Crohn's disease
Cystic fibrosis
Ulcerative colitis
This young child has features of malabsorption, with offensive but not blood stained diarrhoea which would
suggest a diagnosis of coeliac disease rather than inflammatory bowel disease.
Other features may include dermatitis herpetiformis, but often the condition is symptomless.
The diagnosis is based on the demonstration of villous atrophy on a jejunal biopsy.
Treatment involves the imposition of a gluten free diet.
.An infant is suspected of having gastro-oesophageal reflux Which one of the following statements relating to this diagnosis is correct?
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GIT --- Best Answer

(Please select 1 option)
A barium swallow would be the investigation of choice to diagnose it
He is likely to require drug treatment
He is unlikely to present with vomiting.
He may have apnoeic episodes
Vomitus will be bile stained.
Gastro-oesophageal reflux is a common, usually benign and self-limiting cause of vomiting in children. It is
not associated with bile stained vomiting.
It can be treated in many cases with positioning after feeds and smaller frequent feeds. Drug treatment is
reserved for severe cases.

Oesophageal stricture

Cough

Apnoeic episodes

Oesophagitis

Pneumonia and

Failure to thrive

are sequelae.
Barium swallow is an unreliable tool as there may be intermittent reflux of barium, which is not identified
when the x ray is taken.
Other more reliable methods include endoscopy and oesophageal pH probe.
Which of the following statements correctly applies to a baby of 2 months who is considered to be 10% ?clinically dehydrated with gastroenteritis
(Please select 1 option)
He may have blood and mucus in his stools
He will have a full fontanelle
He will have a low packed cell volume
Should not be given milk orally for at least 48 hours
Urea level will be normal
Blood and mucus may be seen with dysentry and Escherichia coli infection.
The fontanelle will be sunken and haematocrit will be raised.
An increased urea will be seen in this degree of dehydration.
Oral feeding should be continued whenever possible.
?Which of the following statements applies to infants with gastroenteritis 15

GIT --- Best Answer

(Please select 1 option)
Always develop lactose intolerance
Frequently have blood in their stools
In most instances require treatment with an antibiotic which is not absorbed from the gut
Should be admitted to hospital if they are unable to tolerate fluid orally
Should have a barium meal if the initial refeeding with milk is unsuccessful
The majority of children do not require antibiotics as the cause is viral.
Formula feeds should not be changed.
Intravenous fluid therapy will be required if they are unable to tolerate oral fluids.
Prolonged lactose intolerance can occur, but is not common.
Barium meals are not useful in the investigation of gastroenteritis.
Blood in the stool is uncommon, and occurs more commonly in bacterial gastroenteritis.
?Which one of the following is a reliable method of assessing dehydration in a 3-month-old infant (Please select 1 option)
Assessment of intra-ocular tension by palpation
Blood pressure
Palpation of the anterior fontanelle
Serum sodium concentration
Skin turgor over the dorsum of the hand
Signs of dehydration are not very reliable in the infant and always lag behind symptoms. Palpation of the
anterior fontanelle is the most useful of the signs mentioned here.
Thirst and oliguria may occur if the child is >5% dehydrated. Tachycardia and low blood pressure only occur
in severe cases of >10% dehydration.
Skin turgor is unreliable in overweight infants. Serum sodium may be entirely normal, or it may be low if
there is electrolyte loss in the stool. However raised serum sodium can be seen when water loss is in
excess of electrolytes.
.A young infant presents with a suspected diagnosis of pyloric stenosis Which of the following is a feature of this diagnosis?
(Please select 1 option)
Anorexia
Hyperchloraemic acidosis
Loose stools
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GIT --- Best Answer

More frequent in girls
Projectile vomiting
Projectile vomiting of large quantities of curdled milk is characteristic.
Anorexia and loose stools are not clinical features.
It is commonest in first-born male children.
The classical biochemical picture is of hypokalaemic, hypochloraemic metabolic alkalosis.
A 3-year-old boy is referred because of an abdominal mass. He otherwise is well apart from sluggish .bowel movements and sleep disturbance, which is causing stress in the family
He was a full term normal delivery weighing 3.4 kg. He had gastroenteritis at 13 months of age.
On examination he is on the 75th centile for height and the 90th for weight. He has tympanic abdominal
distension with no enlarged liver, spleen or kidneys. He has large non-tender irregular indentable masses in
the left iliac fossa and suprapubic region.
What is the most likely diagnosis?
(Please select 1 option)
Constipation/encopresis
Inborn errors of metabolism
Malignancy, for example, neuroblastoma, Wilm's, lymphoma
Pregnancy
Renal anomalies
The history suggests chronic idiopathic constipation.
Often this begins following gastroenteritis, when poor fluid intake results in hard stools. When these are
passed they can tear the delicate anal mucosa, causing a fissure. There is then voluntary stool retention,
completing the vicious circle.
As in this case, psychological stresses are common.
:Which of the following statements is true concerning: Intussesception in children (Please select 1 option)
Is more common between the age of 3 months to 8 years
Bile stain vomiting is an early feature
Bleeding per rectum is the most common presenting symptom
Is usually caused by a polyp or pedunculated tumour
Air reduction plays an important role in the management
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GIT --- Best Answer

Intussusception in children can occur between 3 months and six years of age, but it is more common in the
first 3 years. Colicky abdominal pain, straining and lethargy are clinical features. Bloody mucus and
vomiting occur late when the bowel becomes strangulated and ischaemic. The condition involves the
telescoping of one segment of the bowel into an adjacent segment. Most cases are idiopathic, however in a
minority of cases there is a 'mechanical leading segment' which predisposes to the abnormality e.g.
polyposis, Peutz-Jegher's syndrome.Air reduction is therapeutic in most cases which present within 24
hours.

Dr.Azad Abdul jabar

Haleem ( 14/7/2011)

18