Gastroenterology Practice Questions

Q: A baby on day 4 of its birth presents with repeated vomiting. The vomiting is bilious in nature. What is the most possible diagnosis as per the infantogram?

Duodenal atresia. ***Duodenal atresia*** - The infantogram shows the classic "double bubble" sign, indicating a distended stomach and a dilated duodenum separated by the pylorus. This is pathognomonic for **duodenal atresia**. - **Bilious vomiting** in a neonate, especially from day 1-2 of life, is a key clinical feature of duodenal atresia due to the obstruction being distal to the ampulla of Vater. *Hypertrophic obstructive pyloric stenosis* - This condition typically presents around **3-6 weeks of age** and is characterized by **non-bilious projectile vomiting**. - Radiologically, it would show a distended stomach but not a dilated duodenum; an ultrasound showing a thickened and elongated pyloric channel is diagnostic. *Jejunal atresia* - Jejunal atresia presents with **multiple dilated loops of small bowel proximally** due to the obstruction and air-fluid levels, often leading to a "triple bubble" or multiple air-fluid levels but not the distinct double bubble sign. - While it causes bilious vomiting, the imaging pattern is different from what is seen in the provided infantogram. *Meconium ileus* - This condition is typically associated with **cystic fibrosis** and presents with abdominal distension, failure to pass meconium, and bilious vomiting. - The infantogram would show multiple dilated loops of bowel of varying caliber, often with a "ground glass" appearance due to tenacious meconium, and typically no air-fluid levels or a distinct double bubble.

Q: A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Small intestine. ***Small intestine*** - The image shows **perioral melanotic macules**, specifically around the mouth, which are classic cutaneous manifestations of **Peutz-Jeghers syndrome**. - Peutz-Jeghers syndrome is an **autosomal dominant disorder** characterized by these mucocutaneous pigmentations and an increased risk of developing **hamartomatous polyps** in the gastrointestinal tract. - The **small intestine** is the **most commonly affected site** for polyps in Peutz-Jeghers syndrome, with **60-90% of patients** developing small bowel polyps, particularly in the **jejunum**. - These polyps can cause complications including **intussusception**, bleeding, and obstruction. - Patients also have an increased risk of **malignancies** in the small intestine and other organs (breast, ovary, pancreas, colon). *Colon (Large Intestine)* - While colonic polyps do occur in Peutz-Jeghers syndrome (**20-30% of cases**), they are **less frequent** than small intestinal polyps. - The colon is a secondary site of involvement compared to the small intestine. - Increased risk of colorectal cancer exists but the predominant polyp site remains the small bowel. *Stomach* - Gastric polyps occur in **approximately 25% of patients** with Peutz-Jeghers syndrome. - While gastric involvement can occur, it is **less common** than small intestinal involvement. - The stomach is a secondary site compared to the small intestine. *Esophagus* - Esophageal involvement with polyps in Peutz-Jeghers syndrome is **very rare**. - The typical distribution of hamartomatous polyps extends from stomach to rectum, with minimal esophageal involvement. - Esophagus is the least commonly affected GI organ in this syndrome.

Q: A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:

Duodenal atresia. ***Duodenal atresia*** - The X-ray image shows a classic "double bubble" sign, which is pathognomonic for **duodenal atresia**, caused by air trapped in the stomach and the proximal dilated duodenum. - There is an absence of distal bowel gas, indicating a complete obstruction beyond the duodenum. *Jejunal atresia* - While jejunal atresia also presents with intestinal obstruction, it typically shows **multiple dilated loops of small bowel** proximal to the obstruction, not just two distinct air-filled structures. - The "double bubble" sign is not characteristic of jejunal atresia, as the obstruction occurs further down the small intestine. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** is characterized by the presence of gas within the bowel wall, often appearing as linear lucencies or bubbly patterns on X-ray. - This finding is typically associated with **necrotizing enterocolitis** and is not seen in the provided image. *Hirschsprung's disease* - **Hirschsprung's disease** is characterized by the absence of ganglion cells in the distal colon, leading to a functional obstruction. - X-rays typically show a **dilated colon proximal to the aganglionic segment** and often a paucity of gas in the rectum, but not the specific "double bubble" sign seen here.

Q: Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

During feeding. ***During feeding*** - In **hypertrophic pyloric stenosis**, the characteristic **"olive" mass** formed by the thickened pylorus is most easily palpable **during feeding or immediately after vomiting**. - During this time, the infant’s abdominal muscles are relaxed, making palpation of the mass in the **epigastrium (right upper quadrant)** more successful. *In umbilical area* - The umbilical area is typically where **omphaloceles** or **umbilical hernias** are found, not the pyloric mass. - The pylorus is located much higher in the epigastric region, to the right of the midline. *In epigastric area* - While the pyloric mass is located in the **epigastric area**, palpation is more difficult when the infant is crying or agitated. - The question asks when it can be *best* palpated, emphasizing the conditions under which it is most detectable. *In Right upper quadrant* - The pylorus is indeed located in the **right upper quadrant/epigastrium**. - However, the optimal timing for palpation is during feeding or after vomiting, as the infant's abdomen is relaxed at that point.

Q: Which of the following statements are correct regarding the management of gastrointestinal bleeding in children? I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate III. EST has upto 90 % efficacy in controlling acute bleeding IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding Select the answer using the code given below :

III and IV. ***III and IV*** **Statement I is INCORRECT:** Somatostatin or octreotide infusions are typically administered for **3-5 days** (not 7 days) after initial bleeding has stopped to prevent rebleeding. Prolonged use beyond this period is not generally recommended due to potential side effects and lack of additional benefit. **Statement II is INCORRECT:** Endoscopic Sclerotherapy (EST) for esophageal varices involves injection of sclerosants such as **ethanolamine oleate, sodium tetradecyl sulfate**, or polidocanol. The tissue adhesives **N-butyl-2-cyanoacrylate** or **iso-butyl-2-cyanoacrylate** are used in **endoscopic variceal obturation (EVO)** for **gastric varices**, not in standard sclerotherapy for esophageal varices. **Statement III is CORRECT:** Endoscopic Sclerotherapy (EST) demonstrates **up to 90% efficacy** in controlling acute variceal bleeding, making it a highly effective intervention for managing acute hemorrhage. **Statement IV is CORRECT:** Following an episode of acute variceal bleeding, **all patients should receive secondary prophylaxis** (typically combination of non-selective beta-blockers and endoscopic band ligation) to prevent rebleeding, which is associated with significant morbidity and mortality. *I and III* - Incorrect because Statement I is wrong about the duration of vasoactive drug therapy. *II and IV* - Incorrect because Statement II confuses sclerotherapy agents with tissue adhesives used for gastric varices. *I and II* - Incorrect because both statements I and II contain inaccuracies regarding duration of therapy and sclerosing agents respectively.

Q: Most common cause of intestinal obstruction in childhood is:

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of intestinal obstruction in children between **3 months and 6 years** of age, particularly in infants. - It involves the telescoping of one segment of the intestine into an adjacent segment, leading to obstruction and potentially **ischemia**. *Mucoviscidosis* - **Mucoviscidosis**, or **cystic fibrosis**, can cause intestinal obstruction in newborns due to **meconium ileus**, but it is less common across the entire childhood period than intussusception. - While it is a significant cause of intestinal issues, its prevalence as the *most common overall cause* of obstruction in childhood is lower. *Hirschsprung's disease* - **Hirschsprung's disease** is a congenital absence of **ganglion cells** in the distal bowel, leading to functional obstruction, primarily in **neonates** and infants. - While an important cause of obstruction in early life, its overall incidence is less than intussusception, especially when considering the broader childhood age range. *Volvulus* - **Volvulus** is the twisting of a section of the intestine around its mesentery, which can occur at any age but is less frequent than intussusception in childhood. - It often presents as an acute surgical emergency with severe symptoms, but it is not the *most common* cause of obstruction across childhood.

Q: Consider the following features: 1. Visible gastric peristalsis 2. Bilious vomiting 3. Palpable tumour 4. Melena Which of these is/are feature/features of infantile hypertrophic pyloric stenosis?

1 and 3 only. ***1 and 3 only*** - **Visible gastric peristalsis** is a classic sign of pyloric stenosis, as the stomach attempts to overcome the obstruction. - A **palpable olive-shaped mass** (the hypertrophied pylorus) in the epigastrium is a hallmark physical finding. *2 and 4* - **Bilious vomiting** indicates an obstruction **distal** to the ampulla of Vater (duodenum or beyond), whereas pyloric stenosis is gastric outlet obstruction and typically causes **non-bilious vomiting**. - **Melena** (black, tarry stools) indicates upper gastrointestinal bleeding, which is not a typical feature of pyloric stenosis. *4 only* - **Melena** is not a feature of pyloric stenosis; it indicates upper gastrointestinal bleeding. - Pyloric stenosis primarily causes gastric outlet obstruction, leading to forceful, **non-bilious vomiting** and dehydration. *1, 2 and 3* - While **visible gastric peristalsis** and a **palpable tumour** are characteristic, **bilious vomiting** is not. - Vomiting in pyloric stenosis is typically **non-bilious** because the obstruction is proximal to the entry of bile into the duodenum.

Question 1

All of the following statements regarding this image are true except:

Accepted Answer

Rate of re-occurrence is $50 \%$ after non-operative reduction

Answer

Diagnosis is confirmed by USG

Answer

Seventy percent of the cases can be reduced nonoperatively

Answer

Baby may present with red currant jelly stools

Question 2

A baby presents with colicky abdominal pain. Mother gives a history of bloody stools. All the statements regarding this condition are true except:

Accepted Answer

Treatment of choice in this condition is resection and anastomosis

Answer

Most common age of presentation is between 6-9 months

Answer

Most common site is ileocolic

Answer

Most common cause of this condition is hypertrophy of Peyer's patches

Question 3

A baby on day 4 of its birth presents with repeated vomiting. The vomiting is bilious in nature. What is the most possible diagnosis as per the infantogram?

Accepted Answer

Duodenal atresia

Answer

Hypertrophic obstructive pyloric stenosis

Answer

Jejunal atresia

Answer

Meconium ileus

Question 4

A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Accepted Answer

Small intestine

Answer

Esophagus

Answer

Colon (Large Intestine)

Answer

Stomach

Question 5

A 2-day-old neonate has passed stool of the color shown in the image. Which of the following best describes the clinical possibility?

Accepted Answer

Biliary atresia, perform hepatobiliary scintigraphy

Answer

It is normal meconium passed within first 24 hours

Answer

Meconium plug syndrome, perform sweat chloride test

Answer

Metabolic liver disease, perform urine for reducing substances

Question 6

A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:

Accepted Answer

Duodenal atresia

Answer

Jejunal atresia

Answer

Pneumatosis intestinalis

Answer

Hirschsprung's disease

Question 7

Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

Accepted Answer

During feeding

Answer

In umbilical area

Answer

In epigastric area

Answer

In Right upper quadrant

Question 8

Which of the following statements are correct regarding the management of gastrointestinal bleeding in children?
I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding
II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate
III. EST has upto 90 % efficacy in controlling acute bleeding
IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding

Select the answer using the code given below :

Accepted Answer

III and IV

Answer

I and III

Answer

II and IV

Answer

I and II

Question 9

Most common cause of intestinal obstruction in childhood is:

Accepted Answer

Intussusception

Answer

Mucoviscidosis

Answer

Hirschsprung's disease

Answer

Volvulus

Question 10

Consider the following features:

1. Visible gastric peristalsis
2. Bilious vomiting
3. Palpable tumour
4. Melena

Which of these is/are feature/features of infantile hypertrophic pyloric stenosis?

Accepted Answer

1 and 3 only

Answer

2 and 4

Answer

4 only

Answer

1, 2 and 3

Gastroenterology — MCQs

Gastroenterology — MCQs

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