GIT CASES 2016-2017 Dr. Athl Humo

Q1/ An 11 months old infant is presented because he has vomiting & diarrhea for the last 2 days. Examination gave an estimation of 12% fluid deficit. Weight is 10 kg; serum sodium is 135mmol/L. What are the physical finding expected to be seen in this infant? Calculate the amount of intravenous fluid required in the first 24 hours; mention the type of fluid you are going to give.

Q2/ A 10 months old infant has diarrhea and vomiting for 2 days duration. His weight is 10 kg. Examination revealed that he is conscious, but lethargy, has sunken eyes, poor skin turgor, and dry tongue. His pulse is rapid but still palpable, and his blood pressure is normal. His serum Na+ = 140 mmol What is the severity of this dehydration? Discuss in details the intravenous fluid and electrolyte management of this child.

Q3/ A 9-month-old is brought to the emergency center by ambulance Q3/ A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9.5 kg, down from 11 kg the week prior at her 9-month checkup. You note her heart rate and blood pressure to be normal. She is lethargic, and her skin is noted to be “doughy.” What is the diagnosis? What is the investigations need to done? How you treat this infant?

Q4/ You are admitting to the hospital a 3-month-old infant who has been having poor feeding, emesis, and diarrhea for 3 days. In the emergency center, her electrolytes were found to be: sodium 160 mEq/L, potassium 2.8 mEq/L, blood urea nitrogen (BUN) 68 mEq/L, and glucose 195 mEq/L. She was given a fluid bolus in the emergency center and has subsequently produced urine. Which of the following is the most appropriate next step in her management? a. Slow rehydration over 48 hours b. Continued rapid volume expansion with 1/4 normal saline c. Packed red blood cells (RBCs) d. Rehydration with free water e. Urinary electrolytes

Q5/ An awake, alert infant with a 2-day history of diarrhea presents with a depressed fontanelle, tachycardia, sunken eyes, and the loss of skin elasticity. Which of the following is the correct percentage of dehydration? Less than 1% 1% to 5% 5% to 9% 10% to 15% More than 20%  

Q6/ 1.5 year old baby, have history of watery diarrhea 14 days ago that last 7 days, then diarrhea improve & the baby return to normal feeding. Now the mother consult a physicion because her baby return to have loose stool in last 4 days associated with flatulance and borborygmi. What is the dignosis? What are the investigation that support the diagnosis? What is treatment?

Q7/ 3 months old baby, he is on exclusive breast milk since birth, 2 weeks ago his mother added to him bottle milk. Now the mother consult a physicion because her baby complain of frequent bloody streaked stool with cough and mild dyspnoea. O/E the baby afebrile, good body build, well hydrated and there is bilateral rhonchi on auscultation of chest. What is the most likely diagnosis? What support your diagnosis? What is the treatment?

Q8/ 2 years old child, healthy of good weight, presented with attack of intermittent loose stools in the last 6 months. The mother gave history that her child drink excessive fruit juice. What is the diagnosis? What is the treatment?

Q9/ 1 year old infant, presented with frequent loose, offensive stool for 2 months duration. The baby on exclusive breast milk for 1st 6 months, then weaned to semisolid food and then solid food. O/E: the baby looks irritable, pale, FTT. What is the most likely diagnosis? How you confirm your diagnosis? What is the treatment?

Q10/ A mother brought her 4 weeks old male baby because he complain of severe vomiting, she is worry because he is her 1st baby, she said the vomiting is extremely forceful after every feeding, after vomiting the infant is hungry and wants to feed again. Also he has mild constipation & prolonged neonatal jaundice. What is the most likely diagnosis? What you suspect to found on clinical examination? What are the investigations that help you to confirm the diagnosis?  

 Q11/ A 10-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the 95th percentile, and she is otherwise asymptomatic and without findings on physical examination. What is the most likely diagnosis? What is the treatment?

Q12/ A 10-month-old baby boy, has a 5-hour history of crying, with intermittent drawing up of his knees to his chest. On the way to the emergency room he passes a loose, bloody stool. He has had no vomiting and has refused his bottle since the crying began. Physical examination is noteworthy for an irritable infant whose abdomen is very difficult to examine because of constant crying. His temperature is 38.8°C. The rectal ampulla is empty, but there is some gross blood on the examining finger. What is the diagnosis? What is the investigation need to done? How you treat this baby?

Q13/ A 3-year-old child presents to your office for an evaluation of constipation. The mother notes that since birth, and despite frequent use of stool softeners, the child has only about one stool per week. He does not have fecal soiling or diarrhea. He was born at term and without pregnancy complications. The child stayed an extra day in the hospital at birth because he did not pass stool for 48 hours, but has not been in the hospital since. What is the suspected dignosis? What is investigation that confirm the diagnosis? What is the treatment?

Q14/ A 15-year-old girl is admitted to the hospital with a 6-kg weight loss, bloody diarrhea, and fever that have occurred intermittently over the previous 6 months. She reports cramping abdominal pain with bowel movements. She also reports secondary amenorrhea during this time. Stool cultures in her physician’s office have shown only normal intestinal flora. A urine pregnancy test was negative, while an erythrocyte sedimentation rate (ESR) was elevated. Her examination is significant for the lack of oral mucosal ulcerations and a normal perianal examination. Anti-neutrophil cytoplasm antibodies (p-ANCA) are positive. What is the most likely diagnosis? How you confirm the diagnosis?

Q15/ An 20 mo old baby who was has recently weaned from breast milk is presented with generalized edema. He looks pale and miserable. Bilateral angular stomatitis is noticed. His weight is 8 kg. Urinalysis and liver function are normal. Serum albumin: 2.3mg/dl. What is the most likely diagnosis? What are the complications? Outline the treatment?

Q16/ A mother brings her 8-year-old son to your office with a chief complaint of abdominal pain. The pain started 24 hours ago and has grown progressively worse. It was initially generalized but has localized to the right lower quadrant. The patient had one episode of nonbloody, nonbilious emesis yesterday. He has had no stool today. He has not eaten today, and his urine output is moderately decreased. He denies dysuria. His mother carried him into the office, and he refuses to walk due to the pain. The physical examination reveals a well-nourished, well-developed child curled up on his side on the table, in obvious pain. His temperature is 100.7F, and he is slightly tachycardic, but otherwise, his vitals are within normal limits. No abdominal distension is noted; bowel sounds are hypoactive. Tenderness is localized to the right lower quadrant, and guarding is present. Which of the following conditions is the most likely cause of this child’s pain? A) Acute colitis B) Appendicitis C) Ulcerative colitis D) Pyelonephritis E) Pancreatitis

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