Surgical GI Disorders MCQs

Ans. is 'a' i.e., Rectal biopsy o Rectal suction biopsy is procedure of choice.

Answer- A. CHPS Projectile vomiting in 4th week is quite suggestive of CHPS. In duodenal atresia the vomiting (usually bilious) is right from the 1st day of life. NEC and Hirschsprung's disease have different clinical presentation.

The newborn girl has findings that are suggestive of congenital diaphragmatic hernia. Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest. Although routine prenatal ultrasound screening may identify CDH at a mean gestational age of 24 weeks, there is a wide range of reported sensitivity in its detection. Physical findings include a barrel-shaped chest, a scaphoid-appearing abdomen (because of loss of the abdominal contents into the chest), and absence of breath sounds on the ipsilateral side. Reference: Avery's diseases of the newborn, 1 st SA ed., pg. 772

Things to know and remember about Rotavirus Vaccine: Vaccine withdrawn due to intussusception risk: Rotashield (Oral) Vaccine part of National Immunization Schedule: Rotavac (Oral) How many doses are recommended in NIS: 3 doses, given at 6, 10 and 14 weeks of age. Catch-up vaccination upto: 1 year Other Rotavirus Vaccines: Rotateq, Rotarix, Rotasiil Reference: OP Ghai Essential Pediatrics, 10 th Edition, Page Number 200-201.

The key to making the diagnosis is age and features in this question. This infant likely has an H-type TEF, found later in infancy with recurrent pneumonias and/or feeding difficulty. Patients with esophageal atresia and distal fistula present in the first hours of life because of their inability to swallow oropharyngeal secretions. Infants with imperforate anus also present as neonates. All patients with TEF are at high risk for gastroesophageal reflux. Reference: Nelson textbook of pediatrics, 1 st SA ed., pg. 1783

Hepatic fibrosis is not mentioned as a complication in CDH survivors. Among other options: Option B- Gastroesophageal reflux disease (GERD) is reported in >50% of children with CDH. GERD is more common in children whose diaphragmatic defect involves the esophageal hiatus. Option C- Recurrent diaphragmatic hernia is reported in 5-20% in most series. Option D- Intestinal obstruction is reported in up to 20% of children and may result from a midgut volvulus, adhesions, or a recurrent hernia that became incarcerated. Children with patch repairs are at highest risk. Children with CDH typically have delayed growth in the 1st 2 yr of life. Neurocognitive defects are common and may result from the disease or the interventions. Reference: Nelson 21 st Edition, Chapter 345.1

A water-soluble contrast enema is the investigation of choice in delayed passage of meconium since it is both diagnostic and therapeutic. It can diagnose Hirschsprung disease, meconium ileus, atresias Can also remove meconium plug in meconium plug syndrome and have therapeutic action. Reference: Nelson 21 st Edition, Chapter 358

Symptoms developing beyond 48 hr of birth usually indicates a milder variant of CDH and thus has a better outcome. Extra-Edge: Poor prognosis predictors in congenital diaphragmatic hernia Lung: Head Ratio Severe pulmonary hypoplasia An associated major anomaly Herniation to the contralateral lung Symptoms before 24 hr of age Liver herniation into thorax CDH detected in the 1 st trimester Need for ECMO Reference: Nelson 21 st Edition, Chapter 122.10