גסטרו Flashcards
מה כולל רפלקס ההקאות
ירידת הסרעפת, כיווץ שרירי הבטן והרפיה של הקרדיה של הקיבה
VACTERL syndrome clinical presentation?
V- vertebral anomalies 70%
A- anorectal malformaiton 50%
C- CV anomalis 30%
T- trachesophageal fistula 70%
E- esophageal atersia
R- Renal anomalies 50%
Limb defects- 70%
לרוב יהיה עורק אומביליקלי אחד
which other congenital lesions is most a/w esopahgeal atresia?
Tracheoesopahgeal fistula
90%
Dgx of esophageal atresia?
polyhydrmanoius, no air bubble in stomach
inability to pass zonda to the stomach
Tx- urgent surgery
first, second the third line for infant reflux?
fisrt line- no tx. 88% resolve within 1 yr of age
2nd line- PPI
3rd line- surgery
which disease is more common vomiting, dysphagia, atopic kids, paon in middle upper abdomen?
Allergic esoinophilic esophagitis
Dgx- biopsy
Tx- הפחתת צריכת מזונות אלרגניים, קו שני סטרואידים
Bird beak sign? and dgx?
Acaalesia
dgx- monometria
vomiting in infant age 1 wk- 5 month, with lab reasults of unconjugated hyperbili + metabolic alkelosis hypochloremic we should suspect?
pyloric stenosis
Olive sign in exmination of infant?
pyloric stenosis
Dgx- US
Tx for pyloric stenosis?
hydration + elctrolital repair. surgery
most common congenital GI malgormation in kids?>
Meckels diverticulum
50% of bleeding from lower GI in kids < 2 yrs
remenmant of vitelline duct in the ilium
position of meckel diverticulum?
50-70 cm from iliocecal valve
meckel diverticulum
clinical presentation?
complication?
Dgx?
Tx?
clinical presentation:
painless rectal bleeding and anemia < 2 yrs of age
complication- instetine obstruction, diverticulosis, perforation
Dgx- meckel scan = מיפוי טכניציום - will glow in the stomack and in the divrticulum due to ectopic gastric mucosa
Tx- surgical resection
מהי אנקופרזיס ובאיזה מצב נוכל לראות אותה בילדים?
בריחת צואה מעל גיל 4.
במצב של עצירות / עצירות פונקציונאלית - אי נוחות ללכת לשירותים בבית הספר / גמילה מוקדמת מדי
טיפול בעצירות
ריכוך צואה ותזונה עשירה בסיבים
what is the most common cause of obstruction in lower GI tract (colon)
functional obstraction = Hirshpaung
80% in recto-sigmoid part
definitive Dgx of Hirshpung?
biopsy with absence of gnaglions (2 cm above dentate line)
most common age of intussuscepttion
(התפשלות מעי)
6m-3 yrs
conditions that are a/w intussuseption in kids > 3 yrs
4
- HSP
- lymphoma
- Meckels diverticulum
- polyps- most common
10 month old present with abdominal pain.
on exmination a sausage like feeling. in RUQ with bloody jelly stool and latregy within colic episode
what is the most likley dgx?
what is the tx?
intussuseption
Tx- air / barium anema 80-95% success rate
reccurence rate of intussuseption after anema and after laprotomia?
anema- 10%
surgery- 2-5%
Which vaccine is C/I after intussuseption
Rota virus
Volvulus
when is mostly common seen?
85% of cases- first year
50% first month
X-ray finding of deodunal atresia?
double bubble sign
what is the WHO recommendation for chronic diarrhea?
lactose free diet
שלשול אוסמוטי לעומת סקרטורי
באיזה מהם נמצא חומרים מחזרים בצואה?
שלשול אוסמוטי
most common reason for hypoalbuminemia?
loss trough urine due to kidney disease
Which marker can suggest loss of protein trough the GI Tract?
eleveted levels od alpha-1- AT in stool
Low levels of elastase in stool with loss weight is suggest of?
insufficency of exocrine pancreas
think CF- most common
Which allele is a/w celiac disease?
HLA-DQ2 /8
95% of pt
Extra intestianal menefistation of Celiac in
neurologic
dermatologic
endocrine
neuro- megaloblastic anemia- ataxia, neuropathy and epilepsy
endocrine- late puberty
derma- dermatitis herpetiformis, apthous somatitis
Which Autoimmune diseases are in a/w celiac?
DM type 1
williams
turner
addison
IgA deffic.
Sjoren
RA
down
Dgx of celiac for symptomatic pt?
for IgA deff.
and non IgA deff.
Dgx
TTG IgA < 10X of normal value»_space; dueodenal biopsy
or
TTG IgA > 10X of normal value»_space; HLA + anti- Endomysial - not need also biopsy
for IgA def
TTG IgG+ and as mention above (biopsy or HLA + anti-EM
pass for biopsy if TTG = at least X10 for normal value
a-symptomatic pt but high risk
dgx of celiac?
DM-1, Down, Sick 1st relative
HLA»_space; anti-TTG
Titer Ab > X3»_space; biopsy
Titer Ab < X3»_space; anti-EM»_space; biopsy
Which conditions are a/w IgA deficiency?
Celiac or like celiac syndrome
+
Anaphylaxis for blood transfusion
Dgx- serum IgA < 10 mg/dL with normal other Ig.
which electrolyte disbalance is a/w acute pancreatitis?
Hypocalcemia
Tx for acute pancreatitis?
nasogastric tube
PPI
* imipenem- if necrosis or infection
* ERCP- if stones
* Trauma / abcesses- surgery
prognosis- healing in 4-5 days
which Abs are a/w autoimmune pancreatitis?
IgG4
in kids mainly heart involve with normal levels of IgG4
Tx- steroids
Which gene is involve in Wilson disease?
ATP7B
should connect copper to ceuroplasmin in order to excrete trough the bile
if ceuroplasim is not connected to copper its going degradation
Dgx of wilson disease?
low levels of ceuroplasmin in blood
+ high serum copper leves and 24h of high copper in urine
Tx for wilson?
D-phenycylamine - copper cathelathor
liver damgage + neurologic signs as tremor, worsening hand writing, decrease school performance
with hemolytic anemia and low ceuroplasmin levels
which disease?
wilson disease
Which autoimmune disease can be in a/w Autoimmune hepatitis?
SLE
autoimmune hepatitis (AIH)
type 1 and type 2 Abs?
high IgG
Type 1- ANA, ASMA
type 2- anti- LKM1
Which type of cells and necrosis in seen in hepatocytes in AIH
Plasma cells and lympocytes
Piecemeal necrosis
Tx for AIH?
Steroids and Imuran/ MP6
Approch to swollowing foreign object:
- in stomch
- in esophagus
- when we need to sugcally intervention
- in stomch- supportive.
- in esophagus-endoscopy
- surgery intervention- > 1 magnet, lead objects, lithum battery, large battey > 48 hrs in stomach, large and sharp objects.
C/I for Gastroscopia?
peritonitis signs
