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GIT > 29 Jan 24 > Flashcards

29 Jan 24 Flashcards

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1
Q

Newborn with bilious emesis and h/o omphalocele

A

Intestinal malrotation

Omphalocele and malrotation occur around same gestational age but malrotation isnt identified until pt is symptomatic.

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2
Q

Malrotation types and SS

A

Midgut volvulus. :

     Life threatening 
     Acute bilious emesis 
     Abd distention
     INTERMITTENT VOLVULUS causes chronic SS (episodic bilious emesis , abd pain , irritability , inconsolability)

Duodenal obs:

       Complete obs Presents acutely 
       Caused by ladds bands (cross duodenum and attach cecum to abd wall)
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3
Q

DX of malrotation

A

Clinical
Exam between episodes mayb normal
DX confirmed by Upper GI series.

Ttt:
Surgery (ladds procedure)

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4
Q

Vascular ring CF

A

🚨Esophageal compression
🚨tracheal comp give biphasic stridor prominent with work of breathing -crying , feeding.
🚨Solid food dysphagia
🚨Child is well until 6mo due to all liquid diet.
🚨At weaning dysphagia becomes prominent.
🚨Recurrent food impactions at T3-T4 sitebof aortic arch
🚨HO episodes of pneumonia

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5
Q

DX of vascular ring and ttt

A

CT scan
May require laryngoscopy , bronchoscopy , echo

Ttt:
Surgery

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6
Q

Beckwith Wiedeman syndrome Features

A

Fetal macrosomia , rapid growth until late childhood
(Close monitoring for hypoglycemia due to fetal hyperinsulinemia)
Omphalocele or umb hernia
Macroglossia
Hemihyperplasia

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7
Q

BWS complications

A

Wilms tumor
Hepatoblastoma

Screen. : Abd USG
Alpha Feto protein (3mo to 4years)
Renal USG ( 3mo to age 4-8y)

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8
Q

Meckel diverticulum patho

A

Persistent vitelline duct (obliterates in first trimester)

Often contains ectopic Gastric mucosa ➡️ intestinal ulceration and bleeding

Rule of 2 :

Presents by age 2
<2cm long
Located within 2feet of ileocecal valve

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9
Q

CF of meckel D

A

AS patient with painless rectal bleed and iron def anemia.

Acute abd pain due to :
Intussusception (do abd USG to see telescoping. )
Diverticulitis
Bowel obs , perforation (peritoneal signs)

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10
Q

Mech of bleed in Meckel diverticulum

A

MD contains ectopic gastic tissue that makes HCl.

Acidity causes ulceration and bleed
Hence pallor and anemia.

Stools can range from dark red to maroon depending on colon transit time.

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11
Q

MD complication

A

Serves as lead point for intussusception
Hence causing obstruction.

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12
Q

MD dx and ttt

A

Technetium pertecnetate scan identifies ectopic gastric tissue.

Ttt : symptomatic pts. Should have surgery.

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13
Q

Environmental RF for Pancreatic Ca

A

CIGARETTE smoking
Obesity
Low physical acitivity
Non hereditary Chr pancreatitis

Smoking cessation reduces risk by 25%

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14
Q

Hereditary RF for pancreatic CA

A

First degree relative with P CA
Hereditary pancreatitis
BRCA 1 , BRCA 2 ,Peutz jeghers syndrome

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15
Q

Pancreatic CA presentation

A

⚽️Weight loss , fatigue , anorexia
⚽️Subacute abd pain
⚽️Jaundice
⚽️Unexplained migratory superficial thrombophlebitis

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16
Q

Labs for pancreatic CA

A

⬆️ ALP due to cholestasis
⬆️ direct Bili

(Tumor if pancreatic head compresses on CBD and pancreatic duct leading to cholestasis and ductal dilation)

⬆️CA 19 9

Abd USG : initial imaging

CT scan. : If USG is nondiagnostic

🤪tumor of body and tail do not present with jaundice. Only pain.

17
Q

Pancreatic CA and DM

A

Atypical DM (DM in thin old pt) raises suspicion

Screen newly diagnosed diabetics (<2yrs of dx ) if signs
Gnawing constant epigastric pain
Weight loss

18
Q

Pt with Back pain smoking weight loss and normal spine imaging

A

Tumour of pancreatic tail

19
Q

Mech of back pain in pancreatic tail CA

A

Constant back pain worse at night and while lying supine.

👉🏼Pancreas lies retroperitonealy against post abd wall
👉🏼Innervated by T5-T10
👉🏼Pancreatic tumors irritate visceral afferent fibres
👉🏼Referred back pain to thoracic vertebrae
👉🏼Normal spinal imaging

20
Q

Imaging modality for pancreatic Ca

A

CT scan > 90% sensitive

21
Q

Lifestyle RF of colon Ca

A

Red meat
Tobacco
Alcohol

22
Q

RF for colon CA

A

🗞Inherited Cancer syndromes

 FAP , lynch

🗞Personal family history of adenonatous polyps , Colon CA
🗞ulcerative colitis
🗞 diabetes/obesity
🗞 prior abd /pelvic Radiation
(>4x higher than gen pop)

Diabetes red meat and obesity have small risk. Do not warrant early screen.

23
Q

Screening for colon Ca guideline for pts with HO prior radiation

A

Start early (age 30-40) than average risk (age 45)

24
Q

Protective factors for Colon Ca

A

High fiber diet
Aspirin / NSAID use

25
Q

Zollinger Ellison syndrome CF

A

🎱Multiple and refractory peptic ulcers
🎱Ulcers distal to duodenum
🎱Chronic diarrhea

26
Q

ZES mech

A

Uncontrolled gastrin secretion causes parietal cell hyperplasia causing ⬆️gastric acid.

Gastric acid causes
Inactivation of pancreatic enzymes and injury to mucosal brush border.
Leading to diarrhea and steatorrhea

27
Q

DX of ZES

A

Gastrin >1000
Gastric acid ph<4
Endoscopy shows ulcers
Screen for MEN1
PTH assay
Ionized Ca
Prolactin
CT/MRI & somatostatin receptor scintigraphy for tumor localization

28
Q

MEN 1 tumors

A

Pituitary
Pancreas
Parathyroid

29
Q

Trosseau syndrome

A

Hypercoagulable disorder causes recurrent superficial venous thrombosis at unsual sites
Ass with occult visceral malignancy esp pancreas.

30
Q

Lynch syndrome ass Cancers

A

Endometrial CA
Ovarian CA
Colorectal CA

31
Q

Lynch syndrome Genetics

A

Germline mutation in a DNA mismatch repair gene.
Strong family history (>3 relatives involving multiple generations)

32
Q

Screening in lynch syndrome

A

Colonoscopy
Endometrial biopsy (age 30-35 )
Prophylactic hysterectomy with BSO at age 40 ( or family complete )

33
Q

Intussusception Patho

A

Telescoping (mostly ileocecal segment)
Bowel edema ➡️ ischemia and necrosis
Age 6mo to 3yrs

34
Q

Intussusception RF

A

Hypertrophy of pyer patches (recent viral illness)

Pathologic lead point (meckel , HSP, intestinal tumors)

35
Q

Intussuception CF

A

Sudden intermittent abd pain and vomit
Sausage shape mass in RT abd
Currant jelly stools
Lethargy or Altered mental status

36
Q

DX of intussuception

A

USG : telescoping
Air / saline enema
Surgery

37
Q

Pt with recurrent intussuceptions

A

Do nuclear scintigraphy / technetium pertecnetate for meckel D.

Screen in pts with intussuception who have:

Recurrent episodes
Atypical location
Atypical age
Persistent rectal bleed despite reduction

GIT (20 decks)

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