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7feb 24 Flashcards

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1
Q

Bloody stools , intermittent abd pain
HO viral infection

A

Intussusception

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2
Q

Pathogenesis and epidemiology of intussusception

A

Telescoping of one bowel segment into adj segment (ileocecal)

Bowel edema ➡️ ischemia & Necrosis

Age 6M to 3Y most common

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3
Q

RF of intussusception

A

Hypertrophy if peyer patches (recent viral illness

Pathological lead point (meckel diverticulum , HSP , Intestinal tumor )

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4
Q

CF of intussusception

A

🤮Sudden intermittent abd pain and vomiting
🤮bouts of pain are progressive

🤮symptom free between episodes

🤮Pt drawing legs up towards abdomen with pain (flexes hips and crying inconsolably)

🤮Emesis may follow pain initially non bilious and later bilious as obstruction persists.

🤮Sausage shaped mass in Rt abdomen
(Normally ileocecal junction is in RLQ but invagination of ileum into Colon causes mass to be found in Rt middle or upper abdomen)

🤮Currant jelly stools (from bowel wall ischemia )

🤮Lethargy or AMS

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5
Q

Dx and Ttt

A

USG : Target sign

Ttt:

Air (pneumatic) or saline enema

Surgical intervention for failed enema reduction or signs if peritonitus

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6
Q

Necrotizing enterocolitis pathogenesis

A

Gut mucosal wall invasion by gas producing bacteria

Intestinal inflammation , Necrosis

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7
Q

RF for Necrotizing enterocolitis

A

⚽️Prematurity

     Premature infants have dec bowel motility , inc intestinal permeability , immature host defenses

⚽️Very low birth wt. <1.5kg. 3lb 4oz

⚽️Enteral feeds (exposure to bacteria)

⚽️Infants with reduced mesenteric Oxygen delivery (cyanotic heart dx , hypotension)
Poor intestinal perfusion causes mucosal inf and necrosis and translocation of gas producing bacteria into bowel wall

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8
Q

CF of NE

A

Non specific :

    Apnea 
    Lethargy 
    Vital Sign instability 
    Leukocytosis
    Metabolic acidosis

GI :

   Abd distention
   Feeding intolerance , bilious emesis
   Bloody stools
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9
Q

Xray finding of NE

A

Pneumatosis intestinalis (air in bowel wall)
Pneumoperitoneum. (Free air under diaphragm)
Air in portal venous system

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10
Q

Complications of NE

A

Sepsis

DIC

Late : strictures , short bowel syndrome

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11
Q

Management if Necrotizing Enterocolitis
Immediate ttt

A

Discontinue enteral feeds
NG decompression
Blood cultures and empiric antibiotics
IV fluid repletion

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12
Q

Monitoring Of NE

A

Serial complete CBC , electrolytes
Serial abd exams and imaging

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13
Q

Indication for surgery in NE

A

Bowel perforation (pneumoperitoneum)

Clinical deterioration despite medical management (bowel necrosis)

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14
Q

Delayed passage of meconium cause s

A

Hirshsprung dx
Meconium ileus

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15
Q

Pathophys of hirshsprung dx

A

Failure of neural crest cell migration

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16
Q

Hirshsprung dx level of obs

A

Rectosigmoid

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17
Q

Rectal exam of hirshsprung

A

Inc rectal tone
Positive squirt

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18
Q

Meconium consistency in HD

A

Normal

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19
Q

Dx of HD

A

Plain Xray :
Dilated bowel loops
Absent rectal gas

Contrast enema :

🛞Dilated descending colon
🛞Abrupt transition (between dilated proximal colon and aganglionic segment )
🛞Narrow sigmoid colon

Biopsy :
Rectal suction biopsy (diagnostic) shows absence of ganglion cells

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20
Q

HD associations

A

Downs

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21
Q

Meconium ileus pathophys

A

Obstruction by inspisstaed stool

Ass with Cystic Fibrosis

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22
Q

Obstruction level of Meconium Ileus

A

Iluem

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23
Q

Rectal exam of MI

A

Normal tone
Negative squirt

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24
Q

Consistency of stool in MI

A

Inspissated

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25
Q

Imaging of MI

A

Dilated small bowel
Microcolon

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26
Q

Ttt of HD

A

Surgery

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27
Q

HD S/S

A

Neonates :

Delayed passage of meconium
Bilious vomiting
Enterocolitis

Children/ adolescents :

Chronic constipation
Failure to thrive

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28
Q

HD physical exam

A

🌻Distended abdomen
🌻Tight anal sphincter
🌻Absence of stool in rectal vault
🌻Forceful stool expulsion on rectal exam

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29
Q

STEC pathogenesis

A

🍀Ingestion of contaminated undercooked beef or contact with farm animals.

🍀 isolated cases without clear source very common.

🍀 invasion of intestinal epi cells

🍀production of shiga toxin

30
Q

CF of Ecoli infection

A

🍔Watery ➡️ bloody diarrhea within 3 days

🍔No high fever (altho low grade fever <101.3 may occur)

🍔 presence of high grade fever suggests another dx

31
Q

Dx of STEC

A

Multiplex stool PCR testing

Stool shiga toxin assay

Stool culture

32
Q

Ttt of EColi infection

A

Supportive (aggressive fluid)

Avoid antibiotics. And antidiarrheals
(To prevent HUS)

33
Q

Complication of STEC

A

HUS ( develops 1-2 weeks after diarrhea onset)

34
Q

Pt with abd pain and watery loose stools and then blood streaked stools. Fever 101.8
Dx

A

Campylobacter

35
Q

Infectious ileocecitis pathogenesis

A

Also called pseudoappendicitis

Caused by yersinia and campylobacter

Predilection for ileocecal area

Periumb and RLQ pain (like appendix)

May initially infect jejunum and then ileum and cecum.

Watery , mucoid or bloody stools

With Fever nausea vomiting

36
Q

Campylobacter gastroenteritis CF

A

Fever , abd pain

Mucoid/ watery or bloody diarrhea

RLQ pain due to acute ileocecitis

37
Q

Ttt of acute ileocecitis

A

Supportive self limiting (<7days)

AB.
Indications. ;

    Duration >7days 
    Bloody stools 
    High fevers 
    Pregnant 
    Immunocomp
    Elderly
38
Q

Complications of Campylobacter gastro

A

GBS
Reactive arthritis

39
Q

Dx of campylobacter ileocecitis

A

🌹Imaging
USG
CT
To show ileocecal inf with sparing of appendix

🌹Stool mutiplex PCR , Culture

🌹Surgery not req

40
Q

Pathologic Pediatric constipation RF

A

Delayed meconium passage

Down syndrome ( HD , intestinal atresia /stenosis)

41
Q

Causes of functional constipation

A

Solid food introduction

Toilet training

School entry

Hx:Absence of pathologic features 
      Painful , infreq large caliber or pellet like stools 
      Fecal soiling (encopresis)
42
Q

Presentation of pathologic constipation in paeds

A

Poor weight gain
Poor linear growth
Narrow ribbon stools
Blood mixed in stool
Bilious vomiting or fever

43
Q

Presentation of functional constipation in paeds

A

Absence of pathologic feature s

Painful infreq large caliber or pellet like stools

Fecal soiling (encopresis )

44
Q

Examination findings of constipation

A

Functional:

    Absence of pathologic features 
    Mild abd distention
    Anal fissure (rectal bleed)

Pathological :

   Displaced anus , incr rectal tone or sacral anomalies (hair tuft) 

   Abnormal lower extremity neurologic features (weakness) 

  Severe abd distension
45
Q

How to manage constipation

A

Pathologic :

    Workup for celiac dx , hypothyroidism
   HD , CF , spinal dysraphism

Functional:

 Age appropriate toilet training 
 Dietary changes (fiber , water) 
 Laxatives (polyethylene glycol)
46
Q

Jejunal atresia Causes

A

Poor fetal gut perfusion in utero due to use of vasoconstrictive medicines or substance use (cocaine) and tobacco.

Necrosis and resorption of fetal intestine leaving behind blind proximal and distal ends of intestine.

Can occur anywhere in GIT. Mostly ileum or jejunum

Not ass with any chromosomal abnormalities.

47
Q

Dx and ttt of jejunal atresia

A

Dx : Abd Xray
Triple bubble sign
(Gas trapping in stomach duodenum jejunum)

Ttt:

  Resusitate stabilize 
  Surgery
48
Q

Most common GI anomaly of down syndrome

A

Duodenal atresia

49
Q

Duodenal atresia CF

A

Bilious vomiting in first 2 days of life.

No abd distension as gas cant move forward.

H/O polyhydramnios

Xray shows double bubble sign
And no distal gas.

Ttt: No Enteral feeds
NG decompression
Surgery.

50
Q

Surveillance in Duodenal atresia

A

Echo
For VSD or ASD (ass with downs )

51
Q

Food protein induced allergic proctocolitis
Presentation

A

Age <6Mo
1-4week after initial exposure to offending protein

Painless bloody stools

In a well appearing patient.

52
Q

Cause of FPIAP

A

Cows milk (casein or whey )
Soy proteins

53
Q

What is FPIAP?

A

Non IgE mediated reaction in which a protein in infants diet (breast milk or formula ) causes eosinophilic inf of distal colon or rectum.

54
Q

Ttt of FPIAP

A

Formula fed babies : Switch to hydrolyzed formula

Breast fed babies ; Restrict dairy (soy ) from maternal diet

Pts tolerate products containing offending protein (milk , yogurt ) by age 1.

55
Q

RF of FPIAP

A

Eczema
FH of food allergies

56
Q

Food protein induced enterocolitis syndrome presentation

A

Age <12 Mo
Non IgE mediated
Happens in hours.

Profuse vomiting
Diarrhea bloody or non bloody
Dehydration
Lethargy
Ill appearing

57
Q

IgE mediated food allergy in children

A

Anaphylaxis
(In less than 1 hr)

58
Q

Meconium ileus Pathophy

A

Inspissated stool causing obs at terminal ileum

Related to CF

59
Q

CF of meconium ileus

A

Failure to pass meconium within 24hr of birth
Abd distension
No stool in rectal vault
Bilious emesis

60
Q

DX of meconium ileus

A

Xray : Dilated bowel loops
Contrast enema. : microcolon
CF testing (sweat test

61
Q

Ttt for meconium ileus

A

Hyperosmolar enema
Surgery

62
Q

Association of meconium ileus

A

🪵Chronic Rhinosinusitis
🪵Can occur as early as age 1
🪵Often ass with nasal polyps
🪵Due to thick viscous secretions and impaired mucociliary clearance in sinuses and resp tract

63
Q

Straining infant how to approach

A

If ill appearing or red flags
(Severe distension, abnormal rectal tone , sacral findings , delayed passage of meconium, failure to thrive)

Look for :
HD
CF
Spinal dysraphism
Hypothyroidism

If well appearing :

🌞loose stools (blood or mucus ) 
           FPIAP
🌞normal consistency
            Normal infant dyschezia 
🌞 hard pellet like stool
           Functional constipation 
           (Anal fissure if blood)
64
Q

Infant dyschezia CF and ttt

A

Straining and crying
Turning red in face
Straining fir greater than 10mins followed by passage of soft nonbloody stool
Well appearing normal child

Management:

Resolves by 9mo
Only reassure

65
Q

Pathogenesis of infant dyschezia

A

Failure to coordinate Inc intraabd pressure with relaxation of pelvic floor muscles

Inadequate abd muscle tone to produce an effective Valsalva maneuver

66
Q

Imp CF to remember about hirschsprung Dx

A

🪴 dx severity correlates with length of non functional colon
Pts with short aganglionic segment remain undiagnosed with chronic constipation for years

🪴 altho absence of stool in 48hrs of life is classic , passage of meconiun doesnt exclude HD

🪴 increased rectal tone and squir sign are classic SS

🪴 transition zone is characteristic

67
Q

SS of HD in neonates and children

A

Neonates:

  Delayed passage of meconium
  Bilious vomit 
  Enterocolitis

Children/adolescents :

   Chronic constipation 
   Failure to thrive
68
Q

Congenital hypothyroidism CF

A

A/S at birth (rarely causes delayed meconium)
After maternal thyroxine wanes (wks to Mo)

Lethargy
Poor feeding
Enalrged fontanelle
Protruding tongue puffy face umb hernia
Constipation
Prolonged jaundice
Dry skin

69
Q

How to determine degree of mild dehydration in babies. ?

A

Mild dehydration:
3-5% losses
Dec intake
Inc fluid loss
No clinical symptoms

70
Q

Moderate dehydration in babies signs

A

6-9% vol loss
Decreased skin turgor
Dry MM
Tachycardia
Irritability
A delayed capillary refill (2-3 )
Dec urine output

71
Q

Severe dehydration in babies signs :

A

10-15 volume loss
Cool clammy skin
Delayed cap refill >3sec
Cracked lips
Dry MM
Sunken eyes
Sunken fontanelle
Tachycardia
Lethargy
Min to No urine output
Hypotension or Shock

72
Q

Ttt of dehydration

A

🌸Mild to moderate : Oral rehydration therapy

🌸Moderate to severe:

IV crystalloids bolus
Dextrose is given as maintenence (not used as initial fluid resuscitation)

GIT (20 decks)

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