BRS- Gastro Flashcards
Percent of diet comprised of carbs? proteins?
carbs: 50%
protein: less than 30% (2.2g/kg in baby, 0.8 in adults)
What are micronutrients
vitamins and trace minerals
Vitamin deficiency assc with night blindness and dry cornea
vitamin A
Vitamin deficiency that leads to low phosphate levels
vitamin D
Vitamin deficiency that leads to poor wound healing, immunodeficiency, skin lesions
zinc
Vitamin deficiency that leads to dermatitis, diarrhea, dementia
niacin (pellagra)
Vitamin deficiency that leads to edema, bleeding gums, poor wound healing
Vitamin C (scurvy)
Describe features of Beriberi + what vitamin deficiency causes it?
cardiac failure
peripheral neuropathy
wernickes
B1, thiamine
Vitamin deficiency that causes dermatitis, glossitis, microcytic anemia, peripheral neuritis
B6, pyridoxine
B12 (aka ____) causes ____ anemia, elevated _____ levels, and ______sx.
cobalamin
macrocytic
methylmalonic acid
neuro
Protein deficiency is called ______. Total calorie deficency causes _____.
protein: kawashiorkor
total: marasmus
Kwashiorkor distinct symptoms (3)
hair loss
abnormal skin pigmentation
abdominal swelling
Three general symptoms of malabsorption
- diarrhea
- FTT
- abdominal distention
Test for carbohydrate malabsorption
- clinitest (tests for reducing sugars)
- pH below 5.6 (bacteria turn sugars to acid)
Three causes of protein malabsorption
- congenital enterokinase deficiency
- protein losing enteropathy
- inflammatory disorders
Test for protein malabsorption
stool levels of a1-antitrypsin
serum levels of albumin
Causes of fat malabsorption
- exocrine pancreatic insufficiency (CF, pancreatitis, schwachman diamond syndrome)
- intestinal mucosal atrophy
- bile acid deficiency
- abetalipoproteinemia
Cause of fat malabsorption assc with acanthocytes on peripheral smear
abetalipoproteinemia
Schawchman Diamond Syndrome:
- inheritance pattern
- labs
- symptoms
- AR
- neutropenia vs pancytopenia
- FTT, fat malabosorption (PI)
Frequency of protein intolerance in children + most common source of reactions
8%, cows milk
2 possible manifestations of protein intolerance
enteropathy (progressive diarrhea)
enterocolitis (acute diarrhea + rectal bleeding)
Protein intolerance prognosis
usually transitory and resolves within 1-2 years
acute symptoms resolve 1-2 weeks after withdrawl of stimulus
How common is celiac disease in the US?
Most common age of onset?
1/250
6 months- 2 years
Biopsy location + findings in celiac disease
small bowel
flat villi, deep crypts, vacuolated epi with lymphocytes
Antibodies assc with celiacs
IgA endomysial
serum tissue transglutaminase
antigliadin IgG
Celiacs long term consequences
growth failure + delayed sexual maturity
Causes of small bowel syndrome
- congential lesions (gastroschisis, volvulus, atresia)
- post op for nec. enterocolitis
- chrons, tumors, radiation
If distal small bowel is missing in SBS, ______ are not reabsorbed
B12, bile acids
Treatment for SBS
- TPN
- small bowel transplant with life threatening rxn to TPN
Complications assc with TPN:
- TPN cholestasis
- gallstones
- renal stones
- baterial overgrowth
- secretory diarrhea
Pathophys of GERD (2)
TLESR
Gastric emptying delay
When does emesis assc with GERD generally resolve
6-12 months of age
How does painful esophagitis present in a baby?
Sandifer syndrome (torticollis, arched back)
Symptoms of esophagitis in older kids:
- chest pain
- morning nausea
- hoarseness
- halitosis
Respiratory sequelae assc with GERD
-upper + lower airway disease worsened with GERD due to induced bronchopulmonary constriction
Describe progression of esophagitis –> cancer
chronic inflammation leads to : squamous cell –> columnar cell (barretts) –> adenocarcinoma of the esophagus
Gold standard for diagnosis of GERD
pH probe measurement
constant measurement of esophageal pH over 18 hours
Conservative management of GERD:
thicken feeds, sit up after feeds
H2 blockers, PPis
Pyloric stenosis:
- MC symptom
- MC sex
- nonbilious projectile vomiting in the second or third week of life
- first born males
PE findings in pyloric stenosis + acid base status
“olive” to the upper right of the umbilicus
visible abdominal peristaltic waves
hypochloremic hypokalemic alkalosis
Gold standard for diagnosing pyloric stenosis
U/S = string sign
Treatment of pyloric stenosis
partial pyloromyotomy
Midgut volvulus:
gut rotates around _____
more common in what population?
SMA (assc with Laads bands); males
Normal rotation of gut in utero
-counterclockwise around SMA at 10 weeks
Diagnosis of volvulus
UI contrast imaging shows ligament of treitz right/ jejunum to the right of midline
Classic symptom malrotation:
sudden (bilious) vomiting in otherwise healthy baby
Treatment of malrotation:
surgery +/- TPN
Cause duodenal atresia + assc condition
failure of small bowel to recanalize at 8-10 weeks
downs syndrome
Clinical features duodenal atresia
- polyhydramnios in utero
- scaphoid abdomen
- emesis/ FTT
- double bubble sign on imaging
Treatment duodenal atresia
surgical
Jejunoileal atresia:
cause
symptoms
dx
mesenteric vascular accident
bilious vomiting in first few days of life
radiographs show air fluid levels at lower SI
Treatment of jejunoileal atresia
surgical resection and anastomosis
Peak incidence of intussusception; MC location
5-9 month old males; ileocolic
How commonly is lead point identified in IS
5% of cases (ie Meckels diverticulum)
Clinic features of intussusception
- currant jelly stool
- sudden onset colicky pain
- sausage shaped mass
Dx and tx of intussusception
-constrast enema to dx, acutally relieves 80-90% cases, surgical treatment of remaining cases
Acute abdomen:
- signs of intestinal obstruction
- signs of peritonitis
obstruction: high pitched bowel sounds
peritonitis: diminished or absent bowel sounds, rigidity