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Pediatrics > BRS- Gastro > Flashcards

BRS- Gastro Flashcards

1
Q

Percent of diet comprised of carbs? proteins?

A

carbs: 50%
protein: less than 30% (2.2g/kg in baby, 0.8 in adults)

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2
Q

What are micronutrients

A

vitamins and trace minerals

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3
Q

Vitamin deficiency assc with night blindness and dry cornea

A

vitamin A

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4
Q

Vitamin deficiency that leads to low phosphate levels

A

vitamin D

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5
Q

Vitamin deficiency that leads to poor wound healing, immunodeficiency, skin lesions

A

zinc

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6
Q

Vitamin deficiency that leads to dermatitis, diarrhea, dementia

A

niacin (pellagra)

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7
Q

Vitamin deficiency that leads to edema, bleeding gums, poor wound healing

A

Vitamin C (scurvy)

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8
Q

Describe features of Beriberi + what vitamin deficiency causes it?

A

cardiac failure
peripheral neuropathy
wernickes

B1, thiamine

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9
Q

Vitamin deficiency that causes dermatitis, glossitis, microcytic anemia, peripheral neuritis

A

B6, pyridoxine

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10
Q

B12 (aka ____) causes ____ anemia, elevated _____ levels, and ______sx.

A

cobalamin
macrocytic
methylmalonic acid
neuro

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11
Q

Protein deficiency is called ______. Total calorie deficency causes _____.

A

protein: kawashiorkor
total: marasmus

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12
Q

Kwashiorkor distinct symptoms (3)

A

hair loss
abnormal skin pigmentation
abdominal swelling

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13
Q

Three general symptoms of malabsorption

A
  • diarrhea
  • FTT
  • abdominal distention
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14
Q

Test for carbohydrate malabsorption

A
  • clinitest (tests for reducing sugars)

- pH below 5.6 (bacteria turn sugars to acid)

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15
Q

Three causes of protein malabsorption

A
  • congenital enterokinase deficiency
  • protein losing enteropathy
  • inflammatory disorders
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16
Q

Test for protein malabsorption

A

stool levels of a1-antitrypsin

serum levels of albumin

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17
Q

Causes of fat malabsorption

A
  • exocrine pancreatic insufficiency (CF, pancreatitis, schwachman diamond syndrome)
  • intestinal mucosal atrophy
  • bile acid deficiency
  • abetalipoproteinemia
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18
Q

Cause of fat malabsorption assc with acanthocytes on peripheral smear

A

abetalipoproteinemia

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19
Q

Schawchman Diamond Syndrome:

  • inheritance pattern
  • labs
  • symptoms
A
  • AR
  • neutropenia vs pancytopenia
  • FTT, fat malabosorption (PI)
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20
Q

Frequency of protein intolerance in children + most common source of reactions

A

8%, cows milk

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21
Q

2 possible manifestations of protein intolerance

A

enteropathy (progressive diarrhea)

enterocolitis (acute diarrhea + rectal bleeding)

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22
Q

Protein intolerance prognosis

A

usually transitory and resolves within 1-2 years

acute symptoms resolve 1-2 weeks after withdrawl of stimulus

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23
Q

How common is celiac disease in the US?

Most common age of onset?

A

1/250

6 months- 2 years

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24
Q

Biopsy location + findings in celiac disease

A

small bowel

flat villi, deep crypts, vacuolated epi with lymphocytes

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25
Q

Antibodies assc with celiacs

A

IgA endomysial
serum tissue transglutaminase
antigliadin IgG

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26
Q

Celiacs long term consequences

A

growth failure + delayed sexual maturity

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27
Q

Causes of small bowel syndrome

A
  • congential lesions (gastroschisis, volvulus, atresia)
  • post op for nec. enterocolitis
  • chrons, tumors, radiation
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28
Q

If distal small bowel is missing in SBS, ______ are not reabsorbed

A

B12, bile acids

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29
Q

Treatment for SBS

A
  • TPN

- small bowel transplant with life threatening rxn to TPN

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30
Q

Complications assc with TPN:

A
  • TPN cholestasis
  • gallstones
  • renal stones
  • baterial overgrowth
  • secretory diarrhea
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31
Q

Pathophys of GERD (2)

A

TLESR

Gastric emptying delay

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32
Q

When does emesis assc with GERD generally resolve

A

6-12 months of age

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33
Q

How does painful esophagitis present in a baby?

A

Sandifer syndrome (torticollis, arched back)

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34
Q

Symptoms of esophagitis in older kids:

A
  • chest pain
  • morning nausea
  • hoarseness
  • halitosis
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35
Q

Respiratory sequelae assc with GERD

A

-upper + lower airway disease worsened with GERD due to induced bronchopulmonary constriction

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36
Q

Describe progression of esophagitis –> cancer

A

chronic inflammation leads to : squamous cell –> columnar cell (barretts) –> adenocarcinoma of the esophagus

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37
Q

Gold standard for diagnosis of GERD

A

pH probe measurement

constant measurement of esophageal pH over 18 hours

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38
Q

Conservative management of GERD:

A

thicken feeds, sit up after feeds

H2 blockers, PPis

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39
Q

Pyloric stenosis:

  • MC symptom
  • MC sex
A
  • nonbilious projectile vomiting in the second or third week of life
  • first born males
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40
Q

PE findings in pyloric stenosis + acid base status

A

“olive” to the upper right of the umbilicus
visible abdominal peristaltic waves
hypochloremic hypokalemic alkalosis

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41
Q

Gold standard for diagnosing pyloric stenosis

A

U/S = string sign

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42
Q

Treatment of pyloric stenosis

A

partial pyloromyotomy

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43
Q

Midgut volvulus:
gut rotates around _____
more common in what population?

A

SMA (assc with Laads bands); males

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44
Q

Normal rotation of gut in utero

A

-counterclockwise around SMA at 10 weeks

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45
Q

Diagnosis of volvulus

A

UI contrast imaging shows ligament of treitz right/ jejunum to the right of midline

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46
Q

Classic symptom malrotation:

A

sudden (bilious) vomiting in otherwise healthy baby

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47
Q

Treatment of malrotation:

A

surgery +/- TPN

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48
Q

Cause duodenal atresia + assc condition

A

failure of small bowel to recanalize at 8-10 weeks

downs syndrome

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49
Q

Clinical features duodenal atresia

A
  • polyhydramnios in utero
  • scaphoid abdomen
  • emesis/ FTT
  • double bubble sign on imaging
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50
Q

Treatment duodenal atresia

A

surgical

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51
Q

Jejunoileal atresia:
cause
symptoms
dx

A

mesenteric vascular accident
bilious vomiting in first few days of life
radiographs show air fluid levels at lower SI

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52
Q

Treatment of jejunoileal atresia

A

surgical resection and anastomosis

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53
Q

Peak incidence of intussusception; MC location

A

5-9 month old males; ileocolic

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54
Q

How commonly is lead point identified in IS

A

5% of cases (ie Meckels diverticulum)

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55
Q

Clinic features of intussusception

A
  • currant jelly stool
  • sudden onset colicky pain
  • sausage shaped mass
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56
Q

Dx and tx of intussusception

A

-constrast enema to dx, acutally relieves 80-90% cases, surgical treatment of remaining cases

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57
Q

Acute abdomen:

  • signs of intestinal obstruction
  • signs of peritonitis
A

obstruction: high pitched bowel sounds
peritonitis: diminished or absent bowel sounds, rigidity

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58
Q

In an acute abdomen, CONSTANT pain suggests _____.

A

-strangulation, torsion

59
Q

Labs for acute abdomen:

A
  • CBC
  • U/A
  • AST/ALT
  • amylase/ lipase
  • pregnancy, STDs
60
Q

Peak incidence of appendictis occurs at what age?

A

10-12 years

61
Q

How soon after onset of symptoms does perforation occur in appendicitis?

+ Location McBurneys

A

36-48 hours

2/3 between umbilicus and ASIS

62
Q

1 and #2 causes of pancreatitis in kiddos:

A
  • trauma

- idiopathic

63
Q

Two PE “signs” assc with pancreatitis

A

Gray Turner- blueish flank regions

Cullens- bluish periumbilical region

64
Q

What lab is most specific for pancreatitis?

A

lipase (elevated longer than amylase as well)

65
Q

Describe pseudocyst assc with pancreatitis

A

collection of fluid containing pancreatic enzymes, self resolves in most cases

66
Q

MC management of pancreatitis

A

supportive

67
Q

Two types of cholecystitis

A
  • calculous

- acalculous (salmonella, shigella, e coli)

68
Q

Three conditions predisposing kiddos to chole

A

SCA
prolonged TPN
CF

69
Q

Describe “sign” assc with chole:

A

Murphys- pain with inspiration, causes inspiratory effort to stop with palpation of RUQ

70
Q

Define Chronic abdominal pain:

A

3+ consecutive months pain

71
Q

Function CAP more common in what sex?

A

females

72
Q

Describe functional CAP symptoms

A

5+ year old with periumbilical pain that does not interfere with sleep

73
Q

CAP caused by IBS presents how?

A

-infraumbilical + stool alterations

74
Q

Screening tests for CAP

A
  • CBC, AST/ALT, BMP
  • CRP, ESR
  • H pylori
  • Lactose breath testing
75
Q

Prognosis CAP

A

25% persists into adulthood

76
Q

MCC encopresis

A 
severe constipation 
(liquid stool leaks around a hard mass of retained stool through distended AR canal)
77
Q

Cause of more frequent stools in infant

A

breast feeding

78
Q

Average # stools in baby, 1 year, kiddo

A

baby: 4x/day, 2x/day 1 year, 1x/day kiddos

adults= variable (3x/day–>week)

79
Q

MC form of constipation in kiddos

A

FFR, caused by sentinel event

if organic, MC is hirschsprungs

80
Q

Symptoms of prolonged FFR:

A
  • encopresis
  • fecal halitosis
  • anorectal distention
81
Q

Define delayed meconium passage

A

more than 48 hours after birth

82
Q

Some important systemic causes of constipation

7

A
  • DM
  • hypothyroid
  • lead poisoning
  • botulism
  • CF
  • dehydration
  • celiacs
83
Q

IBD age of onset

A

bimodal (15-20, 50+)

84
Q

Males more commonly suffer from which IBD?

A

CD has 2:1 male: female predominance

85
Q

Location of inflammation: CD/UC

A

CD: transmural
UC: mucosa

86
Q

Which has skip lesions? UC/CD?

A

UC: contiguous
CD: skip lesions

87
Q

Complications of UC:

A

toxic megacolon
risk colon cancer
pyoderma gangrenosum
sclerosing cholangitis

88
Q

Location of intestine affected by UC:

A

rectum –> colon, can get proctitis vs pancolitis

89
Q

Location of intestine affected by CD:

A

any part, most commonly terminal ileum

90
Q

Which IBD is assc with abscesses/ fistulas etc?

A

CD

91
Q

Antibodies assc with UC

A

ANCA, 80% of cases

92
Q

Antibodies assc with CD

A

antisaccharomyces cerevisiae, 70% cases

93
Q

Rectal bleeding is more common in which IBD?

A

UC

94
Q

Medical treatment for mild IBD

A

sulfasalazine

95
Q

Treatment of perianal involvement in IBD

A

metronidazole

96
Q

How is intractable colitis cured in UC?

A

total proctocolectomy

97
Q

Which is surgery not commonly used in CD?

A

high recurrence rate post bowel resection

98
Q

Melena is suggestive of blood proximal to _____.

A

Ligament of Treitz

99
Q

GI bleed is confirmed by _____.
Cause of false negative (1).
Cause of false positive (3)

A

guiac testing
false negative: excess vitamin C
false positive: beets, iron, red meats, etc.

100
Q

Causes of upper GI bleeding: (4)

A
  • swallowed blood
  • ulcers
  • mechanical (mallory weiss)
  • varices
101
Q

How is ongoing bleding of the upper GI tract assessed?

A

NG tube + inspect nose, oropharynx for sources

102
Q

Labs for diagnosing GI bleed/ stability

A

CBC, Hb, platelets, coag, AST/ALT, BUN(elevated)

103
Q

Fluid bolus dose for stabilization in acute GI bleed

A

20 ml/kg normal saline

104
Q

Drugs for treating GI bleed (4)

A
  • octreotide to constrict varices
  • abx for H. pylori
  • H2i/PPi for gastritis/esophagitis/ ulcers
105
Q

Newborn + rectal bleed always think _____.

Kid + rectal bleed think _____.

A

Nec enterocolitis

juvenile polyps most common source in kids

106
Q

Causes of lower GI bleeding (6)

A
  • necrotizing/ infectious enterocolitis
  • Juvenile polyps
  • allergic colitis
  • meckels diverticulum
  • HUS, HSP
  • IBD
107
Q

CBC findings in HUS

A
  • microangiopathic hemolytic anemia

- thrombocytopenia

108
Q 
HSP is \_\_\_\_\_ mediated. 
Sx include (4)
A
  • IgA

- rash at buttocks, arthralgias, renal involvement, GI bleeding

109
Q

Tissue + most common location of Meckels diverticulum

A
  • ectopic gastric tissue

- MC in terminal ileum

110
Q

Presentation of Meckels diverticulum

A

acute painless rectal bleed

111
Q

Three liver enzymes + which is most sensitive/ specific

A
  • AST (senstitive)
  • ALT (specific)
  • LDH
112
Q

Three biliary enzymes

A
  • alk phos
  • gamma glutamyl transpeptidase (GGTP)
  • 5 nucleotidase (5NT)
113
Q

Enzyme responsible for bilirubin conjugation

A

UDP glucuronyl transferase

114
Q

How to measure liver fxn

A
  • albumin
  • prothrombin time
  • lactate
  • ammonia
115
Q

Define infant jaundice

A

-more than 3mg/dl bili after the neonatal period

116
Q

Cholestatic jaundice is retention of _____.

It is defined as ______.

A

bile in the liver

more than 2mg/dL conjugated bili, or greater than 15% total bili being conjugated.

117
Q

Percentage of neonates with unconjugated jaundice?

Pattern of spread

A

50%

cranial to caudal

118
Q

Test of choice for suspected cholestasis

A

HIDA scan

119
Q

Three pathologic causes of decreased UDP glucuronyl transferase

A
  • Gilbert, 50% enzyme reduction, mild, jaundice with stress
  • Crigler Najar I, AR, 100% reduction
  • Crigler Najar II, AD, 90% reduction
120
Q

Causes of newborn cholestasis (6)

+ which is most common?

A
  • infection
  • mechanical obstruction
  • a1at deficiency
  • TPN assc disease
  • metabolic derangements
  • idiopathic hepatitis**
121
Q 
Neonatal hepatitis:
cause 
predominant sex 
incidence 
diagnosis 
prognosis
A 
idiopathic 
male 
1/5k-10k
exclusion, biopsy 
self resolves in 70%
122
Q

How commonly is jaundice seen in neonatal hepatitis during week 1 of life?

A

50% of cases, 33% asx until FTT/ more liver symptoms later

123
Q

Treatment for neonatal hepatitis

A

ursodeoxycholic acid

transplant when refractory

124
Q

Biliary atresia:
incidence
most common age of presentation
dx

A

1/10,000
2/3 present between week 4-6 of life
intraoperative cholangiogram

125
Q

Biliary atresia:

  • treatment
  • prognosis if left untreated
A

Kasai portoenterostomy by 50-70 days of life, transplant if failed or repeated cholangitis occurs

complete obilteration and cirrhosis by 4 months if not treated.

126
Q

Alagille Syndrome

  • inheritance pattern
  • chromosome
  • gene
A

AD, 20, jagged 1 gene

127
Q

List features of Alagille syndrome

A
  • cholestatic liver disease
  • debilitating pruritis
  • unusual face
  • cardiac disease
  • renal/eye/MSK abnormalities
  • FTT
128
Q

Two major strains of hep viruses affected kids

A

A, B

129
Q

What virus types are hep ABCDE

A 
A-picorna 
B- DNA 
C- flavi, RNA 
D- delta, RNA 
E- hepe, RNA
130
Q

What hep strain causes disease in 50% of adolescents in undeveloped countries? Also causes hepatic failure in 20% preggos.

A

Hep E

131
Q

Route of infection for:
A,E
B,C

A

A,E: fecal oral

B,C: vertical, body fluids, parenteral

132
Q

Antigens positive in early Hep B infxn

A

HbsAg, HbeAg

133
Q

Antibody assc with vaccination AND/ OR live infection, against Hep B

A

HbsAb

134
Q

Antibody assc with LIVE infection

A

HbcAb

135
Q

Antibody assc with lade infection of Hep B

A

HbeAb

136
Q

Early and late antibodies assc with Hep A infection

A

IgM, persist for 6 months

IgG, life long, late

137
Q

Hep type most responsible for transfusion assc hepatitis

A

Hep C

138
Q

Hep D requires _____ to replicate

A

HbsAg

139
Q

Type 1 autoimmune hepatitis antibodies

A

ANA, ASMA

140
Q

Type 2 autoimmune hepatitis antibodies

A

antiliverkidney

anti liver cytosol type 1

141
Q

Most common population suffering from autoimmune hepatitis

A

females, pre-pubertal

142
Q

PResentation of autoimmune hep

A

50% acute hep, 50% chronic liver disease

143
Q

Nonhepatic signs autoimmune hep

A

rash, nephritis, vasculitis, arthritis

144
Q

Three labs used to dx autoimmune hep

A

autoantibodies
elevated liver enzymes
hypergammaglobulinemia

Pediatrics (12 decks)

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