Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders

Question 1

The sensation of something stuck in the throat without a clear etiology

Answer 1

Globus

Question 2

Swallowing is a complex process that starts where

Answer 2

In the mouth with mastication

Question 3

Occurs when transfer of food bolus from mouth to esophagus is imapired

Answer 3

Oropharyngeal dysphagia

Question 4

Oropharyngeal dysphagia is aka

Answer 4

Transfer dysphagia

Question 5

Structures affected in oropharyngeal dysphagia

Answer 5

Striated muscles of the mouth, pharynx, and UES

Question 6

Most serious complication of oropharyngeal dysphagia

Answer 6

Life-threatening aspiration

Question 7

Occurs when there is difficulty in transporting food bolus down the esophagus

Answer 7

Esophageal dysphagia

Question 8

Causes of esophageal dysphagia

Answer 8

1) Neuromuscular disorders 2) Mechanical obstruction

Question 9

T/F Primary motility disorders causing impaired peristaltic function and dysphagia is common in children

Answer 9

F, rare

Question 10

Cause a fixed impediment to the passage of food bolus because of a narrowing within the esophagus, as in a stricture, web, or tumor

Answer 10

Intrinsic structural defects

Question 11

Caused by compression from vascular rings, mediastinal lesions, or vertebral abnormalities

Answer 11

Extrinsic obstruction

Question 12

T/F Structural defect cause more problems in swallowing solids than liquids

Answer 12

T

Question 13

A thin ring of mucosal tissue near the lower esophageal sphincter that is a mechanical cause of recurrent dysphagia

Answer 13

Schatzki ring

Question 14

Esophageal symptoms are usually referred to what anatomic landmark

Answer 14

Suprasternal notch

Question 15

The effortless movement of stomach contents into the esophagus and mouth

Answer 15

Regurgitation

Question 16

T/F Infants with regurgitation are often hungry immediately after an episode

Answer 16

T

Question 17

A result of GER through an incompetent or immature LES

Answer 17

Regurgitation

Question 18

T/F Regurgitation or “spitting” resolves with maturity

Answer 18

T

Question 19

Prolonged lack of appetite

Answer 19

Anorexia

Question 20

Satiety is stimulated by

Answer 20

Distention of the stomach or upper small bowel

Question 21

A highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching

Answer 21

Vomiting

Question 22

Vomiting, as a reflex process is coordinated in the

Answer 22

Medullary vomiting center

Question 23

2 causes of bile-stained vomitus

Answer 23

1) Obstruction below 2nd part of duodenum 2) Repeated vomiting in the absence of obstruction when duodenal contents are refluxed into stomach

Question 24

A syndrome with numerous episodes of vomiting interspersed with well intervals

Answer 24

Cyclic vomiting

Question 25

2 criteria that must be present for cyclic vomiting in children as defined by Rome III criteria

Answer 25

1) 2 or more periods of intense nausea and unremitting vomiting 2) Retching lasting hours to days and return to usual state of health lasting weeks to months

Question 26

Onset of cyclic vomiting is usually

Answer 26

Between 2 and 5 years of age

Question 27

Average frequency of vomiting episodes in cyclic vomiting

Answer 27

12 episodes per year, each episode lasting 2-3 days and 4 or more emesis episode per hour

Question 28

Episodes of vomiting in cyclic vomiting usually comes during what time of the day

Answer 28

Early hours or upon wakening

Question 29

Precipitants of cyclic vomiting

Answer 29

1) Infection 2) Physical stress 3) Psychologic stress

Question 30

T/F More than 80% of children with cyclic vomiting have a 1st-degree relative with migraines

Answer 30

T

Question 31

T/F Many patients with cyclic vomiting develop migraines later in life

Answer 31

T

Question 32

Diarrhea is best defined as

Answer 32

Excessive loss of fluid and electrolyte in the stool

Question 33

Acute diarrhea is defined as a sudden onset of excessively loose stools of ___mL/kg/day in infants and ____g/24 hrs in older children

Answer 33

>10, >200

Question 34

By definition, acute diarrhea lasts for how long

Answer 34

Less than 14 days

Question 35

Chronic or persistent diarrhea lasts for how long

Answer 35

>14 days

Question 36

Normally, a young infant has approximately ___ /day stool output

Answer 36

5mL/kg

Question 37

The greatest volume of intestinal water is absorbed in which part of the GIT

Answer 37

Small intestine

Question 38

T/F The colon concentrates intestinal contents against a high osmotic gradient

Answer 38

T

Question 39

T/F Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea

Answer 39

T

Question 40

Small-volume, frequent bloody stools with mucus, tenesmus, and urgency

Answer 40

Dysentery

Question 41

The predominant symptom of colitis

Answer 41

Dysentery

Question 42

Basis of all diarrhea

Answer 42

Disturbed intestinal solute transport and water absorption

Question 43

Secretory vs osmotic diarrhea: Cholera

Answer 43

Secretory

Question 44

Secretory vs osmotic diarrhea: Large volume

Answer 44

Secretory

Question 45

Secretory vs osmotic diarrhea: Stops with fasting

Answer 45

Osmotic

Question 46

Secretory vs osmotic diarrhea: Occurs after ingestion of a poorly absorbed solute

Answer 46

Osmotic

Question 47

Secretory vs osmotic diarrhea: Stool osmolality predominantly indicated by electrolytes

Answer 47

Secretory

Question 48

Secretory vs osmotic diarrhea: Lactulose

Answer 48

Osmotic

Question 49

Secretory vs osmotic diarrhea: Ion gap of 100 mOsm/kg or less

Answer 49

Secretory

Question 50

Secretory vs osmotic diarrhea: Sorbitol

Answer 50

Osmotic

Question 51

Secretory vs osmotic diarrhea: Lactase deficiency

Answer 51

Osmotic

Question 52

Secretory vs osmotic diarrhea: Rotavirus diarrhea

Answer 52

Osmotic

Question 53

Secretory vs osmotic diarrhea: Anion gap will not be explained by electrolyte content

Answer 53

Osmotic

Question 54

Secretory vs osmotic diarrhea: Anion gap is >100 mOsm

Answer 54

Osmotic

Question 55

Secretory vs osmotic diarrhea: No stool leukocytes

Answer 55

Both

Question 56

Secretory vs osmotic diarrhea: Bile salt malabsoprtion

Answer 56

Secretory

Question 57

Secretory vs osmotic diarrhea: Toxigenix E. coli

Answer 57

Secretory

Question 58

Secretory vs osmotic diarrhea: Neuroblastoma

Answer 58

Secretory

Question 59

Secretory vs osmotic diarrhea: C. difficile

Answer 59

Secretory

Question 60

Secretory vs osmotic diarrhea: Cryptosporidiosis in AIDS

Answer 60

Secretory

Question 61

Formula for ion gap of stool

Answer 61

Stool osm - [(Stool Na + stool K) x2]

Question 62

Secretory vs osmotic diarrhea: Increased breath hydrogen with carbohydrate malabsorption

Answer 62

Osmotic

Question 63

T/F A hard stool passed with difficulty every 3rd day should be treated as constipation

Answer 63

T

Question 64

T/F A soft stool only every 2nd or 3rd day without difficulty should be treated as constipation

Answer 64

F

Question 65

True constipation during the neonatal period is most likely secondary to what 3 entities

Answer 65

1) Hirschprung disease 2) Intestinal pseudo obstruction 3) Hypothyroidism

Question 66

Watery content from the proximal colon might percolate around hard retained stool and pass per rectum unperceived by the child. This is called

Answer 66

Involuntary encopresis

Question 67

``` T/F A child with functional abdomi- nal pain (no identifiable organic cause) may be as uncomfortable as one with an organic cause. ```

Answer 67

T

Question 68

Reassuring PE findings in a child who is suspected of having functional abdominal pain

Answer 68

1) Normal growth and PE 2) Absence of anemia or hematochezia

Question 69

Types of nerve fibers that transmit painful stimuli in the abdomen

Answer 69

1) A fibers: Sharp, localized, skin and muscle 2) C fibers: Dull, poorly localized, viscera, peritoneum, and muscle

Question 70

In the gut, the usual stimulus provoking pain is

Answer 70

Tension or stretching

Question 71

Pain that suggests a potentially serious organic etiology is associated with (14)

Answer 71

1) Younger than 5 y/o 2) Weight loss 3) Fever 4) Bile or blood-stained emesis 5) Jaundice 6) Hepatosplenomegaly 7) Back or flank pain or pain in a location other than the umbilicus 8) Awakening from sleep in pain 9) Referred pain to shoulder, groin, or back 10) Elevated ESR, WBC, or CRP 11) Anemia 12) Edema 13) Hematochezia 14) Strong family history of IBD or celiac disease

Question 72

Pain that tends to be dull and aching and is experienced in the dermatome from which the affected organ receives innervation

Answer 72

Visceral pain

Question 73

Referred pain: Liver

Answer 73

Epigastrium

Question 74

Referred pain: Pancreas

Answer 74

Epigastrium

Question 75

Referred pain: Distal small bowel

Answer 75

Umbilicus

Question 76

Referred pain: Distal large bowel

Answer 76

Suprapubic

Question 77

Referred pain: Appendix

Answer 77

Umbilicus

Question 78

Referred pain: Biliary tree

Answer 78

Epigastrium

Question 79

Referred pain: Stomach

Answer 79

Epigastrium

Question 80

Referred pain: Upper bowel

Answer 80

Epigastrium

Question 81

Referred pain: Cecum

Answer 81

Umbilicus

Question 82

Referred pain: Urinary tract

Answer 82

Suprapubic

Question 83

Referred pain: Proximal colon

Answer 83

Umbilicus

Question 84

Pain from the cecum, ascending colon, and descending colon sometimes is felt at the site of the lesion because

Answer 84

Short mesocecum and corresponding mesocolon

Question 85

Pain from the transverse cool is usually felt in the

Answer 85

Suprapubic region

Question 86

Pain that is intense and is usually well localized

Answer 86

Somatic pain

Question 87

Pain from extraintestinal locations, from shared central projections with the sensory pathway from the abdominal wall, can give rise to abdominal pain, as in pneumonia when the parietal pleural pain is referred to the abdomen

Answer 87

Referred pain

Question 88

Hematemesis is bleeding that originates from

Answer 88

Esophagus, stomach, or duodenum

Question 89

Hematochezia signifies bleeding from as far as

Answer 89

Distal ileum

Question 90

Melena signifies

Answer 90

Mild to moderate bleeding from sites above the distal ileum

Question 91

Black tarry stool is aka

Answer 91

Melena

Question 92

MCC of GI bleeding

Answer 92

Erosive damage to the mucosa of the GIT

Question 93

T/F Vascular malformations are a common cause of GI bleeding in children

Answer 93

F

Question 94

Capsule endoscopy facilitates evaluation of bleeding from

Answer 94

Small intestines

Question 95

Useful means of locating the site of bleeding if it is brisk and intestinal in origin

Answer 95

Tagged RBC scan

Question 96

Guaiac test is very sensitive but can miss ___

Answer 96

Chronic blood loss

Question 97

T/F GI hemorrhage can produce hypotension and tachycardia but rarely causes GI symptoms

Answer 97

T

Question 98

Ascitic fluid is usually: Transudate vs exudate

Answer 98

Transudate

Question 99

Ascitic fluid is usually: High in protein vs low in protein

Answer 99

Low

Question 100

Ascitic fluid results from (2)

Answer 100

1) Reduced plasma colloid osmotic pressure from hypoalbuminemia 2) Raised portal venous pressure

Question 101

What happens to serum Na excretion in the urine as the ascitic fluid accumulates

Answer 101

Decreases

Question 102

When ascitic fluid is high in protein, it is usually secondary to

Answer 102

1) Inflammation 2) Neoplastic lesion

Question 103

Nonspecific pain, often periumbilical

Answer 103

Functional ab pain

Question 104

Intermittent cramps, diarrhea, and constipation

Answer 104

IBS

Question 105

Peptic ulcer–like symptoms without abnormalities on evaluation of the upper GI tract

Answer 105

Nonulcer dyspepsia

Question 106

Bloating, gas, cramps, and diarrhea, not associated with lactose intake

Answer 106

Parasite infection, especially Giardia

Question 107

Burning or gnawing epigastric pain; worse on awakening or before meals; relieved with antacids

Answer 107

PUD

Question 108

Epigastric pain with substernal burning

Answer 108

Esophagitis

Question 109

Periumbilical or lower abdominal pain; may have blood in stool (usually painless)

Answer 109

Meckel diverticulum

Question 110

RUQ pain, might worsen with meals

Answer 110

Cholelithiasis