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Peds II > Exam 1 - Gastroenterology > Flashcards

Exam 1 - Gastroenterology Flashcards

1
Q

When comparing GER versus GERD, which one is referred to as “unhappy spitter” due to the child being irritable, having dystonic neck posturing, and feeding refusal?

A

GERD

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2
Q

When does GERD typically resolve in infants?

A

Symptoms usually resolve by 9-12 months

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3
Q

What is the 1st line treatment for GERD?

A

Lifestyle modifications

  • avoid tobacco smoke exposure
  • upright positioning 30 min. after feeds
  • do not overfeed
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4
Q

When should you consider prescribing medication for GERD?

What are these medications?

A
  • Unresponsive to lifestyle modifications
  • Complicated disease (underlying condition, esophagitis)

PPI versus H2 blocker (PPI typically chosen first)

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5
Q

What disease is associated with the use of macrolide antibiotics during first few weeks of life?

A

Infantile Hypertrophic Pyloric Stenosis

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6
Q

What is the classic presentation associated with Pyloric Stenosis?

A

3-6 week old infant with forceful, nonbilious, “projectile” vomiting immediately after feeding

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7
Q

What is typically seen on physical exam in a patient with Pyloric Stenosis?

A

“Olive-like” mass in RUQ (indicates hypertrophy)

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8
Q

What is the treatment for Pyloric Stenosis?

A
  • Pyloromyotomy (definitive management)
  • IV fluid
  • Electrolyte resuscitation
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9
Q

What is Congenital Intestinal Atresia?

What is the most commonly affected site?

A

When one or more segments of bowel may be absent and/or obstructed at birth.

Duodenum is most commonly affected site.

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10
Q

What populations have an increased risk of Congenital Intestinal Atresia?

A
  • Cystic fibrosis
  • Down syndrome
  • Maternal cigarette smoking
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11
Q

The following symptoms are associated with what disorder?

  • Vomiting within first 48 hours of life (often bile-stained bilious)
  • Abdominal distention
  • Failure to pass meconium
A

Congenital Intestinal Atresia

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12
Q

What is typically seen on x-ray to help in diagnosis of Congenital Intestinal Atresia, specifically duodenal atresia?

A

“Double bubble” sign due to gas and dilation in both the stomach and duodenum

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13
Q

What is typically seen on x-ray to help in diagnosis of Congenital Intestinal Atresia, specifically jejunoileal/colonic atresia?

A

Dilated loops of bowel with air fluid levels

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14
Q

What is the management of Congential Intestinal Atresia?

A
  • Feedings withheld
  • Broad spectrum antibiotics to prevent post-op infection
  • Surgical intervention (depends on site)
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15
Q

What does malrotation increase the risk of?

A

Volvulus

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16
Q

What is volvulus and what can it lead to?

A

Small bowel twists around superior mesenteric artery.

Vascular compromise can lead to small bowel ischemia and necrosis.

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17
Q

The following symptoms are associated with what disorder?

  • Vomiting (typically bilious-green or fluorescent yellow)
  • Abdominal pain
  • Hemodynamic instability
  • +/- Hematochezia
A

Midgut Malrotation +/- Volvulus

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18
Q

What physical exam findings are associated with midgut malrotation?

A
  • Abdominal distention

- Abdominal tenderness

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19
Q

What is the gold standard test to detect malrotation +/- volvulus?

What is the classic sign seen on this study?

A

Upper GI

“Corkscrew appearance” of duodenum

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20
Q

What imaging studies can be obtained to help in the diagnosis of malrotation +/- volvulus?

A
  • X-ray (r/o obstruction)
  • Upper GI (gold standard)
  • Ultrasound (not the best for confirmation)
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21
Q

What is the treatment for malrotation +/- volvulus?

A

Ladd procedure

- Bowel is untwisted and repositioned in abdomen which creates adhesions to “hold” bowel in place

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22
Q

What is the most common abdominal emergency in kids < 2 years old?

A

Intussussception

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23
Q

The following symptoms are associated with what disorder?

  • Sudden onset of intermittent, severe, crampy abdominal pain
  • Vomiting
  • Palpable sausage-shaped mass
  • Currant jelly stools
A

Intussusception

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24
Q

While 75% of Intussusception cases are idiopathic, what is the most common cause in remaining cases?

A

Meckel diverticulum

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25
What is the initial test of choice for Intussception? What will be seen?
Abdominal ultrasound "Target sign", "coiled spring"
26
What is the treatment of choice for Intussception if there is no perforation or shock?
Hydrostatic/Pneumatic enema (diagnostic and therapeutic)
27
When must surgery be performed for Intussception?
If reduction unsuccessful or patient unstable
28
The following symptoms are associated with what disorder? - Anorexia - Pain that migrates from the periumbilical region to RLQ and increases with movement - Vomiting AFTER onset of pain
Appendicitis
29
What physical exam findings can suggest appendicitis?
Signs of peritoneal irritation: - Guarding - Rebound tenderness - Positive Rovsing, Obturator or Ileopsoas sign
30
What is the treatment for appendicitis?
- Surgical consult - Appendectomy (treatment of choice) - Fluid resuscitation - IV antibiotics - Analgesia
31
When would you obtain a surgical consult for appendicitis prior to getting imaging?
If patient presents with classic presentation (high risk of appendicitis)
32
What are the most common viral etiologies of acute diarrhea?
- Norovirus - Rotavirus - Adenovirus
33
What is the definition of acute diarrhea?
3 or more loose, water stools per day x 5 days or less
34
What is the most common etiology for gastroenteritis?
Most commonly viral
35
Are routine stool cultures recommended in cases of acute diarrhea?
No
36
What is the treatment for acute diarrhea?
- Focus on hydration - Antibiotics sometimes (only use if specific pathogen has been isolated; not in well appearing children) - +/- Probiotics - Antidiarrheal agents are NOT recommended
37
What are some differential diagnoses to consider if patient presents with chronic diarrhea for more than one month?
- Celiac disease - Allergic enteropathy - Malabsorption - Functional (Toddler's) Diarrhea
38
What is an immune mediated inflammatory disease of the small intestine caused by gluten sensitivity? How is it diagnosed? What is the treatment?
Disease: Celiac Disease Diagnosis: IgA antibodies to tissue transglutaminase Treatment: Gluten free diet
39
What is an abnormal immune response to food protein? What is the treatment?
Disease: Allergic enteropathy Treatment: Dietary elimination: hydrolyzed or free amino acid based formula (Nutramigen)
40
What are the two main subtypes of Inflammatory Bowel Disease?
- Crohn | - Ulcerative colitis
41
Is smoking associated with an increased risk for Crohn's or UC?
Crohn's
42
The following symptoms are associated with what disorder? - Diarrhea, abdominal pain, tenesmus - Growth failure, delayed puberty - Nutrient deficiencies - Anemia - Extraintestinal manifestations
Inflammatory Bowel Disease
43
What studies can help differentiated Crohn's disease from UC?
- Colonoscopy/Endoscopy | - MRE
44
Ulcerative colitis puts patients at a higher risk of what disease?
Colon cancer
45
What is the location of Crohn's disease versus Ulcerative Colitis?
CD: mouth to anus UC: rectum and colon
46
What is the ulceration pattern of Crohn's disease versus Ulcerative Colitis?
CD: Skip lesions, Cobblestone UC: Continuous/Diffuse
47
What is the depth of inflammation of Crohn's disease versus Ulcerative Colitis?
CD: Transmural inflammation UC: Superficial inflammation/Mucosal layer only
48
What is the etiology of Crohn's disease versus Ulcerative Colitis?
Both: Genetic, Autoimmune, Environmental factors
49
What are the 5 principal components of treatment for IBD?
- Medications - Surgery - Nutritional rehab - Behavioral health support - Colorectal cancer screening for older patients
50
What are the medication options for IBD?
- Aminosalicylates - Immunomodulating agents - Steroids - +/- Antibiotics
51
What is the primary therapy used for acute flares of IBD?
Steroids
52
What is the Rule of "2's" associated with Meckel's Diverticulum?
- 2% of population - 2:1 M:F ratio - 2% develop complication (usually before age 2) - 2 feet from the ileocecal valve
53
What condition is due to embryonic remnant of the vitelline duct that can cause GI bleed?
Meckel's diverticulum
54
What does bleeding occur from in Meckel's Diverticulum?
Mucosal ulceration
55
The following clinical presentations are associated with what disorder? - Painless rectal bleeding - Obstruction - Diverticulitis
Meckel's Diverticulum
56
What imaging study is used in Meckel's Diverticulum and identifies ectoptic gastric mucosa in the diverticulum.
Technetium-99 scan (Meckel's Scan)
57
What is the management of Meckel's Diverticulum?
Surgical resection
58
What is encopresis?
Leakage of retained stool which can occur during constipation/stool impaction.
59
What is the recommended daily fiber intake for children ages > 2 years old and infants < 2 years old?
> 2 years old: Age + 5-10 grams < 2 years old: 5 grams
60
The following symptoms are associated with what condition? - +/- fecal leakage - Abdominal discomfort - Hypoactive bowel sounds if impacted - Anal fissures
Constipation
61
What are management options for constipation?
- Fluids - Gradual increase in daily fiber intake - Decrease dairy intake - Juice (apple, prune, pear) - Medication - Counseling and positive reinforcement
62
What condition is characterized by the absence of ganglion cells in mucosal and musclar layers of colon? What occurs in this condition?
Hirschsprung Disease: Congenital Agonglionic Megacolon Colon fails to relax and may lead to obstruction
63
What is the classic presentation of Hirschsprung Disease?
Failure to pass meconium in first 48 hours of life
64
What is the clinical presentation of Hirschsprung Disease?
- Bilious vomiting | - Abdominal distention
65
While late presentation is less common in Hirschsprung Disease, how might an older child present?
Older children may present with chronic constipation and FTT (later the disease, less severe disease)
66
What are some physical exam findings associated with Hirschsprung Disease?
- Abdominal distention - Tight anal sphincter on rectal exam - Squirt sign
67
What is Squirt Sign and what condition is it associated with?
Explosive release of gas/stool when finger is removed during rectal exam. Associated with Hirschsprung Disease
68
What is the gold standard for diagnosis of Hirschsprung Disease and what does it confirm?
Rectal biopsy confirms absence of ganglion cells
69
What is the treatment of Hirschsprung Disease?
Surgical resection of the aganglionic segment of colon
70
What are some diarrhea red flags?
- Fever - Blood in stool - Dehydration - Leukocytosis - Persistent symptoms

Peds II (11 decks)

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