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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
Q

What is the initial test of choice for Intussception?

What will be seen?

A

Abdominal ultrasound

“Target sign”, “coiled spring”

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26
Q

What is the treatment of choice for Intussception if there is no perforation or shock?

A

Hydrostatic/Pneumatic enema (diagnostic and therapeutic)

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27
Q

When must surgery be performed for Intussception?

A

If reduction unsuccessful or patient unstable

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28
Q

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
A

Appendicitis

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29
Q

What physical exam findings can suggest appendicitis?

A

Signs of peritoneal irritation:

  • Guarding
  • Rebound tenderness
  • Positive Rovsing, Obturator or Ileopsoas sign
30
Q

What is the treatment for appendicitis?

A
  • Surgical consult
  • Appendectomy (treatment of choice)
  • Fluid resuscitation
  • IV antibiotics
  • Analgesia
31
Q

When would you obtain a surgical consult for appendicitis prior to getting imaging?

A

If patient presents with classic presentation (high risk of appendicitis)

32
Q

What are the most common viral etiologies of acute diarrhea?

A
  • Norovirus
  • Rotavirus
  • Adenovirus
33
Q

What is the definition of acute diarrhea?

A

3 or more loose, water stools per day x 5 days or less

34
Q

What is the most common etiology for gastroenteritis?

A

Most commonly viral

35
Q

Are routine stool cultures recommended in cases of acute diarrhea?

A

No

36
Q

What is the treatment for acute diarrhea?

A
  • 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
Q

What are some differential diagnoses to consider if patient presents with chronic diarrhea for more than one month?

A
  • Celiac disease
  • Allergic enteropathy
  • Malabsorption
  • Functional (Toddler’s) Diarrhea
38
Q

What is an immune mediated inflammatory disease of the small intestine caused by gluten sensitivity?

How is it diagnosed?

What is the treatment?

A

Disease: Celiac Disease

Diagnosis: IgA antibodies to tissue transglutaminase

Treatment: Gluten free diet

39
Q

What is an abnormal immune response to food protein?

What is the treatment?

A

Disease: Allergic enteropathy

Treatment: Dietary elimination: hydrolyzed or free amino acid based formula (Nutramigen)

40
Q

What are the two main subtypes of Inflammatory Bowel Disease?

A
  • Crohn

- Ulcerative colitis

41
Q

Is smoking associated with an increased risk for Crohn’s or UC?

A

Crohn’s

42
Q

The following symptoms are associated with what disorder?

  • Diarrhea, abdominal pain, tenesmus
  • Growth failure, delayed puberty
  • Nutrient deficiencies
  • Anemia
  • Extraintestinal manifestations
A

Inflammatory Bowel Disease

43
Q

What studies can help differentiated Crohn’s disease from UC?

A
  • Colonoscopy/Endoscopy

- MRE

44
Q

Ulcerative colitis puts patients at a higher risk of what disease?

A

Colon cancer

45
Q

What is the location of Crohn’s disease versus Ulcerative Colitis?

A

CD: mouth to anus

UC: rectum and colon

46
Q

What is the ulceration pattern of Crohn’s disease versus Ulcerative Colitis?

A

CD: Skip lesions, Cobblestone

UC: Continuous/Diffuse

47
Q

What is the depth of inflammation of Crohn’s disease versus Ulcerative Colitis?

A

CD: Transmural inflammation

UC: Superficial inflammation/Mucosal layer only

48
Q

What is the etiology of Crohn’s disease versus Ulcerative Colitis?

A

Both: Genetic, Autoimmune, Environmental factors

49
Q

What are the 5 principal components of treatment for IBD?

A
  • Medications
  • Surgery
  • Nutritional rehab
  • Behavioral health support
  • Colorectal cancer screening for older patients
50
Q

What are the medication options for IBD?

A
  • Aminosalicylates
  • Immunomodulating agents
  • Steroids
  • +/- Antibiotics
51
Q

What is the primary therapy used for acute flares of IBD?

A

Steroids

52
Q

What is the Rule of “2’s” associated with Meckel’s Diverticulum?

A
  • 2% of population
  • 2:1 M:F ratio
  • 2% develop complication (usually before age 2)
  • 2 feet from the ileocecal valve
53
Q

What condition is due to embryonic remnant of the vitelline duct that can cause GI bleed?

A

Meckel’s diverticulum

54
Q

What does bleeding occur from in Meckel’s Diverticulum?

A

Mucosal ulceration

55
Q

The following clinical presentations are associated with what disorder?

  • Painless rectal bleeding
  • Obstruction
  • Diverticulitis
A

Meckel’s Diverticulum

56
Q

What imaging study is used in Meckel’s Diverticulum and identifies ectoptic gastric mucosa in the diverticulum.

A

Technetium-99 scan (Meckel’s Scan)

57
Q

What is the management of Meckel’s Diverticulum?

A

Surgical resection

58
Q

What is encopresis?

A

Leakage of retained stool which can occur during constipation/stool impaction.

59
Q

What is the recommended daily fiber intake for children ages > 2 years old and infants < 2 years old?

A

> 2 years old: Age + 5-10 grams

< 2 years old: 5 grams

60
Q

The following symptoms are associated with what condition?

  • +/- fecal leakage
  • Abdominal discomfort
  • Hypoactive bowel sounds if impacted
  • Anal fissures
A

Constipation

61
Q

What are management options for constipation?

A
  • Fluids
  • Gradual increase in daily fiber intake
  • Decrease dairy intake
  • Juice (apple, prune, pear)
  • Medication
  • Counseling and positive reinforcement
62
Q

What condition is characterized by the absence of ganglion cells in mucosal and musclar layers of colon? What occurs in this condition?

A

Hirschsprung Disease: Congenital Agonglionic Megacolon

Colon fails to relax and may lead to obstruction

63
Q

What is the classic presentation of Hirschsprung Disease?

A

Failure to pass meconium in first 48 hours of life

64
Q

What is the clinical presentation of Hirschsprung Disease?

A
  • Bilious vomiting

- Abdominal distention

65
Q

While late presentation is less common in Hirschsprung Disease, how might an older child present?

A

Older children may present with chronic constipation and FTT (later the disease, less severe disease)

66
Q

What are some physical exam findings associated with Hirschsprung Disease?

A
  • Abdominal distention
  • Tight anal sphincter on rectal exam
  • Squirt sign
67
Q

What is Squirt Sign and what condition is it associated with?

A

Explosive release of gas/stool when finger is removed during rectal exam.

Associated with Hirschsprung Disease

68
Q

What is the gold standard for diagnosis of Hirschsprung Disease and what does it confirm?

A

Rectal biopsy confirms absence of ganglion cells

69
Q

What is the treatment of Hirschsprung Disease?

A

Surgical resection of the aganglionic segment of colon

70
Q

What are some diarrhea red flags?

A
  • Fever
  • Blood in stool
  • Dehydration
  • Leukocytosis
  • Persistent symptoms

Peds II (11 decks)

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