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Royal College Peds 2021 > Gastro Jan > Flashcards

Gastro Jan Flashcards

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1
Q

FTT What are causes of Failure to Thrive?

A

1.Decreased Intake (common)

  • Social (food security)
  • Central (satiety signaling)

2.Malabsorption*

3.Hypermetabolism

  • Inflammatory (catabolic)
  • Neoplastic (consumptive)
  • Chronic Disease (combination) IBD, ..
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2
Q

FTT What are the causes of protein malabsorbtion?

A

1. Pancreas: proteases

  1. SI: AA transporters e.g. CF, Schwachman- Diamond
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3
Q

FTT What are the causes of Fat malabsorbtion?

A

Biliary:bile emulsifies

Ileum: reabsorbs bile

e.g. cholestasis, CF,

Crohn’s disease

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4
Q

FTT What are the causes of Carbohydrate malabsorbtion?

A

Primary causes: enzyme deficiencies rare

e.g. Sucrase-isomaltase, treholase, lactase*

Dietary causes: saturation of normal enzyme levels

e.g. Toddler’s diarrhea

Malabsorption

Duodenum: brush

border hydrolysis

e.g. primary causes vs

dietary causes

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5
Q

FTT What are the causes of Panmalabsorption ?.

A

Generalized intestinal inflammation/resection

e.g. Celiac, IBD, lymphangiectasia, immunodeficiency,

intestinal resection

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6
Q

Celiac disease What is the cause for Celiac Disease?

A

Autoimmune enteropathy caused by systemically acting antibodies that are formed against gluten ( NOT allergy…causes problems long after substance is removed)

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7
Q

Celiac What are the Extraintestinal Manifestations of

Celiac Disease?

A
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8
Q

Celiac What Conditions are Associated with Celiac Disease?

A
  1. IgA Deficiency 30 % chance if IGA in celiac

• 2. Syndromic: Down, Turner Syndrome & Williams

Syndrome

• 3. Autoimmune: T1 DM; Thyroid, liver, arthritis

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9
Q

Celiac Transmission risk in families?

A

First Degree Relative with Celiac (1:20 risk)..all have

about 20% risk

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10
Q

Celiac What are the Dietary Triggers for Celiac Disease?

A
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11
Q

Celiac How do the Screening Bloodwork Test

Compare (TTG IGA vs EMA-IgA)

A
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12
Q

Celiac Recommendations for DGP in < 2 and > 2 yrs ?

Deamidated Gliadin Peptide

A

*Must send DGP in patients <2yo (TTG-IgA poor accuracy in this age group)

• >2yo, many false positive DGP tests

• ie. TTG-IgA negative, DGP-IgG positive, biopsy negative - NOT celiac disease

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13
Q

Celiac DDx for Patients who report feeling better off gluten?

A
    1. Nothing
    1. Celiac Disease (must have 12wk

intake)

• 3.Food intolerances/allergies:

a.Non-Celiac Gluten Sensitivity (NCGS)

b. Wheat allergy
c. Difficulty digesting highly fermentable carbohydrates

FODMAPS

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14
Q

Celiac What are FODMAPS?

A
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15
Q

IBD How do clinical Fx of CD and UC compare?

A
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16
Q

IBD How do Endoscopic Fx of CD and UC compare?

A
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17
Q

IBD How do Pathology Fx of CD and UC compare?

A
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18
Q

IBD What are the extraintestinal manifestations of IBD?

A
  1. Eye
  2. Skin and Rheum
  3. GIT: Liver, pancreas & biliary
  4. MSK and hematological
  5. Oncology and Urologic
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19
Q

IBD What are the Eye extraintestinal manifestations of IBD?

A
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20
Q

IBD What are the Skin and Rheum extraintestinal manifestations of IBD?

A
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21
Q

IBD What are the GIT and MSK extraintestinal manifestations of IBD?

A
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22
Q

BD What are the Hem/Oncology and Urologic extraintestinal manifestations of IBD?

A
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23
Q

IBD Which Sx correlate with disease activity?

A

peripheral arthritis, Erythema nodosum, anemia

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24
Q

IBD Which Sx DO NOT correlate with disease activity?

A

primary sclerosing cholangitis (PSC), sacroiliitis, ankylosing spondylitis

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25
Q

IBD What are the inv steps for IBD?

A

1. Laboratory evaluation

a. Typical biochemical abnormalities: leukocytosis, anemia, thrombocytosis, hypoalbuminemia, LFT’s
b. Serum inflammatory markers: erythrocyte sedimentation rate (ESR) and CRP often elevated
c. Stool:
- Rule out enteric infections, including Clostridium difficile, before endoscopy
- Fecal calprotectin

2. Endoscopy: Endoscopy (OGD and colonoscopy) with confirmatory biopsies demonstrating chronic inflammatory changes is diagnostic gold standard

3. Imaging

SBFT, CT/CTE, MRI/MRE

US/CE, VCE (video capsule endoscopy)

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26
Q

IBD What is the relevance of -Fecal calprotectin?

A

Elevated concentrations in the stool if GI inflammation is ongoing

Cut off of >200 to 300 μg/g has been suggested as optimal combination of sensitivity and specificity

Fecal calprotectin cannot distinguish between inflammation from IBD versus infection, malignancy, or nonsteroidal antiinflammatory drug (NSAID) use; cannot determine the location of disease in the bowel; and has been found to be elevated in healthy infants and toddlers

Valuable as a noninvasive marker of disease activity after diagnosis

▪

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27
Q

IBD What serologies can be used for UC and Crohns?

A

Atypical perinuclear antineutrophil cytoplasmic antibodies (pANCA) in UC and

anti-Saccharomyces cerevisiae antibodies (ASCA) in CD

N.B. No sufficient data to support IBD serologic testing for screening evaluation of suspected IBD

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28
Q

IBD What Rx can be used to reduce remission?

A

Induce Remission

  1. Tube feeds (common; Crohn’s only), less benefit in uC
  2. Corticosteroids - both, esp in UC, oral budesonide
  3. OTHER
    a. Mild: 5-ASA (Mesalamine, sulfasalazine) 1st line in UC less efficacy in Crohns
    b. Severe: Biologics (BOTH) Infliximab > Adalimumab
  4. Antibiotics: Decrease inflammation by decreasing pro-inflammatory bacteria in the GI tract
    Perianal disease, abscess, postoperative prophylaxis
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29
Q

IBD How to maintain remission?

A
  1. 5-ASA - mild; UC, less clear in Crohns
  2. Tube Feeds (Crohn’s only)

3. Immunosuppresive;

a. Azathioprine & Methotrexate (moderate)
b. Biologics (severe)

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30
Q

IBD What is the DDx for terminal ileitis?

A
  • 1.Crohn’s & Chronic CGD
    1. Lympho’s; Lymphoma & Lymphoreticularhyperplasia( LN)
    1. Infection: Yersinia Infection…r& TB
    1. Severe Eosinophilic Gastroenteropathy
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31
Q

Constipation What are the pathological causes?

A

Idiopathic

  1. Disease:

Hypothyroidism

• Celiac Disease, CF

  1. Chem: Lead Poisoning; Medications (chemo)
  2. Elect:High Ca, Low K
  3. CNS disorders

o Hirschprung’s

o Cerebral palsy

o Neural tube defects

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32
Q

Constipation What are the 4 categories of constipation meedications?

A
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33
Q

GERD What are the DDx for Gastroesophageal Reflux &

Dysphagia?

Physiologic….more relaxation than 4% of the time

  • Eosinophilic Esophagitis
  • Hiatal Hernia (LES angle affected)
  • Gastroparesis (delayed gastric emptying)
  • Medications
  • Dysmotility
  • Gastritis/gastroparesis
A

Physiologic….more relaxation than 4% of the time

  1. Eosinophilic Esophagitis
  2. Mechanical: Hiatal Hernia (LES angle affected)
  3. Pathophysio:

Gastroparesis (delayed gastric emptying)

Dysmotility

Gastritis

  1. Medications
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34
Q

GERD What are the causes for Delayed Gastric Emptying?

A
  1. Idiopathic
  2. Intestinal effect:

a. Ileus: Post infectious/Post surgery

b. Constipation
c. Inflamatory/immune
d. Neurological

3. Medication

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35
Q

GERD What are the treatment guidelines for GERD?

A
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36
Q

What are the DDx for Dysphagia & Odynophagia?

A
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37
Q

CMPI What is the incidence and cross reactivity with soy milk?

A
38
Q

CMPI What are the Signs and Symptoms of Respiratory and Cutaneous IgE and Non IgE CMPI?

A
39
Q

CMPI What are the Signs and Symptoms of GIT and Unclassified IgE and Non IgE CMPI?

A
40
Q

CMPI What are the Management goals in CMPI for Breastfed infants?

A
41
Q

CMPI What are the formula options in CMPI for formula fed infants?

A
42
Q

GIT Bleeding What are the Causes of Lower GI Bleeding in children?

A
43
Q

GIT bleeding What are the Causes of upper GI Bleeding in children?

A
44
Q

GIT bleeding What are the Meckel’s: Rule of 2’s?

A
45
Q

GIT infections which ones bleed?

A
46
Q

GIT Infections which ones to treat?

A
47
Q

FGID What are the Functional GI Disorders?

A
  1. Neonatal/Toddler FGID
  2. Childhood/Adolescence FGID
48
Q

FGID What are the Neonatal/Toddler FGID’s?

A
  1. Infant Regurgitation
  2. Infant Colic
  3. Functional Diarrhea
  4. Infant Dyschezia
  5. Functional Constipation
49
Q

FGID FGID What are the Childhood and adolescent FGID’s?

A
50
Q

FGID How do you approach Functional GI Disorders - OSCE?

A
51
Q

FGID What is Infant Regurgitation?

Age onset

Frequency

features NOT seen?

A
52
Q

FGID What are the features of Infantile Colic?

Onset age

Frequency

Featrures NOT seen

A
53
Q

FGID What are the features of IFunctional diarrhea?

Onset age

Day or night?

Description?

Featrures NOT seen

A
54
Q

FGID What are the features of Infant Dyschezia?

Onset age

Description?

What may help?

A
55
Q

FGID What are the features of Functional constipation?

Description?

A
56
Q

FGID What are the features of Cyclic vomiting?

Description?

What conditions to exclude?

A
57
Q

FGID What are the features of Functional constipation?

Description?

A
58
Q

FGID What are the features of Functional dyspepsia?

Description?

A
59
Q

FGID What are the features of IBS?

Description?

A
60
Q

FGID What are the features of Abdo migraine?

Description?

A
61
Q

FGID What are the features of Functional abdo pain?

Description?

A
62
Q

FGID What are the features of Functional constipation?

Description?

A
63
Q

FGID What are the features of Non retentive fecal continenence?

Description?

A
64
Q

Liver Casues of hyperbilirubinemia?

A
65
Q

Liver Prehepatic Causes of Hyperbilirubinemia?

A
66
Q

Liver What are Hepatic Causes of Hyperbilirubinemia (IMMIN)

A
67
Q

Liver Posthepatic Causes of Hyperbilirubinemia?

A
68
Q

Liver Causes of Neonatal cholestasis?

A
69
Q

Liver What are the clinical features of liver failure?

A
70
Q

Liver What are the Management Principles of liver failure?

A
71
Q

Liver What are the chronic infection srates for Hep by ages?

Infants

1-5 yr

> 5 yrs

A
  • infants—90%
  • children 1-5 yo—25-50%
  • older children and adults—6-10%
72
Q

Liver How do you prevent Hep B?

A
73
Q

Liver What are the 3 disease states with Hep B?

A
74
Q

Liver What is significance of forllowing hep B markers?

Hep BsAg

Hep Bs Ab

Hep Bc Ag

Hep Bc Ab

A
75
Q

Liver What is the relavance of the following in Hep B?

Hep B e Ag

Hep B e Ab

Hep B DNA

Hep B genotypes

A
76
Q

Liver What are Rx options for Hep B?

What are S/E of the drugs?

A

1. Interferon-a (IFN- a)

S/E: neutropenia (39%), fever, myalgia, headaches, arthralgia, anorexia with weight loss, mood changes

  1. Nucleoside analogue (e.g. lamivudine)

• well tolerated, but high mutation rate leading to resistance

77
Q

Liver What are indications for Rx for Hep B?

A

For children >2 yo:

  1. HBsAg+ for >6 months
  2. ALT>2X normal and evidence of viral replication

(HBeAg+ or HBV DNA >4 log if HBeAg-ve)

OR

Chronic hepatitis on liver biopsy

Rx with eitehr Interferon OR Lamuvudine..

78
Q

Liver What are the surveillance recommendations for Px treated for Hep B?

A
  1. Exams; regularly for chronic liver disease
  2. Immunisations:

• Immunize household & patient against Hepatitis A

  1. Labs:
    a. Measure ALT q6 mths in >2yo
    b. Measure HBeAg and HBeAb yearly in

patients with normal ALT

c. AFP annually
4. Imaging: U/S annually
5. Liver biopsy and consider treatment in

children >2yo with ALT >1.5x normal

79
Q

Liver What is prognosis for treated Hep B?

A
  1. Spontaneous seroconversion and clearance 70-

80%

  1. Risk of Hepatocellular Carcinoma

(HCC) is 15-35X greater than noninfected

population

  • Lifetime risk of HCC or cirrhosis is

15-25%

80
Q

Liver What type of virus is Hep C

What is the Prevalance in children?

A

RNA virus ( Hep B is DNA)

Prevalance:

  1. 2% of children 6-11yo and
  2. 4% of children 12-19yo
81
Q

Liver Hep C

Spontaneous clearance rate?

Cirrhosis risk

Genotype - no of types, types in N america and importance?

A

Spontaneous clearance in children is

20% in first 3 years of life, up to 50% by age 18

Cirrhosis takes 10-20 years to develop, if ever

6 genotypes, 1-3 common in North America

• 1 carries worst prognosis

82
Q

Liver How do you Dx Hep C

A
  1. Hepatitis C Ab (high false +ve)
  2. Confirm with Hepatitis C PCR and genotype
  3. In at risk infants, continue screening until at least 18

months of age with two –ve Hepatitis C Ab’s test in a row

….note..Persistence of maternal antibodies, lack of measurable self antibodies suggests spontaneous clearance

  1. Liver biopsy controversial
83
Q

Liver What are the guidelines for treatment for Hep C?

A
84
Q

Liver What are the focus areas for Liver Transplant Longterm Followup?

A
  1. Neurodevelopment
  2. Medication: Side effects/adherence
  3. Transplant:
    a. Secondary graft dysfunction LFT’s
    b. Chronic GVHD
    c. Infections - common, opportunistic
    d. Thrombosis
85
Q

Pancreatitis Acute management?

Pancreatitis

  • Acute management
  • Fluids (1.5-2x maintenance)
  • Enteral nutrition early
  • If not tolerated, NJ tube feeding
  • If still not tolerated, TPN
  • Watch for complications (SIRS response)
A
    1. Fluids (1.5-2x maintenance)
    1. Enteral nutrition early
  • If not tolerated, NJ tube feeding
  • If still not tolerated, TPN
  1. Watch for complications (SIRS response)
  2. Analgesia
86
Q

Pancreatitis What are the causes of chronic pancreatitis?

A
87
Q

Celiac How do you handle a child who is TTG IGA +ve?

A

TTG+ve?

•> 10 x ULN Can offer non-biopsy diagnosis if:

•Anti-EMA positive (from separate sample)

AND

  • HLA-DQ2 or HLA-DQ8 positive (“permissive haplotype”)
  • <10x ULN Must do upper endoscopy with duodenal biopsies

Alway srefer to gastreoentrologistfor discussion

88
Q

Celiac How do you screen for high risk patients for Celiac with no symptoms?

A

“Screen”

•1. TTG/IgA,

OR

2.HLA-DQ2/HLA-DQ8 testing TTG/IgA if either present

89
Q
A
90
Q

Celiac How do you manage a child at risk of celiac with no Sx who tests +ve for TTG IGA?

A
  1. >3 x ULN and/or Anti-EMA positive Must do EGD with duodenal biopsies
  2. < 3 x ULN, Anti-EMA negative - Repeat ATTG q3-6 mo
91
Q

Food Allergy What are the most used screening tests for food allergies?

A

Royal College Peds 2021 (55 decks)

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