GASTRO/NUTRI Flashcards by Maria Cristina Mariano

Smoking is a risk factor to _ but a protective factor to _.

UC / CD

Smoking is a risk factor to Crohn’s Disease but a protective factor to Ulcerative Colitis.

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Skip lesions on histopath are more common in UC or CD?

Crohn’s Disease

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Rectal bleed is more common in UC or CD?

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Toxic megacolon and sclerosing cholangitis is more common in UC or CD?

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p-ANCA more positive in UC or CD?

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MC cause of Lower GIT obstruction in neonates

Hirschsprung disease

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Gold standard for diagnosis of Hirschsprung disease

Rectal biopsy
> absent ganglion cells and acetylcholinesterase positive stain

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MC micronutrient deficiency

Iron

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Micronutrient deficiency that is the most important preventable cause of mental retardation

Iodine deficiency

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The major risk period for growth stunting is _

between 4 mos and 24mos
Chp 55

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TRUE OR FALSE. Breastmilk is a poor source of Vitamin D

TRUE

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The following are true about important principles for weaning EXCEPT:

A. begin at 6 mos old
B. Introduce 1 new food at a time
C. Give no more than 24 oz/day of cow’s milk
D. Fluids other than BM, water and formula are allowed

D. Fluids other than BM, water and formula are allowed
> other fluids are DISCOURAGED
Table 56.7

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When should bottle weaning begin?

A. 12-15mos
B. 15-20mos
C. 18-24mos
D. >24mos

A. 12-15mos

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The ff are specific nutrients of concern in vegetarianism except:

A. Iron
B. Zinc
C. Vitamin D and Calcium
D. Vitamin C

D. Vitamin C

Specific nutrients of concern:
1. iron
2. Zinc
3. Vit D and Ca
4. Fatty acids
5. Vit B12
6. Iodine

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Bitot spots is seen in what vitamin deficiency

Vitamin A

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Excess of which vitamin can cause fetal abnormalities/teratogenic?

Vitamin A

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Manifestation of pellagra
What micronutrient deficiency

3D
Dementia
Dermatitis
> symmetric
> sun exposed areas- sunburn
> glove/stocking appearance
> casal necklace
Diarrhea

Vitamin B3 deficiency

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Which of the ff drug is associated with Vitamin B6 deficiency?

A. Phenobarbital
B. isoniazid
C. Valproic acid
D. Olanzapine

B. isoniazid

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The greatest risk of undernutrition occurs when?

first 1000 days, from conception to 24mos
Chp 57

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_ stimulates appetite
_ stimulates satiety

Ghrelin
Leptin

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Reduced/Elevated levels of adiponectin are asstd w reduced insulin sensitivity

Reduced

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Level of adiponectin in obese patients

Low
> elevated levels of free fatty acids and plasma triglycerides

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When does adiposity rebound happen?

Approximately 5.5yo

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Electrolyte abnormality in refeeding syndrome

Low K, Ph and/or Mg

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Scorbutic rosary is seen in what micronutrient deficiency

Vitamin C deficiency

Rachitic rosary is seen in what micronutrient deficiency

Vitamin D deficiency

Osteomalacia vs rickets

Osteomalacia > inadequate mineralization of bone matrix in both adults and children Rickets > bone matrix not mineralized in growing bones, before closure of the epiphyses

Which micronutrient deficiency is the leading cause of preventable blindness in children?

Vitamin A deficiency

Criterion for obesity BMI overweight

Overweight BMI 85-95p Obesity BMI =>95p

Clinically apparent jaundice appears when serum bilirubin are at _ levels

2-3mg/dL in children and adults In neonates, can be as high up to 5mg/dL

Most severe type of PFIC

PFIC 1 > Amish jews > Byler disease > CM: steatorrhea PFIC 2 > Rapidly progressive cholestatic giant cell hepatitis PFIC 3 > elevated GGT

Abdominal UTZ finding in patients with biliary atresia

Triangular cord sign > coe-shaped fibrotic mass cranial to the bifurcation of the portal vein

Golden period for Kasai procedure

The success rate for establishing good bile flow after the Kasai procedure is much higher (90%) if performed before the 8th week of life 60 days.

The first step in the management of patients with ascites is: A. Paracentesis B. Abdominal UTZ C. rule out SBP and restrict Na intake

C. rule out SBP and restrict Na intake Na intake to 0.5g (1-2meqs/kg/day)

MC hereditary hyperbilirubinemia

Gilbert syndrome > unconjugated hyperbilirubinemia > occurs after puberty, therefore no chronic liver disease > no treatment required > mild elevations in total serum bili with NO evidence of liver damage

Crigler Najjar vs Gilbert vs Dubin Johnson vs Rotor

Crigler Najjar & Gilbert > UNCONUGATED hyperbil Criggler: > early-onset: as early as 3rd DOL > extreme hyperbil Type 1: jaundice, acholic stools Type 2: no acholic stools, PARTIAL gluoronyl transferase deficiecnt Dubin Johnson > CONJUGATED hyperbil > asx, mild jaundice > diagnosed in adol or early adulthood > total urine coproporphyrin normal levels > Liver histo: black pigment similar to melanin Rotor syndrome > CONJUGATED hyperbil > asx, mild jaundice > diagnosed in adol or early adulthood > total urine coproporphyrin ELEVATED levels > Liver histo: NO black pigment

Kayser-Fleischer rings seen in _

Wilson Disease > hepatolenticular degeneration

Most important marker of liver injury A. Bilirubin levels B. Synthetic liver functions C. Aminotransferase levels D. Coagulation factor levels

B. Synthetic liver functions Altered synthetic function is the most important marker of liver injury. Synthetic dysfunction is reflected by a combination of abnormal protein synthesis (prolonged PT, high international normalized ratio [INR], low serum albumin levels), metabolic disturbances (hypoglycemia, lactic acidosis, hyperammonemia), poor clearance of medications dependent on liver function, and altered sensorium with increased deep tendon reflexes (hepatic encephalopathy). > Abnormal liver synthetic function is a marker of liver failure and is an indication for prompt referral to a transplant center

Most prevalent form of Hepatitis

Hepa A

Fulminant types of Hepatitis

B D and E Table 385.1

Fecal-oral spread of Hepatitis

A and E Table 385.1

Pre-exposure prophylaxis for those with chronic liver disease, which of the ff is recommended? A. Ig only B. HAV only C. None if fully immunized D. Both Ig and HAV

D. Both Ig and HAV If travel is planned in < 2 wk, older patients, immunocompromised hosts, and those with chronic liver disease or other medical conditions should receive both Ig and the HAV vaccine.

Persistence of HBsAg over _ defines chronic infection state

6 months

(+) anti HBs (+) anti HBc A. resolved infection B. immunized w Hepa B vaccine C. Both D. NOTA

A. resolved infection (+) anti HBs ONLY = immunized

Marker of Hepa B infectivity

HBe Ag

HBIG should be given to infants of HBsAg positive mothers within _.

12 hrs ASAP but not later than 7 days Table 385.9

MC cause of chronic liver disease in children

Non alcoholic fatty liver disease

MC HBD associated with IBD

sclerosing cholangitis

Stage of Hepatic Encephalopathy: Stupor, but arousable, confused with asterixis and rigidity. EEG show markedly abnormal triphasic waves A. Stage I B. II C. III D. IV

C. III Table 391.1

Choledochal cyst that is a diverticula of the CBD A. Type I B. IA C. II D. III

TYPE II MC is Type I - cyst (saccular or fusiform) dilation on the CBD

MC cause of extrahepatic portal hypertension

Portal vein thrombosis

MC cause of portal hypertension in children

Liver cirrhosis

MC presentation of portal HTN

Bleeding > MC rupture of esophageal varices

Can cause chronic hepatitis infection

B C D

The only serum marker present during the window phase (4-6mos)

Anti HBc IgM

The only marker for Hep B not detected in serum

HBc Ag > only found in liver tissue

All primary teeth erupt by _ yo All permanent teeth are completed by _ yo

3yo 13yo

MC congenital anomaly of the esophagus

Esophageal atresia

Persistent vomiting in caused by pyloric stenosis can lead to _ A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B. Metabolic alkalosis > Progressive loss of fluid, hydrogen ion, and chloride leads to hypochloremic metabolic alkalosis