GASTRO/NUTRI Flashcards
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.
Skip lesions on histopath are more common in UC or CD?
Crohn’s Disease
Rectal bleed is more common in UC or CD?
UC
Toxic megacolon and sclerosing cholangitis is more common in UC or CD?
UC
p-ANCA more positive in UC or CD?
UC
MC cause of Lower GIT obstruction in neonates
Hirschsprung disease
Gold standard for diagnosis of Hirschsprung disease
Rectal biopsy
> absent ganglion cells and acetylcholinesterase positive stain
MC micronutrient deficiency
Iron
Micronutrient deficiency that is the most important preventable cause of mental retardation
Iodine deficiency
The major risk period for growth stunting is _
between 4 mos and 24mos
Chp 55
TRUE OR FALSE. Breastmilk is a poor source of Vitamin D
TRUE
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
When should bottle weaning begin?
A. 12-15mos
B. 15-20mos
C. 18-24mos
D. >24mos
A. 12-15mos
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
Bitot spots is seen in what vitamin deficiency
Vitamin A
Excess of which vitamin can cause fetal abnormalities/teratogenic?
Vitamin A
Manifestation of pellagra
What micronutrient deficiency
3D
Dementia
Dermatitis
> symmetric
> sun exposed areas- sunburn
> glove/stocking appearance
> casal necklace
Diarrhea
Vitamin B3 deficiency
Which of the ff drug is associated with Vitamin B6 deficiency?
A. Phenobarbital
B. isoniazid
C. Valproic acid
D. Olanzapine
B. isoniazid
The greatest risk of undernutrition occurs when?
first 1000 days, from conception to 24mos
Chp 57
_ stimulates appetite
_ stimulates satiety
Ghrelin
Leptin
Reduced/Elevated levels of adiponectin are asstd w reduced insulin sensitivity
Reduced
Level of adiponectin in obese patients
Low
> elevated levels of free fatty acids and plasma triglycerides
When does adiposity rebound happen?
Approximately 5.5yo
Electrolyte abnormality in refeeding syndrome
Low K, Ph and/or Mg
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
