Gastroenterology Flashcards
What ages does pyloric stenosis develop?
Between 3-8 weeks of life (would not suspect in a brand new neonate)
GI manifestations associated with Down’s Syndrome
Duodenal atresia, imperforate anus, Hirschsprung’s disease
Family history of liver cirrhosis and transplantation at a young age, hematemesis, elevated AST/ALT and anemia, neuropsychiatric symptoms (ataxia, choreathetoid movements), Kayser-Fleischer rings. Name the disorder ?
Wilson’s disease (autosomal recessive)–accumulation of Copper in liver and brain–> cirrhosis and esophageal varices. Defect in movement of copper from liver to bile.
Labs- low serum Cu2+ and low ceruloplasmin (but Cu overload–deposited in the tissues), high urine Copper excretion
Treatment: chelation (D-penicillamine), decreased Cu intake, intake of Zn (competes with Cu for absorption)
How do you definitively diagnose a biliary atresia?
Intraoperative cholangiogram (fluoroscopy during surgery watching contrast flow through the biliary tree); HIDA scan is not specific enough
Is achalasia associated with an increased or decreased LES resting tone?
Increased tone/pressure, aganglionic distal portion of the esophagus–does not relax and so you have a functional distal obstruction of the esophagus
GI disorders associated with Erythema nodosum?
Crohn’s, Ulcerative colitis
Bifid thumbs and other bony deformities, greasy foul-smelling stools, failure to thrive, normal sweat chloride testing; cyclic neutropenia
Schwachman-Diamond Syndrome (Autosomal recessive)
(Bone and bone marrow problems)– skeletal deformities, neutropenia +/- anemia/thrombocytopenia, so increased risk of bacterial infections
(Pancreatic exocrine insufficiency)– foul, smelling stools, FTT, poor absorption of ADEK vitamins
Pyoderma gangrenosum is commonly associated with which GI disorder? Also areas where lesions can be located?
IBD (Crohn’s and Ulcerative colitis); starts of raised violaceous, maculopapular and then becomes necrotic and pustular (autoimmune); can be located on the shins, head and anogenital regions commonly
Causes of Autoimmune Hepatitis? What is an associated lab finding with this disorder?
Medications (Isoniazid, Minocycline, Nitrofurantoin, Sulfonamides); associated with hypergammaglobulinemia (increased antibodies against smooth muscle, liver, kidney, mitochondria, etc); check total IgG level
What conditions can make you more susceptible to SMA?
SMA- Superior Mesenteric Artery Syndrome; LOSING WEIGHT; loss of mesenteric fat leads to tightening of space within the bifurcation of the aorta into the SMA and abdominal aorta; the duodenum 2-3rd portions lie within this space and gets squished
What kind of positioning leads to improvement of SMA syndrome related nausea and vomiting?
Knee to chest, left lateral side lay; relieves the functional duodenal obstruction by widening this space
Acrodermatitis Enteropathica usually coincides with the removal of what from the diet?
Breast-Milk; autosomal recessive absence of Zinc-binding ligand in the GI tract of affected infants–breast milk has zinc-binding ligand
Symptoms of acrodermatitis enteropathica?
Loose stools, FTT, irritability, mucosal bullous lesion that bursts and crusts over
Celiac disease– intestinal mucosa finding? What skin condition is celiac disease associated with?
Effacement of microvilli, scalloping (bumpiness) of intestinal mucosa; dermatitis herpetiformis (IgA deposition in the skin preceded by herpetic appearing vesicular lesions that burst and scar)
Blood in stools, otherwise asymptomatic exam– how do you diagnose this condition?
Technetium 99 scan–although low negative predictive value, so would still need surgical management if you are unable to find it on imaging; meckel’s diverticulum (ectopic gastric tissue)
Foul, smelling loose stools and gets sick very often, FTT; sweat chloride test negative; what is the diagnosis?
Shwachman-Diamond Syndrome- 1. (bony abnormalities at metaphyses and growth plate of bones + bone marrow hypoplasia– neutropenia, anemia, thrombocytopenia); 2. pancreatic exocrine insufficiency (loose stools)
Peutz-Jeghers syndrome signs and symptoms?
Blue-black mucocutaneous macules (nose, mouth, elbows, hands) and intestinal hamartomas (increased risk of GI adenocarcinomas and intussusception).
Risk factors for intestinal atresia?
Maternal tobacco and cocaine use, low birth weight, multiple births
Autoimmune hepatitis presentation?
Sudden onset jaundice and evidence of hepatitis in someone who was previously healthy; Type I (10-20 years old, usually female); Type II (younger children, usually more serious); may need steroids and immunosuppressive meds; Type III is for adults
Gallbladder hydrops is commonly associated with which disorder?
Kawasaki disease (distention of gallbladder by sterile bile)
Triple A or Allgrove Syndrome features?
Achalasia (failure of esophageal relaxation at the LES–> bird’s beak), alacrima (reduced ability to produce tears), and Adrenal insufficiency (primary); associated with autonomic dysfunction
Crohn’s disease can be associated with which eye condition?
Anterior uveitis
Antibodies associated with Type I Autoimmune Hepatitis
Anti-smooth muscle and ANA antibodies
Antibodies associated with Type II Autoimmune Hepatitis
Anti-liver and anti-liver-kidney antibodies (more severe because targets organs–this is only a mnemonic)
PRSS1 gene mutation is related to which disorder?
Hereditary pancreatitis– converts trypsinogen into active trypsin while still in the pancreas, instead of waiting for it to be released into the stomach lumen
What is Reye’s syndrome?
Swelling of the brain and liver 2/2 to taking salicylates while have the chicken pox or flu or either vaccines. Can have behavioral changes related to brain swelling.
How long should you avoid salicylates after receiving Influenza or VZV vaccines?
6 weeks
