Gastroenterology Flashcards

Question

In what situations could pediatricians recommend the use of probiotics?

Answer 1

1. Physicians can consider recommend probiotics to: 1. Prevent antibiotic-associated diarrhea 2. Shorten duration of acute infectious viral diarrhea 3. Prevent NEC in preterm infants at risk of NEC 4. Decrease symptoms of colic 5. Decrease some symptoms of IBS 2. Insufficient evidence to suggest for the prevention of atopic disease 3. Be aware probiotics carry small risk of invasive disease to immunocompromised children

Answer 2

* Can safely participate in sports without disease exacerbation. * Should participate in moderate fitness, flexibility and strengthening exercises. * Can participate in impact activities and competitive contact sports if their disease is well controlled and they have adequate physical capacity. * Should be encouraged to be physically active as tolerated. Those with moderate to severe impairment or actively inflamed joints should **limit activities within pain limits**. * Should gradually return to full activity following a disease flare. * Should take individualized training (especially for children with severe joint disease) within a group exercise format for physical/social benefit. Physiotherapists on paediatric rheumatology health care teams should coordinate individual exercise programs. * Should have radiographic screening for **C1–C2 instability** before participation in collision/contact sports if they have neck arthritis. If present, further evaluation is required. * Should wear appropriately fitted mouth guards during activities with jaw and dental injury risk (per general population), especially if they have jaw involvement. * Should wear appropriate eye protection (per general population) during activities with ocular injury risk

Answer 3

* Should receive appropriate **factor prophylaxis** to reduce the risk of bleeding in sport. * Should undergo vigilant assessment of **joint and muscle function** before sport selection. If restrictions are required, physicians should counsel children and their families about safe alternatives. * Should be carefully assessed before allowing participation in contact or collision sports such as martial arts, hockey or football. Consultation with a sport medicine physician and/or paediatric hematologist may help. * Require written strategies (coach, parent or school) before sport participation to prevent or treat bleeds. * Should wear **protective equipment**, undergo physical therapy or take prophylactic factor replacement therapy. * Require **factor replacement, ice, splinting and rest** to manage acute bleeds. Physical activity should be avoided until joint pain or swelling has resolved. Return to sport requires individualized assessment and appropriate rehabilitation

Answer 4

* Are able to participate in any physical activity if symptoms are well controlled. Swimming is less likely to trigger EIB than running. * Should keep an accurate history of symptoms, trigger exposures, treatments and course of recovery from episodes of bronchospasm. * Should be diagnosed with EIB by a drop in **FEV1 (10% to 15%) after a 6 min to 8 min** exercise challenge and a positive response to beta-2 agonist medication. Eucapnic voluntary hyperventilation testing is recommended in athletes. * Should use leukotriene inhibitors, inhaled corticosteroids and/or long-acting beta-2 agonists for optimal long-term disease control, and avoid overuse of short-acting beta-2 agonists. * Should take **inhaled beta-2 agonists 15 min to 30 min before exercise**. * Should not scuba dive if they have asthma symptoms or abnormal PFTs. * Who compete nationally or internationally require a therapeutic use exemption with confirmation of asthma and/or EIB to use certain medications. Consultation with a sport medicine physician is suggested.

Answer 5

* Should be encouraged to participate in any physical activity. Consultation with a sport medicine physician or **paediatric respirologist is suggested**. * Should have **individualized exercise programs** that include strength training. * Require supervised or unsupervised home exercises that elevate heart rate by 70% to 80% of maximum to increase aerobic exercise tolerance. * Who cough during exercise should not necessarily stop activity. * Those with severe CF should undergo **exercise testing** to identify maximal heart rate, levels at which oxygen desaturation and ventilation limits occur, exercise related bronchospasm and response to therapy. * Should absolutely **avoid scuba diving** → risk of pneumothorax! * Should drink **flavoured sodium chloride-containing fluids** above thirst levels to prevent hyponatremic dehydration. Those with diabetes mellitus require additional carbohydrates during prolonged exercise. * With an enlarged spleen or diseased liver should avoid contact or collision sports

Answer 6

1. Prevent antibiotic-associated diarrhea 2. Shorten duration of acute infectious viral diarrhea 3. Prevent NEC in preterm infants at risk of NEC 4. Decrease symptoms of colic 5. Decrease some symptoms of IBS

Answer 7

1. Hepatitis (inflammation) 2. Storage disorders 1. Glycogen (GSD) 2. Lipid (Gaucher, NASH) 3. Protein (A1AT) 4. Iron (hemochromatosis) 3. Infiltrative 1. Benign liver tumors 2. Malignant liver tumors 3. Disseminated tumors ![]() 4. Biliary obstruction 5. Post-hepatic obstruction 1. Cardiac (Right HF) 2. Thrombus (hepatic vein, IVC) 3. Intrahepatic (sinusoids)

Answer 8

* For children \>2yo: * 1. HBsAg+ for \>6mo * 2. ALT 2x normal + * 3. Evidence of viral replication (HBeAg+ or HBV DNA \>4 log if HBeAg-) * OR Chronic hepatitis on liver biopsy * Treat with either IFN-alpha or lamivudine * 20-58% spontaneous conversion / clearance

Answer 9

* Measure ALT q6months in children \>2yo * Measure HBeAg and HBeAb yearly in patients with normal ALT * Liver biopsy in children \>2yo with elevated ALT * Examine for chronic liver disease * Immunize household * Immunize patient against Hepatitis A * Alpha fetoprotein & ultrasound annually

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Gastroenterology Flashcards

Brainscape's Knowledge Genome^TM