Gastroenterology Flashcards
Acute Diarrhea
Excessive loss of fluid and electrolyte stool
infants - >10 mL/kg/day
older children >200 g/24 hr
<14 days
Chronic or persistent diarrhea
> 14 days
Watery diarrhea vomiting
Day care center
Infants and Toddlers
Rotavirus
ETEC
Watery diarrhea vomiting
Profuse diarrhea and vomiting
Flecks of mucous on voluminous diarrhea
Cholera
Watery diarrhea vomiting
Profuse diarrhea after eating raw oysters or undercooked shellfish
Vibrio parahaemolyticus
Watery diarrhea vomiting
Greasy stool after camping gas
Giardiasis
Watery diarrhea vomiting
after history of travel
ETEC
Bloody diarrhea
Pus and WBC in stool
Trophozoites w/ ingested RBCs
Amoebiasis
Bloody diarrhea
Pus and WBC in stool
Abdominal cramps, systemic toxicity after antibiotic use
Clostridium difficile
Bloody diarrhea
Pus and WBC in stool
Abdominal cramps, tenesmus, abundant pus and WBC in stool
Shigella
Bloody diarrhea
Pus and WBC in stool
High fever, headache, drowsiness, confusion, meningismus, seizures, abdominal distention
History of eating eggs, poultry, unpasteurized milk
Salmonella
Bloody diarrhea
Pus and WBC in stool
Diarrhea w/ blood after eating hamburger
EHEC
Abdominal cramps
Diarrhea
Sweating
No fever
Ham, potato salad, cream pastries
Staphylococcus
Bloody diarrhea
Pus and WBC in stool
Home canned food
Muscle weakness
Diplopia
Blurring of vision
Botulism
Shiga-toxin producing E.coli;
bloody diarrhea
EHEC
Infantile explosive diarrhea with dehydration; few or no structural changes in the gut mucosa
ETEC
Cause colonic lesions like dysentery
EIEC
Non-bloody diarrhea with mucus; prolonged
EPEC
Significant dehydration; prolonged diarrhea
EAEC
Drugs used in Cholera
Tetracycline (not for <9 yrs old)
OR
Doxycycline
Alternatives
TMP-SMX
Erythromycin
Furazolidone
Incubation period of enteric fever
7-14 days
Signs and symptoms of enteric fever
prolonged fever + weird signs and symptoms (may present w/ UTI, pneumonia, GI symptoms, myocarditis etc)
High-grade fever, malaise, myalgia, cough, abdominal pain, hepatosplenomegaly, anorexia, diarrhea / constipation
Maculopapular rashes (ROSE SPOTS) in 25% - visible on day 7-10 of illness on the lower chest or abdomen and lasts 2-3 days
Complications of enteric fever
Intestinal hemorrhage
Perforation
If with perforation – RLQ pain, tenderness, vomiting, features of peritonitis
Treatment of enteric fever
UNCOMPLICATED
Fully Sensitive - CHLORAMPHENICOL
MDR - AMOXICILLIN, FLUOROQUINOLONE or CEFIXIME, AZITHROMYCIN or CEFTRIAXONE
Treatment of enteric fever
COMPLICATED
Fully Sensitive - FLUOROQUINOLONE
MDR - FLUOROQUINOLONE
QUINOLONE-RESISTANT - CEFTRIAXONE, CEFOTAXIME
S dysenteriae serotype 1 produce a potent protein which inhibit exotoxin causes HUS
SHIGA TOXIN
Symptoms of Shigellosis
severe abdominal pain high fever emesis anorexia generalized toxicity PAINFUL DEFECATION urgency
Differential diagnosis for Bloody Diarrhea
CEECSY
Campylobacter jejuni EIEC Entamoeba histolytica Clostridium difficile Salmonella Yersinia enterolitica
Empiric Treatment for Shigellosis
Cefixime
Ceftriaxone
Azithromycin
WHO recommendation for all patients w/ BLOODY DIARRHEA irrespective of age
Ciprofloxacin 30 mg/kg/day in 2 divided doses
Improves immune response to Shigella
Zinc 20 mg/day for 14 days
Abdominal pain
Vomiting
+/- Distention
Bloody currant stool
Sausage shaped RUQ mass
(-) bowel sounds RLQ
COILED SPRING SIGN
Intussusception
occurs when a portion of the alimentary tract is telescoped into an adjacent segment
MCC of intestinal obstruction b/w 3 mos-6 y/o
Correlation w/ ADENOVIRUS
Ultrasound finding in intussusception
Target sign
Abdominal pain
Vomiting
+/- Distention
post prandial vomiting, NON BILIOUS
Down syndrome
olive shaped mass
barium studies - SHOULDER SIGN, DOUBLE TRACT SIGN
PYLORIC STENOSIS
shoulder sign - elongated pyloric channel, bulge of the pyloric muscle into the antrum
double tract sign - streaks of barium in the narrowed channel
BILIOUS VOMITING (-) abdominal distention usually noted on the 1st day
DUODENAL ATRESIA
DOUBLE BUBBLE SIGN - d.t. distended and gas filled stomach and proximal duodenum
MCC of lower intestinal obstruction in neonates
MALES
Congenital aganglionic megacolon
HIRSCHPRUNG DISEASE
(-) ganglion cells in the bowel wall beginning in the internal anal sphincter
RECTOSIGMOID - 80%
Gold standard for diagnosis of Hirschsprung disease
RECTAL SUCTION BIOPSY
Abdominal pain
Vomiting
+/- Distention
normal history or recurrent obstructive symptoms
painless rectal bleeding
intermittent pain
MECKEL DIVERTICULUM
Scintigraphy scan - detect gastric tissue
Abdominal pain
Vomiting
+/- Distention
can’t pass NGT
severe pain and emesis
VOLVULUS
OMEGA SIGN
COFFEE BEAN SIGN
Meckel Diverticulum Rule of 2
2% of the population is affected 2 yrs old on presentation (usually) 2 times more females are affected 2 inches long 2 feet from the ileocecal valve 2 types of common ectopic tissue (gastric and pancreatic)
Does not apply 2 everyone!
Prolonged elevation of the serum levels of conjugated bilirubin beyond the 1st 14 days of life
NEONATAL CHOLESTASIS
Non-cystic Obliterative Cholangiopathy
BILIARY ATRESIA
extrahepatic
2 types:
fetal and perinatal
Cone shaped fibrotic mass cranial to the bifurcation of the portal vein
May be seen in patients w/ biliary atresia
TRIANGULAR CORD SIGN
Gold standard for the treatment of biliary atresia
Direct Cholangiography
Management of Biliary Atresia
Nutritional Support
KASAI HEPATOPORTOENTEROSTOMY
- 60 days - golden period
- success rate much higher if performed before 8 weeks
Definitive management for Biliary Atresia
LIVER TRANSPLANT
MCC of viral gastroenteritis in infants
Rotavirus
Intussusception has correlation with viral infection
Adenovirus
MC intestinal segment affected in Hirschsprung disease
Rectosigmoid colon
Stool softeners that should be AVOIDED in children with functional constipation
Senna or Bisacodyl
Foreign body ingestion needed URGENT removal
Sharp objects
Button batteries
FBs with respiratory symptoms
Required for ALL symptomatic patients who had CAUSTIC ingestion
UPPER ENDOSCOPY
MC pancreatic disorder in children
Acute Pancreatitis
sentinel loop
cutoff sign
blurring of the left psoas margin
peripancreatic extraluminal gas bubbles
TRUE or FALSE
Ranson criteria and APACHE score are appropriate prognostic scores for children with acute pancreatitis
FALSE
1st clinical evidence of HBV infection
ALT elevation
Most valuable single serologic marker for ACUTE HBV infection
anti-HBcAg
1st serologic marker to appear in HBV infections
Antigen used in Hep B infection
HBsAg
Only serologic marker POSITIVE during the WINDOW period of HBV infection
IgM anti-HBc
Serologic markers positive in patients who are immune d.t. natural HBV infection
Anti-Hbc
Anti-Hbs
Only serologic marker positive in patients who are immune d.t. Hep B vaccine
Anti-Hbs
(+) HBsAg
(+) HbeAg
Incubation period
(+) HBsAg
(+) IgM
(+) HBeAg
Acute Infection
(+) IgM anti HBc
Window Period
(+) anti-HBs
(+) IgG anti HBc
Complete Recovery
(+) HBsAg
(+) IgG
(-) HBeAg
Chronic Carrier
(+) HBsAg
(+) IgG
(+ HBeAg
Chronic Active
(+) anti-HBs
Vaccinated