Gastroenterology Flashcards by Sam Biniazan

Positive psoas sign (pain on strengthening out the leg

Absence of air in the RLQ on Xray

Appendicitis

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Causes of acute abdominal pain

Constipation
Ovarian
Mesenteric
Mono
Pancreatitis
Hepatitis
UTI
Trauma
Surgical

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Epigastric abdominal pain
Not relieved with defecation
No evidence of inflammatory, anatomic, metabolic, neoplastic, or recent infection

Present for > 1x per week for > 2 mo

Functional dyspepsia

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Criteria for H pylori testing

Endoscopic or radiologic evidence of gastric or duodenal ulcers

MALT lymphoma

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Abdominal discomfort improved with defecation
Change in stool frequency or consistency
No organic explanation of symptoms

Present for > 1x per week for > 2 mo

Irritable bowel syndrome (IBS)

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Recurrent Abdominal pain
Urinary retention
Tachycardia
Blurred vision
Dry mouth

TCA ingestion

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Abdominal pain for > 1x/wk for > 2 mo
Loss of daily activity
Headache, limb pain, sleep disruption

Childhood functional abdominal pain

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Acute, incapacitating periumbilical abdominal pain
> 1 hr
Interferes with normal activity
Must include 2 of the following :
Pallor, anorexia, nausea, vomiting, headache, photophobia

Have symptom free periods

Management

Abdominal migraine

Triptans

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Vomiting
HAGMA
Hypoglycemia
Hyperammonemia
No fevers

Inborn error of metabolism

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Bilious vomiting
Double bubble sign
Icteric (diminished enterohepatic circulation)

Duodenal atresia

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Bilious Vomiting
Abnormal intestinal rotation
Cecum’s failure to descend
Bloody stool

Management’s

Malrotation

Surgical emergency

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Bilious vomiting
Right sided abdominal distention
Ladd bands
Gastric/duodenal dilatation
Decreased intestinal air
Cork screw appearance of small bowel

volvulus

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3 mo to 6 yr
Recurrent Abdominal pain with drawing up legs
Vomiting
Lethargic
Bloody/currant jelly stool
Sausage like mass

Intussusception

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Management and causes

Air enema (diagnostic + therapeutic)

Under 3 yo - idiopathic
Over 3 yo - meckel, polyps, HSP vasculitis, lymphoma

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Dystonic movement of head/neck
GE reflux

Sandifer syndrome

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MOA of Zofran

serotonin receptor antagonist

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GE reflux
Abdominal pain
Arching of back with feeds
Apnea
FTT

GERD

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Management for GERD

Reflux precautions
Reassurance

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Progressive non-bilious vomiting
Second month of life
Hypochloremic hypokalemic metabolic alkalosis

Hypertrophic pyloric stenosis

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US diagnostic criteria for hypertrophic pyloric stenosis

Pyloric length > 14 mm
Or
Pyloric muscle thickness > 4 mm

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Acute and chronic management for cyclical vomiting syndrome

Acute: IV hydration

Chronic: cyproheptadine, propranolol, TCA

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Frequent passive regurgitation of ingested food into mouth that is then re-chewed and swallowed or spit out

Rumination

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PseudoCyst on floor of mouth
“Mucocele”
Bluish

Ranula

Treatment: excision

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Underdeveloped or absent teeth
X-linked

Ectodermal hypoplasia

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Most common type of TE fistula

Blind upper esophageal pouch

Chronic immune/antigen mediated condition Presents as GERD/dysphagia Food impaction

Eosinophilic esophagitis

Peptic ulcer disease medication contraindicated in pregnancy

Misoprostol

Postprandial emesis Epigastric pain that wakes up patient +/- guaiac positive stool

Peptic ulcer disease

FTT Muscle wasting Diarrhea/abdominal distention Nonresolving iron-deficiency anemia

Celiac disease

Best screen for celiac disease

IgA Ab against TTG IgA Ab to endomysium (If normal IgA levels)

Macrocephaly Papillomatous papules Mucocutaneous lesions Actual keratosis

PTEN Hamartoma Syndrome (Aka Cowden and Multiple Hamartoma syndromes)

Familial adenomatous polydipsia CNS tumors

Turcot syndrome

Age to being sigmoidoscopy/colonoscopy in FAP

10-12 years

FAP Intestinal polyps extra teeth Osteomas Soft tissue tumors

Gardner’s syndrome

Mucocutaneous pigmentation of lips/gums Hundreds of polyps Colicky abdominal pain

Peutz-Jegher syndrome

Rectal ulcer Hematochezia Superficial ulcer with crypt abscesses Toxic megacolon Erythema nodosum Arthritis Pyoderma gangrenosum Ankylosing spondylitis Sclerosing cholangitis p-ANCA +

Ulcerative colitis

Screening and management of UC

colonoscopy every 1-2 years beginning 8 years after diagnosis 5-ASA

Perirectal fistulas Skip lesions Cobblestone Nocasesting granulomas Rectum spares Toxic megacolon String sign +ASCA

Chrohn’s disease

Screening and management of chron’s

colonoscopy every 1-2 years beginning 8 years after diagnosis 5-ASA

No passage of meconium in first 48 hr Absconds of parasympathetic inner action of the internal anal sphincter Congenital aganglionic megacolon Down syndrome

Hirschsprung’s disease

Diagnosis and management of Hirschsprung’s

Rectal biopsy “Squirt sign” Surgical excision of aganglionic segment

Most common cause of upper GI bleeding

Gastritis due to Peptic or acid irritation

Negatibe Apt test

Ingested blood of maternal origin

False positive guiaic

Meat Ingestion Horseradish Iron

Painless rectal bleeding Around age 2 Gastric/intestinal tissue 2 feet from ileocecal valve 2in in length 2% of population Diagnosis

Meckel diverticulum Technetium 99m pertechnate scintigraphic study

Watery, non bloody diarrhea Neonates to < 2 yo Poor sanitation

Enteropathogenic E. coli (EPEC)

Severe watery, nonbloody diarrhea Travelers diarrhea

Enterotoxogenix E. Coli (ETEC)

Bloody diarrhea Hemorrhagic colitis HUS

Enterohemorrhagic/Shiga toxin E. coli (STEC)

Dysentery Tenesmus Afebrile

Enteroinvasive E. Coli (EIEC)

Most commons cause of parasitic diarrhea worldwide

Giardiasis

Management for Giardiasis

Tinidazole Metronidazole Nitazoxanide

Watery non bloody diarrhea Childcare centers Swimming pools Petting zoos

Cryptosporidium

Protracted diarrhea Newborns Infants Toddlers Older children

Short gut syndrome Viral infection / protein intolerance Toddler’s diarrhea Lactose intolerance

Most common cause of chronic diarrhea in children up to 3 yo Etiology

Toddler’s diarrhea Excess fruit intake

Hyperalimentation-induced cholestasis

Protein intake associated with TPN

Most common cause of cholestatic jaundice in newborn

TPN

Diagnostic test for evaluation of biliary atresia

1) intraoperative cholangiogram 2) ultrasound 3) HIDA

Neonatal jaundice Fever Acholic stools RUQ pain Palpable mass

Choledochal cyst

Intermittent Unconjugated hyperbili Stress or illness Familial Glucoronyl transferase deficiency

Gilbert Syndrome

Recent illness or varicella Aspirin Elevated LFTs and ammonia

Reye’s syndrome If 2nd occurrence, think inborn error of metabolism

Liver disease in children/teenagers Neuropsychiatric disease in adults Elevated hepatic/urine copper Decreased ceruloplasmin Low serum copper Management

Wilson disease D-penicillamine

Neonatal jaundice, hepatitis, cholestasis COPD Necrotizinf panniculitis and psoriasis in adults

A1AT deficiency

Diagnosis of portal hypertension

Portal venous pressure > 5 mmHg Portal to hepatic vein pressure gradient > 10 mmHg

Most sensitive indicator of portal hypertension and varices

Splenomegaly

Flu like symptoms Jaundice Elevated LFTs Fecal-oral route Poor hygiene/sanitation Contaminate water Raw/undercooked food

Hepatitis A + serum IgM

DNA virus Blood, sex, perinatal transmission Arthritis Papular acrodermatitis (gianotti-crosti) PAN GN

Hepatitis B

Most feared complications of chronic HBV infection

Fulminant hepatic failure and HCC

HBsAg + Anti HBs - IgM

Acute HBV

HBsAg + Anti HBs - IgG Elevated AST

Chronic HBV

HBsAg + Anti HBs - IgG Normal AST

Carrier of HBV

HBsAg - Anti HBs + IgG

Past HBV infection

HBsAg - Anti HBs + No Anti-HBc

Post HBV vaccination

HBsAg - Anti HBs - IgG

Chronic HBV Past HBV False positive

Most common blood borne infection in US Most common cause of chronic viral hepatitis

Hepatitis C

Fecal oral route Asia, Africa, Mexico Contaminated water Hepatitis

Hepatitis E

Most specific test for diagnosing pancreatitis

Abdominal ultrasound

Most common cause of recurrent pancreatitis

Hereditary pancreatitis

Fever pain Radiating to R scapula Palpable mass in RUQ

cholecystitis

Radiolucent cholelithiasis

Cholesterol Obesity, Hispanic, familial, female

Black cholelithiasis

Pigmented Hereditary hemolytic anemias

Brown cholelithiasis

Infection Bacterial or parasitic

Diagnostic test for primary sclerosing cholangitis

MRCP

Most common genetic mutation that leads to hereditary pancreatitis

PRSS1

Allgrove syndrome

Achalasia Alacrima (no tears) Adrenal insufficiency

Crigler-Najjar syndrome

Unconjugated hyperbilirubinemia Type 1: complete absence of UDP-gluconyltranserase Type 2: near complete absence of UDP-gluconyltranserase