Gastroenterology Flashcards
Positive psoas sign (pain on strengthening out the leg
Absence of air in the RLQ on Xray
Appendicitis
Causes of acute abdominal pain
Constipation
Ovarian
Mesenteric
Mono
Pancreatitis
Hepatitis
UTI
Trauma
Surgical
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
Criteria for H pylori testing
Endoscopic or radiologic evidence of gastric or duodenal ulcers
MALT lymphoma
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)
Recurrent Abdominal pain
Urinary retention
Tachycardia
Blurred vision
Dry mouth
TCA ingestion
Abdominal pain for > 1x/wk for > 2 mo
Loss of daily activity
Headache, limb pain, sleep disruption
Childhood functional abdominal pain
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
Vomiting
HAGMA
Hypoglycemia
Hyperammonemia
No fevers
Inborn error of metabolism
Bilious vomiting
Double bubble sign
Icteric (diminished enterohepatic circulation)
Duodenal atresia
Bilious Vomiting
Abnormal intestinal rotation
Cecum’s failure to descend
Bloody stool
Management’s
Malrotation
Surgical emergency
Bilious vomiting
Right sided abdominal distention
Ladd bands
Gastric/duodenal dilatation
Decreased intestinal air
Cork screw appearance of small bowel
volvulus
3 mo to 6 yr
Recurrent Abdominal pain with drawing up legs
Vomiting
Lethargic
Bloody/currant jelly stool
Sausage like mass
Intussusception
Management and causes
Air enema (diagnostic + therapeutic)
Under 3 yo - idiopathic
Over 3 yo - meckel, polyps, HSP vasculitis, lymphoma
Dystonic movement of head/neck
GE reflux
Sandifer syndrome
MOA of Zofran
serotonin receptor antagonist
GE reflux
Abdominal pain
Arching of back with feeds
Apnea
FTT
GERD
Management for GERD
Reflux precautions
Reassurance
Progressive non-bilious vomiting
Second month of life
Hypochloremic hypokalemic metabolic alkalosis
Hypertrophic pyloric stenosis
US diagnostic criteria for hypertrophic pyloric stenosis
Pyloric length > 14 mm
Or
Pyloric muscle thickness > 4 mm
Acute and chronic management for cyclical vomiting syndrome
Acute: IV hydration
Chronic: cyproheptadine, propranolol, TCA
Frequent passive regurgitation of ingested food into mouth that is then re-chewed and swallowed or spit out
Rumination
PseudoCyst on floor of mouth
“Mucocele”
Bluish
Ranula
Treatment: excision
Underdeveloped or absent teeth
X-linked
Ectodermal hypoplasia
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
