Gastroenterology Flashcards
Vitamin deficiencies: 1 vitamin A 2 vitamin D 3 vitamin E 4 vitamin K 5 vitamin B1 6 vitamin B6 7 vitamin B12 8 Vitamin C 9 niacin 10 zinc
- Night blindness, dry conjunctiva/cornea
- Ricketts/osteomalacia/dental caries, hypophosphatemia, hypocalcemia
- Anemia/hemolysis, neurologic Deficits, altered prostaglandin synthesis
- Coagulopathy, abnormal bone matrix synthesis
- Beriberi (high output cardiac failure, peripheral neuropathy, hoarseness, Wernecke’s)
- Dermatitis, chelosis, glossitis, microcytic anemia, peripheral neuritis
- Demyelination, megaloblastic anemia
- Scurvy
- Pellagra – diarrhea, dermatitis, dementia,
- Skin lesions, poor wound healing, diarrhea, immune dysfunction
Marasmus versus Kwashiorkor?
Energy depleted state with very thin patient versus protein deficient state (edema, Abdominal distention, alterations in skin pigmentation)
carbohydrate malabsorption – Causes? Findings?
- Congenital enzyme deficiency (lactase deficiency)
- Mucosal atrophy
- Acidic (below 5.6) stool
- Positive Clinitest – Non-glucose reducing substances
Causes of protein malabsorption? Test?
- Congenital enterokinase deficiency – hypoproteinemia with edema, massive nitrogen loss in stool
- Protein-losing enteropathies – inflamed intestinal mucosa cannot absorb protein
- Inflammatory disorders – Crohn’s disease etc.
Fecal alpha-1-antitrypsin levels
Causes of fat malabsorption?
- Exocrine pancreatic insufficiency – cystic fibrosis, chronic pancreatitis, Schwachman-Diamond
- Intestinal mucosal atrophy
- Bile acid deficiency
- Abetalipoproteinemia
Blood finding in abetalipoproteinemia?
Acanthocytosis of erythrocytes
Schwachman-Diamond syndrome?
- Pancreatic exocrine insufficiency
- Neutropenia or pancytopenia
- Failure to thrive/short stature
protein intolerance – Main cause? Clinical features? Management?
Cows milk greater than sign soy/egg
- Enteropathy – diarrhea, vomiting, irritability,
- Enterocolitis – diarrhea, rectal bleeding, irritability
Avoidance of dietary protein. Usually resolves by 1 to 2 years of age
Celiac disease – presents when? Gold standard for diagnosis? Serum antibodies?
6 months to 2 years of age
Small bowel biopsy
Tissue transglutaminase antibody, antigliadin (in IGA deficient patients)
Short bowel disease – causes? Complications (5)? Management?
- Congenital lesions – gastroschisis, volvulus, intestinal atresia
- Surgery for necrotizing internal colitis, Crohn’s disease, radiation
- Carbohydrates/fat malabsorption with stearrhea
- Secretory diarrhea, dehydration, hyponatremia, hypokalemia
- If distal bowel involved – decreased B12, bile acid absorption
- Intestinal bacterial overgrowth
- Poor bone mineralization, renal stones
- TPN
- Currently enteral feedings to ensure Adaptic growth of rest of bowel
- Transplantation
GERD – predominant cause during childhood? Clinical features of physiologic reflux? Physiologic reflux resolves by?
Inappropriate LES relaxation
Physiologic – “happy spitters” (Resolved by 6-12 months)
GERD – clinical features of pathologic reflux? Unlikely to have spontaneous resolution if?
- Emesis
- esophagitis - Feeding refusal, constant hunger
- Sandifer syndrome – torticollis caused by painful esophagitis
- Nausea and weakening, hoarseness, halitosis, wheezing
Symptomatic over one year of age
GERD – complications?
- Airway disease – laryngitis, hoarseness, wheezing, subglottic stenosis
- G.I. – esophageal strictures, Barrett’s
GERD – gold standard for diagnosis? Other methods? Management? Type of surgery?
- Gold standard: pH probe (number of acidification episodes)
- Scintigraphy for aspiration
- Bronchoscopy with alveolar lavage if aspiration strongly suspected
- Endoscopy when uncertain diagnosis
- Barium swallow – poor test for diagnosis
- Positioning, frequent small meals,
- antacids/H2-blockers/PPI,
- metoclopramide
- Surgery – Nisen fundoplication (wraps fundus of stomach around esophagus), gastric antroplasty, G-tube
Intestinal anatomic obstructions that result in vomiting?
- Hypertrophic pyloric stenosis
- Malrotation and midgut volvulus
- Atresia
- Intussusception
- Hirschsprung’s disease
Hypertrophic Pyloric stenosis – clinical features? Physical exam? Lab findings? Radiographic sign? Management?
Non-bilious, projectile vomiting immediately after feeding 2-3 weeks after birth
- Palpable “Olive” mass
- Visible abdominal peristaltic waves
- Hypochloremic, hypokalemic metabolic acidosis
Ultrasound showing string sign
Partial pyloromyotomy
Malrotation/Midgut volvulus – pathogenesis? Clinical features?
Midgut twist around superior mesenteric vessels due to
- lack of fixation – Results in peritoneal bands (Ladd’s bands), that compress the duodenum
- Narrow pedicle which suspends the small bowel that can easily twist
Bilious vomiting and sudden onset abdominal pain with blood tinged stools
Malrotation/Midgut volvulus – X-ray shows? Upper contrast imaging shows? Lower contrast imaging? Management?
- X-ray – distention with little distal bowel gas
- Upper Contrast imaging – abnormal position of ligament of Treitz, jejunum (Right of midline)
- Lower contrast studies – cecum and left abdomen or right upper quadrant
Volvulus is surgical emergency
Most common cause of obstruction in neonatal period? defect occurs when during gestation? Most typical patient? Clinical features? Impact of gestation? Diagnosis? Management?
Intestinal atresia; 8 to 10 weeks gestation; male with down syndrome.
- Scaphoid abdomen with epigastric distention
- Bilious emesis
Polyhydramnios
- Double bubble sign on AXR
- Intestinal contrast days
- Nasogastric decompression
- Duodenoduodenostomy/surgery resection and anastomosis of atretic segment
Most common cause of obstruction within the first two years? peak incidence occurs at what age? Most common location? Causes? Clinical features?
Intussusception; 5-9 months of age; ileocolic region
Lead point (Meckel’s diverticulum, polyp, Pyers patch, lymphoma) may draw intestine inward
- Seven onset of abdominal pain, with infants drawing legs to chest
- Vomiting and currant jelly stool (mucosal sloughing)
- Sausage-shaped mass in right upper quadrant
Intussusception – evaluation? Management?
- Contrast enema is gold standard – “coil spring” sign
- Radiographs showed dilated loops of bowel
- Contrast enema – pressure reduces intussusception
- If contrast enema fails – surgery
Physical exam: intestinal obstruction versus peritonitis?
High-pitched bowel sounds, visible peristalsis versus diminished bowel sounds, guarding/rebound
Acute pancreatitis – most common cause in children? Physical exam findings? Laboratory findings? Imaging modalities and purpose?
Trauma
- Gray-Turner sign (bluish discoloration on flank)
- Cullen Sign (bluish discoloration of paraumbilical area)
Leukocytosis, hyperglycemia, hypocalcemia, elevated transaminases
- Abdominal ultrasound for diagnosis/management.
- Abdominal CT for complications (pseudocyst, abscess, necrosis)
Cholecystitis – seen in what type of pediatric patients? Acute acalculous cholecystitis caused by? Evaluations?
Sickle cell disease, cystic fibrosis, prolonged TPN
Salmonella, Shigella, E. coli, abdominal trauma, burns
Abdominal ultrasound, scintigraphy
Classification of chronic abdominal pain?
- Epigastric pain – equivalent of nonulcer dyspepsia
- Periumbilical local pain – classic functional abdominal pain
- Infraumbilical pain – equivalent of irritable bowel syndrome
Laboratory evaluation for functional chronic abdominal pain? Prognosis?
- Screening labs
- H. pylori testing if symptoms of dyspepsia
- Lactose breath hydrogen testing
Only 50% have resolution during childhood, 25% continue to have pain as adults
Encopresis? Pathophys?
Inappropriate release of stool, almost always associated with severe constipation (liquid stool leaks around hard retained still mass and involuntarily released)
Normal stool frequency?
Four times daily during first week of life
Two times daily by one year of age
Once daily by four years
