Gastroenterology 2 Flashcards
when to suspect Organic versus functional fecal retention?
Organic:
- delayed meconium passage
- constipation during infancy
- history of pelvic surgery
- encopresis younger than three,
- inability to toilet train
Constipation after toilet training, sentinel event (abuse, diarrhea, painful stool)
Functional fecal retention?
Behavioral pattern of stool withholding that may lead to large amounts of retained feces, encopresis, painful diarrhea,
Examples of organic causes of constipation?
- Hirschsprung’s disease
- NeuroEnteric dysfunction
- Medications (narcotics/sedatives)
- Low fiber
- Anatomic
- Systemic (dehydration, hypothyroid, cystic fibrosis, diabetes)
- Infant botulism
- Lead toxicity
- Anorexia
Ulcerative proctitis?
Ulcerative colitis restricted only to the rectum
Antibody in UC versus Crohn’s disease?
P-ANCA versus Anti-Saccharomyces
Pharmacotherapy for IBD? If perianal involvement?
- Sulfasalazine – mild disease
- Corticosteroids
- Immunosuppressive agents – long-term remission
- Metronidazole if perianal involvement
Melena indicates bleed proximal to?
Ligament of Treitz
Reasons to get a false positive guaiac test? False negative?
Iron, rare meat, beats, cantaloupe, broccoli, cauliflower
Large dose of vitamin C
Patient with upper G.I. bleed – management?
- IV axis with two large-bore prefer lines
- Rapid fluid bolus of 20 mL per kilogram
- Octreotide/vasopressin to constrict varices
- Antibiotics for H pylori,
- H2-blockers/PPI’s for gastritis/esophagitis
- Endoscopy if active bleeding or Leapley
- Arteriographic embolization for serious bleeding from AVMs
- Surgery if ulcer with active bleeding, perforation, varices
Necrotizing enterocolitis – clinical picture? Juvenile polyp? Meckel’s diverticulum? Henoch-Schonlein purpura?
- Rectal bleeding, feeding intolerance, abdominal distension
- Painless intermittent bleeding
- Painless, acute rectal bleeding
- Purpuric rash on buttocks, joint arthralgias, renal involvement, intussusception, bowel perforation
Markers with increasing specificity for biliary disease?
5’-nucleotidase >Gamma glutamyl transpeptidase > alkaline phosphatase
Cholestatic jaundice?
- Retention of bile within the liver
2. Direct bilirubin >2 or >15% of total
Crigler-Najjar type one versus type two?
1 – 100% percent absence of enzyme activity, Autosomal recessive
2– 90% absence of enzyme, autosomal dominant
Neonatal hepatitis – diagnostic criteria? Features? Management?
Idiopathic hepatic inflammation during the neonatal period. diagnosis of exclusion
- Transient jaundice, and acholic stools in first week of life
- They progress to liver failure, cirrhosis, portal hypertension
- Increased nutritional support
- Ursodeoxycholic acid
- Liver transplantation
Biliary atresia – clinical features? Progression? Associated with?
- Jaundice, dark urine, acholic stools between 4-6 weeks of life
- Elevated bilirubin
- Hepatosplenomegaly, ascites, stearrhea
Rapid progression, with the bile duct obliteration and cirrhosis occurring by four months
Associated with polysplenia syndrome
Biliary atresia – diagnosis? Management?
- Abdominal ultrasound, radionucleotide imaging, liver biopsy in sequence to rule out other causes
- Intraoperative Cholangiogram with laparotomy to confirm
- Kasai portoenteroscopy – roux-en-Y intestinal loop attached to porta hepatis (Establishes bile flow)
- Liver transplantation for late presentations
Alagille syndrome? Clinical features? Diagnosis?
Paucity of intrahepatic bile ducts
- Debilitating Pruritus
- Unusual facial characteristics – large forehead, wide spaced eyes, saddle nose, pointed chin, large ears
- Cardiac pulmonary outflow obstruction
- Renal disease
- Eye anomalies
- Musculoskeletal – butterfly vertebra
- Growth Failure
- Pancreatic insufficiency
Clinical features make diagnosis
Hepatitis A – when is virus shed in stool? Incubation period?
2-3 weeks before symptoms and one week after jaundice
2 to 6 week incubation
Type 1 versus type 2 autoimmune hepatitis - markers?
Type one – ANAs, anti-smooth muscle antibody
Type two – anti-liver-kidney-microsome antibody or anti-liver-cytosol antibody
Non-hepatic signs of autoimmune hepatitis? Labs?
arthritis, rash, nephritis, vasculitis
Elevated serum transaminases, hypergammaglobulinemia, circulating antibodies
