Gastroenterology Flashcards

Question

Ulcerative Colitis

Answer 1

``` o Limitedtocolon o Continuous & Limited to the Mucosa Mucosa is friable and bleeds o Typically bloody diarrhea w/mucosa At least 3-4w o Ranges in Severity Rectal Bleeding, diarrhea, abdominal pain, Hypoalbuminemia o P-ANCA o Complication Toxic Megacolon ↑ Risk for Colorectal Cancer o Tx Sulfasalazine Can be cured w/ total proctocolectomy, but reserved for intractable colitis Immunosuppressive Agents & Corticosteroids ```

Answer 2

o Any segment (mainly terminal Ileum) Can have mouth ulcers o Skip lesions & segmental inflammation o Transmuralinflammation Fistulas, Crypt Abscesses, Strictures o Malabsorption Vit B12, Zinc, Folate, Fe2+ o Perianal disease (verycommon) often precedes intestinal disease Skin Tags, abscesses, fistulas o ExtraintestinalManifestations Much more common than in UC FUO, arthritis, mouth ulcers, skin manifestations (erythema nodosum), weight loss, malaise, and growth retardation o Anti-SaccharomycescerevisiaeAb o Granulomas(30%) o Imaging String Size Thickened bowel folds w/ narrowing of the tract o Tx Metronidazole When fistulas presents Esp. w/ inflammation Immunosuppresive Agents & Corticosteroids Azathioprine, cyclosporine, tacrolimus, TNF-α

Answer 3

``` o Hematemesis Coffee ground appearance o Hematochezia Bright red, lower GI or significant rapid upper GI o Melena Dark tarry, upper GI (proximal to Ligament of Treitz) o Occult bleeding from GI Guaiac + False + o Ingested iron False - o Large amounts of ingested Vit. C ```

Answer 4

``` o Swallowed maternal blood o Endoscopy if active bleeding w/hemodynamic changes o Tx Initial: Fluid Bolus w/ IV access Octreotide for varices PPIs Arteriographic embolization for serious bleeding Vascular malformations ```

Answer 5

Consider in any newborn w/ rectal bleeding, feeding intolerance, & abdominal distension More common in prematures & Low birth weight Immaturity of the stomach plus exposure to bacteria from enteral feeds leads to bowel inflammation and damage Caused by local ischemia, dilation, and infarction of loops of bowel S/Sx Abdominal distension, Hematochezia (or occult blood), pneumatosis intestinalis (air in the bowel wall, double line/train track appearance) Blood in NG tube Complications Intramural air spreading to portal vein (venous portal gas) Later on intestinal perforation o Pneumoperitoneum Breast feeding reduces the risk of NEC Tx Mild o Decompression, electrolyte repletion, IV ABx, serial abdominal exams checking for perforation Severe (perforation) o Severe if perforation (free air on lateral decubitus or under diaphragm), fixed dilated bowel on serial X-rays, abdominal wall cellulitis o Surgical resection and reanastomosis (exploratory laparotomy) Following surgery, parenteral feeds for 14d Allows for bowel rest

Answer 6

``` Lower GI bleeding: #1 cause beyond infancy (>5y?) Bleeding is painless, intermittent, & often streaky Tx Colonoscopy w/ polypectomy ```

Answer 7

Sensitization to milk protein

Answer 8

Salmonella, Shigella, Yersinia, & E. Coli

Answer 9

Outpouching terminal ileum | Infants 2% (typically

Answer 10

Intestinal ulceration & infarction of the bowel cause bleeding

Answer 11

``` o AST Sensitive, but not specific o ALT Specific for liver disease o LDH Nonspecific for liver disease, but may serve as a marker for liver necrosis ```

Answer 12

o Alkaline Phosphate ↑ in Biliary Disease Can also be ↑ in Rapid Growth, Renal/GI disease, & trauma o Gamma Glutanyl Transpeptidase &5NT ↑ Biliary disease 5NT more specific than GGTP for biliary tract disease

Answer 13

o ↑TB Clinically evident TB > 3 o Kernicterus Risk w/ indirect hyperbilirubinemias ≥20 Risk factors Sulfisoxazole and other drugs that bind albumin and ↑ dissociation of bilirubin Metabolic acidosis, ↑ bilirubin dissociation Hypoalbuminemia Sepsis o Interrupts BBB Phenobarbital induces glucuronyl transferase

Answer 14

First 2-4d of life (peak) No higher than 12 mg/dL Disappears by 1w Rate of rise

Answer 15

``` Inadequate calories & dehydration Breast feeding failure: inadequate feedings, poor latching ↑ enterohepatic circulation o Indirect Hyperbilirubinemia Signs of dehydration o Decreased wet diapers o May not regain birth weight o Brick red urate crystals in diapers Typically second to fourth day (first week) Tx Rehydrate w/ fluids or formula Lactation consult o Should be breastfeeding ever 2-3h for 10-20mins each breast Threshold for phototherapy o 4dold >20 Threshold for transfusion therapy o 4dold >25 ```

Answer 16

Enzyme in milk is inhibitor of glucuronyl transferase ↑ indirect bilirubin Gaining weight, no signs of FTT Typically during second week (>7d) Tx If Pathological (~17-20) DC breast feeding for 1 to 2d, formula then o Resume breast feeding after precipitous drop in TB w/out fear of rise to toxic levels Reassurance if levels are not too high

Answer 17

Retention of bile in liver | Direct Bilirubin > 2

Answer 18

> 50% caused by neonatal hepatitis or Biliary Atresia | If suspect cholestasis, HIDA Scan

Answer 19

Associated w/ Hemolysis or very large hematoma | Starts w/ ↑ Indirect, but switches to ↑ direct as the liver ramps up

Answer 20

``` Gilbert's Syndrome 50% Enzyme Mild Jaundice w/ stress or poor nutrition Crigler Najjar Indirect Hyperbilirubinemia TypeI o 100%Enzymeabsent o AR o Kernicterus caused by ↑ TB Type II o 90%EnzymeDeficient o AD o Bilirubin lvls are variable w/ ↓ chance of Kernicterus ```

Answer 21

o Progressive fibrosclerotic changes of extrahepatic bile ducts o Presents w/in first 2m of life o S/Sx Jaundice, dark urine, acholic (pale) stools Moderate ↑ TB Direct Hyperbilirubinemia Rapid progression w/ Bile duct obliteration & cirrhosis by 4m Hepatomegaly, Ascites, Coagulopathy, Edema o Some have associated Polysplenia Syndrome Bilobed lings, abdominal Heterotaxy, & situs invertus o Dx First perform US Lack of Gallbladder and Triangle Sign Will also catch other Gall Bladder DO Hepatobiliary Scintigraphy Failure of tracer excretion from liver Intraoperative cholangiogram w/ Laparotomy to examine biliary tree (gold standard) o Tx Kasai Portoenterostomy Establishes bile flow by attaching intestinal loop to porta hepatis Success is highest if

Answer 22

Tx | All newborns of mothers w/ active Hep B (HbsAG, HBeAG + esp.) receive HBIG (Hep B immune globulin) & Vaccine

Answer 23

o Destructive&Progressive o ↑ serum transaminases, hypergammaglobulinemia, auto-Ab o Types Type I ``` Type II o Females before o S/Sx 50% w/ Antinuclear Ab (ANA) or Anti-Smooth muscle Ab More common than Type II Anti-Liver Kidney Microsomes? puberty Acute Hepatitis Mimics viral hepatitis 50% Chronic liver disease Mild to Moderate Jaundice o Tx Corticosteroids Immunosuppressive Agents Azathioprine 6-MP ```

Answer 24

Remove from environment.

Answer 25

o Vomiting, choking, coughs w/ first feeds o Frothing at mouth o May have respiratory distress, abdominal distension depending on fistula presence/location o Associated w/ VACTER Constellation Vertebral anomalies, anal atresia, cardiovascular anomalies, transesophageal fistula, renal/radial anomalies Usually accompanied by tracheoesophageal fistula leading to abundance of gas in GI tract o Immediate coiling of nasogastric tube confirms

Answer 26

o Lower esophageal tear from forceful retching w/ or w/out vomiting Hematemesis Painless bleeding

Answer 27

``` o Overgrowth Syndrome w/ predisposition to neoplasms Neoplasms Wilm’s Tumor & Hepatoblastoma o Screening w/ Abdominal US and AFP Large-sized patients Hemihyperplasia Macrosomia Macroglossia Liver/Kidney enlargement Hyperinsulinism Hypoglycemia at birth Midline abdominal defects Omphalocele, umbilical hernia ```