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Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Histology changes in coeliac

A

Vilnius atrophy
Mononuclear infiltrate lamina propria
Crypt hyperplasia

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2
Q

90-95% coeliac HLA what

A

DQ2

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3
Q

Advice re coeliac and starting solids

A

Weaning onto a gluten containing diet 5-7 months with bf delays onset but doesn’t alter incidence

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4
Q

Risk factors for coeliac and percent

A

First degree relative 4-11% (normal risk 1-2%)
Downs (7-19%)
Turners
Williams
IgA def, DM1 10% and highest risk apart from relative and downs, JIA, thyroid

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5
Q

Metabolic causes of pancreatitis

A 
Hyperlipid
Increased calcium
Glycogen storage
Organic acidaemia 
Burn
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6
Q

Failure to inhibit activation in which enzyme most commonly leads to familial pancreatitis

A

Trypsinogen (75%)

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7
Q

How much gut req to live

A

15cm with ileocaecal valve and 40 without

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8
Q

Stool osmolality

A

(Na + k) x 2

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9
Q

Osmotic diarrhoea (gap >50) and secretory diarrhoea (gap <50) causes

A

Osmotic: infectious, disaccharide def, laxative abuse, impaired absorption
Secretory: toxic E. coli, cholera, tumour, enteropathy

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10
Q

Low alk phos causes

A

Wilson and zinc def

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11
Q

ALT and AST also raised in

A

Muscle necrosis (check CK)

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12
Q

Treatment for wilsons

A

Copper chelation (penicillamine and pyridoxine)

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13
Q

Absorption of Fe and amino acids

A

Duodenum

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14
Q

Folate absorbed in

A

Jejunum

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15
Q

Galactose and fructose transporters

A

Galactose SLGT1

Fructose GLUT 5

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16
Q

Sucrose if from

A

Fructose and glucose

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17
Q

Most sensitive and specific coeliac test

A

Anti TTG IgA

(hLADQ2/8 99% of CD)

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18
Q

Eosinophilia oesophagitis presentation

A

Impacted food (obstructive dysphagia)

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19
Q

Meckles scan

A

tc99 scan

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20
Q

Hirsprungs incidence

A

1/5000

More boys

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21
Q

Percent of UC With primary sclerosing cholangitis

A

5%

Pyoderma gangreosum also assoc

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22
Q

Gilbert’s percentage

A

5-10%

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23
Q

Sucrose isomaltase def

A

Presents at 6m when sucrose added

Mx: sucrose free diet, enzyme replacement

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24
Q

Melanesia coli occurs with

A

Laxative abuse

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25
Q

100ml breast milk contains ?kcal

A

67 (280kj)

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26
Q

Caloric value of glucose

A

3.4kcal/g

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27
Q

Fat and CHO and protein kcal

A

Cat 10kcal/g

CHO and protein 4kcal/g

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28
Q

Triangular cord sign on USS

A

Biliary atresia

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29
Q

Crohns treatment

A 
Enteral therapy (Crohn’s)
5 asa’s
Prednisone
Azathioprine
Methotrexate
TNF monocloncal antibodies
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30
Q

Two familial issues with what in familial pancreatitis

A

SPINK1
Trypsinogen activation within the pancreas is inhibited
by pancreatic secretory inhibitor (PSTI or SPINK1)
PRSS1
Multiple isoforms of trypsinogen – missense mutation
lead to premature activation within pancreas

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31
Q

Short gut causes renal stones by

A

Calcium binds to malabsorbed fat, allows an increased absorption of oxalate

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32
Q

Pill induced oesophagitis commonly from…

A

Tetracycline, Doxycycline
NSAIDs, aspirin

Potassium

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33
Q

AST:ALT ratio >4 highly suggestive
And low ALP

A

Wilson’s disease
Confirmed by keiser flesher ring
ATP7B (multiple mutations though)

ALP low because raised copper displaces zinc in the ALP enzyme and reduces its concentration

34
Q

Total protein raised in what??

A

Autoimmune disease

35
Q

Assoc with autoimmune hepatitis

36
Q

Beading on cholangiogram suggests

A

Sclerosing cholangitis (cryptosporidium most common cause in immunosuppressive)

37
Q

AST and ALT also raised in

A

Muscle damage

ALT up for longer and longer half life but more delayed and more liver specific

38
Q

Antibiotics for campylobacter, shigella, salmonella, yersinia

A

Campylobacter- erythromycin
Salmonella - cotrimox
Shigella -
Yersinia - doxy or cotrimox

39
Q

Baby with jaundice, panniculitis (hard skin with painful lumps) or SOB exertion and lung affected

A

Signs and symptoms of alpha one antitrypsin def

40
Q

Furrowing and white specs on gastroscopy indicate

(or ringed occasionally)

A

Eosinophilic oesophagitis

41
Q

Folate absorbed in

42
Q

Fat globules vs fat crystals causes

A

Globules fat not split by lipase

Crystals not absorbed

43
Q

Leg swelling and diarrhoea (protein losing enteropathy)
Nausea, vomiting, fatty stools, and abdominal pain may also develop.
Children have delayed growth.

A

Intestinal Lymphangiectasia
Leaky lymph into small intestines
Need lymph to transport long chain Fa in micelles therefore have fat globules in stool

44
Q

Acidic stool and reducing substances present indicate what?

A

Carbohydrate malabsorption (c.diff or cryptosporidium)

45
Q

Three monosaccharides

A

Glucose, galactose, fructose

46
Q

Sucrose =

A

Glucose and fructose

47
Q

Lactose =

A

Galactose and glucose

48
Q

Starch is long chains of…

A

Maltose (Glucose and glucose)

49
Q

Glucose galactose malabsorption from

A

SGLT1 transporter

50
Q

Sequelae of cleft

A

Recurrent otitis media and hearing loss are frequent with cleft palate.
Malposition of the teeth.
Speech development

51
Q

Coeliac incidence

A

1%
T cell response to gliadin
Oats may be contaminated
Related also to Williams and tuners

52
Q

Severe fat malabsorption from birth in

A

Abetalipoproteinemia

53
Q

Low elastase in stool indicates

A

Exocrine pancreas insufficiency (most common CF)
Pearson syndrome (ePancreas-marrow failure)
Schwachman-diamond

54
Q

Recurrent pancreatitis or chronic in child think

A

Genetic: cationic trypsinogen gene (PRSS1), chymotrypsin C gene
(CTRC), CF gene (CFTR), trypsin inhibitor gene (SPINK1).

55
Q

Differential of jaundice: 4 syndromes

A

Conjugated and asymptomatic: rotor and dubin-johnson
Unconjugated and asymptomatic: 5-10% population Gilbert’s
Unconjugated and severe - type 1 Crigler-najjar (NO UGT1A1 activity) diagnosed by measuring glucuronyl transferase activity in liver from biopsy (liver normal)

56
Q

Two types autoimmune hepatitis

A

Type 1: anti smooth muscle, ANA.
Type 2: liver kidney microsomal antibodies. Tend to be more refractory
to treatment and need long term immunosuppression.

57
Q

Night blindness vitamin deficient

58
Q

What can cause exacerbated SE azathioprine

A

Low or no TPMT

thiopurine methyltransferase catabolises 6MP to 6MMP, activity is genetically regulated

59
Q

Three syndromes assoc with hirsprungs

A

Odines curse (autonomic dysfunction)
Wardenburg
Downs

60
Q

Erythema nodosum is

A

Redness overlying panniculitis (inflame don’t adipose under skin)

61
Q

Jaundice

UPD deficient and low in?

A

Low in Gilbert’s

Absent/low in crigler-najjar (can try phenobarb)

62
Q

Gloss it is and chelosis related to

A

B12 and B2 (riboflavin)

63
Q

Pellagra (dermatitis, diarrhoea) due to?

A

B3 niacin deficiency

64
Q

Thiamine deficiency causes

A

Heart failure from B1 deficiency

65
Q

Northern vs southern blow

A

Northern looks for RNA and southern DNA

66
Q

Liver failure from tyrosinaemia type 1 or galactosemia how to differentiate

A

Reducing substances urine and RBC galactose 1 phosphate uridyl transferase in galactosemia
Plasma a.a in tyrosinaemia and urine succinylacetone

67
Q

B12 also called

68
Q

Pancreatic dysfunction from what in schwachman diamond syndrome

A

Acinar cell hypoppasia

69
Q

Three common causes acute pancreatitis in children

A

Idiopathic
Systemic disease such as HUS or vasculitis autoimmune
Trauma (blunt or child abuse)
Drugs (valproate L-Aapariginase and azathioprine)

70
Q

Chronic pancreatitis cause in child

A

Hereditary from PRSS1 mutation (trypsin autoactivation)
CTFR
chymotrypsinC gene
SPINK1 (trypsin activity inadequately controlled)

71
Q

Focal biliary cirrhosis from

72
Q

Portal HTN value

73
Q

Spontaneous bacterial peritonitis organisms

A

E. coli
Klebsiella
Strep
Enterococci

74
Q

Drug induced pancreatitis causes

A

V. FAT SHEEP

Valproate verapamil

Frusemide
Azathiorone asparginase
Tetracycline 
Statin sulfonamides
Hydrochlorthiazide
Estrogen
Pentamidine
75
Q

R side aortic arch and difficulty swallowing has

A

Vascular ring

76
Q

Diabetic with bowel obstruction and H2 breath test positive caused by?

A

Bacterial overgrowth

77
Q

Protein req per day per kg

A

0.75g/kg/day

78
Q

Water absorbed intestines due to

A

Diffusion (coupled with glu and a.a.)

79
Q

High volume secretory diarrhoea can be due to

A

Cholera or other toxins

cholera upregulating chloride channel

80
Q

Most common s.i atresia

81
Q

Liver synthesises all factors except

Paediatrics (19 decks)

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