Gastroenterology Flashcards
1
Q
what plays an essential role in infant brain development
A
essential fatty acids
2
Q
The most common energy depletion state? characterize it
A
Marasmus: protein and nonprotein deficiencies
3
Q
Kwashiorkor
A
protein-deficient
- generalized edema, abdominal distension, changes in skin pigmentation, and thin, sparse hair
4
Q
Vitamin B1 (thiamine) deficiency can cause
A
Beriberi:
cardiac failure, peripheral neuropathy, hoarseness or aphonia, Wernicke’s encephalopathy
5
Q
Vitamin C deficiency
A
scruvy
6
Q
Niacin deficiency
A
Pellagra:
Diarrhea, dermatitis, dementia
7
Q
what is property of undigested sugars
A
osmotically active: draw water into intestinal lumen
8
Q
what is the stool like in carbohydrate malabsorption
A
watery and acidic
- reducing substances (unabsorbed sugars)
9
Q
what test can be done to confirm carbohydrate malabsorption
A
Clinitest
10
Q
causes of carbohydrate malabsorption
A
- isolated congenital enzyme deficiency
2. mucosal atrophy
11
Q
3 causes of protein malabsorption
A
- congenital enterokinase deficiency
- Protein losing enteropathies
- inflammatory disorders
12
Q
fecal levels of what can be used to document enteric protein los
A
alpha1-antitrypsin levels
13
Q
Decreased lipase activity in gut results in
A
- steatorrhea
2. decrease absorption of DAKE
14
Q
causes of fat malabsoprtion
A
exocrine pancreatic insufficiency
15
Q
Schwachman-Diamond syndrome
A
pancreatic exocrine insufficiency
FTT
short stature
neutropenia
16
Q
difference between enteropathy and enterocolitis in protein intolerance
A
enteropathy: progressive onset
enterocolitis: acutely
17
Q
what is gluten found in
A
wheat, rye, barley and oats
18
Q
primary symptoms of celiac disease
A
- diarrhea
- vomiting
- bloating
- anorexia
19
Q
gold standard evaluation for celiac disease? other tests and who can use it
A
small bowel biopsy (gold standard)
- Serum IgA-endomysial
- Serum tissue transglutaminase antibody testing
If IgA deficient: serum antigliadin IgG antibody
20
Q
Name a cause of short bowel syndrome
A
- congenital lesions of gut
21
Q
after gut resection, what is commonly seen
A
carbohydrate and fat malabsorption with steatorrhea
22
Q
Distal small bowel resection limits what aborption
A
Vitamin B12 and bile acid absorption
23
Q
Management of small bowel resection
A
- total parenteral nutrition
- Early enteral feedings
- Small bowel transplantation ( last resort)
24
Q
Predominant cause of GERD during childhood
A
Inappropriate transient lower esophageal sphincter relaxation
25
is emesis benign or pathologic for babies
benign
26
Sandifer syndrome
torticollis with arching of the back caused by painful esophagitis
27
how do older children present with GERD
midepigastric pain ("heartburn")
28
acid reflux does what to the pulmonary system
bronchopulmonary constriction
29
Barrett's esophagus
normal stratified squamous epithelium of esophagus
| into columnar epithelium
30
is Barium upper GI study good? what does it do?
poor test for GERD
| - anatomy of esophagus, stomach, and duodenum
31
how does Scintigraphy work
radioactive marker (technetium 99m) and food
- measure rate of gastric emptying
- if detected in lung then aspiration occurred
32
Gold standard to diagnose GERD
pH probe measurement
33
If aspiration is strongly suspected in GERD, what management can be done
bronchoscopy with alveolar lavage
34
what medication can be given for GERD
Metoclopramide
35
Surgery options for GERD
Nissen fundoplication
| - in infants: nissen and gastrostomy tube
36
hypertrophic pyloric stenosis
thickening of circular pylorus muscle
37
who usually hypertrophic pyloric stenosis
Caucasians, first-born male child
38
clinical feature of hypertrophic pyloric stenosis
nonbilious milky projectile vomit
39
PE for hypertrophic pyloric stenosis
"olive" mass
40
electrolyte imbalance in hypertrophic pyloric stenosis
hypochloremic
hypokalemic
metabolic alkalosis
41
what are 2 diagnostic tools for hypertrophic pyloric stenosis
ultrasound ( best method)
| UGI: "string sign"
42
what gender usually gets malrotation of gut
male
43
lack of fixation of small bowel results in peritoneal bands? what is the problem
- Ladd's band
| compress duodenum
44
clinical feature of malrotation
Bilious vomiting
| sudden onset of abdominal pain in an otherwise healthy infant
45
diagnostic tool of choice for malrotation
upper intestinal contrast imaging
46
Management of malrotation
surgical emergency
| fluid restriction
47
when does duodenal atresia form
8-10 weeks gestation
48
most common cause of obstruction
intestinal astresia
49
who usually gets duodenal obstruction
Down syndrome
| males
50
clinical feature of duodenal obstruction
polyhydramnios
| scaphoid abdomen with epigastric distension
51
how do you evaluate duodenal obsturction
- Abdominal radiography: "double bubble"
| - intestinal contrast studies
52
what causes jejunoileal atresia
mesenteric vascular accident during fetal life
53
Intussusception
telescoping or invagination of a more proximal portion of intestine into a more distal portion
54
what age range gets Intussusception
5-9 months
55
most common location of intussusception
ileocolic intussusception
56
what is common cause of Intussusception in older children
lead point: Meckel's diverticulum, polyp
57
clinical feature of Intussusception
- sudden onset of crampy or colicky abdominal pain
- "current jelly" stool
- sausage-shaped mass
58
Gold standard diagnosis for Intussusception
air or contrast enema
| - "coil spring" sign
59
Management of Intussusception
contrast enema
| operative reduction
60
Most common pediatric emergency operation
appendicitis
61
age for appendicitis
10-12 years
62
clinical features of appendicitis
1. periumbilical pain
2. then right lower quadrant pain
tenderness at McBurney's point
63
acute pancreatitis
acute inflammatory process of the pancreas
64
causes of acute pancreatitis
- trauma (most common)
- infections
- idiopathic (2nd)
65
clinical feature of pancreatitis
- periumbilical or epigastric pain, may radiate to the back
- Gray-Tuner sign: bluish discoloration of flanks
- Cullen sign: bluish discoloration of periumbilical area
66
what is elevated in pancreatitis
- serum amylase: remains elevated longer
| - serum lipase ( more specific)
67
what is a common method used for diagnosing pancreatitis
abdominal ultrasound
68
common complication of pancreatitis
pseudocyst: collection of fluid rich in pancreatic enzymes that arise from pancreatic tissue
69
Cholecystitis
inflammation of gallbladder with transmural edema
70
acute acalculous cholecystitis
no gallstones
71
Cholecystitis may occur in children with what predisposing condition
sickle cell disease
72
what can cause acute acalculous cholecystitis
infection (Salmonella, Shigella, E. coli)
73
PE for Cholecystitis
Murphy's sign: palpation of right upper quadrant during inspiration elicits intense pain, causes patient to stop inspiratory stridor
74
how is diagnosis confirmed for Cholecystitis
abdominal ultrasound
75
define chronic abdominal pain
abdominal pain that occurs each month for at least 3 consecutive months
76
encopresis? associated with?
developmentally inappropriate release of stool
| - associated with severe constipation
77
breastfed or formula babies, which one defecate more frequently
breastfed
78
most common form of constipation during childhood
Functional fecal retention
79
what is a common cause of functional fecal retention
traumatic event
80
most common cause of organic constipation
Hirschsprung's disease
81
Management of functional fecal retention
1. stool evacuation
2. Mineral oil (soften stool)
3. education
82
Ulcerative colitis
mucosa
localized to colon
begins at rectum, continuous
83
disease of the rectum only
ulcerative proctitis
84
disease affecting the entire colon
pancolitis
85
Complications of severe UC
Toxic megacolon: fever, abdominal distension, septic shock
| increase risk of colon cancer
86
Crohn's disease
any segment of GI tract
"skip lesions"
transmural
87
most children have crohn's disease located where
terminal ileum
88
extraintestinal manifestations of UC
pyoderma gangrenosum
89
Serologic testing for UC
anti-neutrophil cytoplasmic antibody
90
serologic testing for Crohn's disease
Anti-Saccharomyces cerevisiae antibody
91
Pharmacotherapy for IBD
1. Sulfasalazine
2. corticosteroids
3. Immunosuppressive agents
4. Metronidazole
92
Surgery treatment for UC
total proctocolectomy
| recurrence rate is high
93
Hematemesis
blood vomit
94
Hematochezia
bloody stool
95
Melena
- dark, tarry stools
| - upper GI bleed proximal to the ligament of Treitz
96
what drug can constrict varicies
Octreotide
97
what should be considered in any newborn with rectal bleeding, feeling intlerance, or abdominal distension
Necrotizing enterocolitis
98
Most common lower GI bleeding beyond infancy
Juvenile polyps
99
clinical feature of Meckel's diverticulum
painless acute rectal bleeding
100
AST or ALT which one is specific for liver disease
ALT
101
name 3 hepatocellular enzymes
AST
ALT
lactate dehydrogenase
102
Biliary enzymes
1. Alkaline phosphatase
2. GGTP: gamma glutamyl transpeptidase
5. 5'NT 5'-nucleotidase
103
what enzyme creates conjugated bilirubine
UDP-glucuronyl transferase
104
Cholestatic jaundince
retention of bile within the liver
| - increase direct component of bilirubin
105
how does jaundice appear
begins cranially and extends caudally
106
can you tell how much bilirubin is present by looks of baby
NO,
| always get lab bili lab values
107
Inspissated bile syndrome
associated with hemolysis or hematoma
| - unconjugated hyperbilirubinemia
108
3 types of UDP-glucuronyl transferace deficiency
1. Gilbert's syndrome
2. Crigler-Najjar type 1
3. Crigler-Najjar type 2
109
Gilbert's syndrome
half of UDP-glucuronyl transferace activity is absent
110
Crigler-Najjar type 1
autosomal recessive
| almost all UDP-glucuronyl transferace activity absent
111
Crigler-Najjar type 2
autosomal dominant
| 90 of UDP-glucuronyl transferace activity absent
112
cholestasis
retention of bile
| - prolonged elevation of conjugated bilirubin
113
clinical features of cholestais
1. jaundice
2. acholic or light stool
3. dark urine
4. hapatomegaly
5. bleedings
6. FTT
114
Most common cause of cholestasis in new born
neonatal hepatitis
115
presenting features of neonatal hepatitis in first week of life
jaundice and hepatomegaly
116
Management of neonatal hepatitis
supportive
- nutritional
- Ursodeoxycholic acid
117
Biliary atresia
progressive fibrosclerotic that impacts extrahepatic biliary tree
118
at what age does biliary atresia show up
4-6 weeks
119
progression of biliary atresia
progression is rapid
- bile duct obliteration and cirrhosis
- by 4 months
120
what confirms diagnosis of biliary atresia
Intraoperative cholangiogram with laparotomy
121
treatment of choice to establish bile flow in biliary atresia? best done when
- Kasi portoenterostomy
| - 50-70 day of age
122
Alagille syndrome
autosomal dominant
| - paucity of intrahepatic bile ducts and multiorgan involvement
123
cardiac problem in Alagille syndrome
pulmonary outflow obstruction
124
eye anomaly in alagille syndrome
posterior embryotoxon
125
majority of viral hepatitis caused by what in children and adolescents
A and B
126
most viral hepatitis infections during infancy and childhood symsptoms
asymptomatic
127
management of viral hepatitis
supportive
128
how is Hep A transmitted
fecal-oral
129
how long in intubation phase for Hep A
2-6 weeks
130
serology for HepA
elevated IgM anti-HAV
| elevated IgG anti-HAV
131
transmission of Hep B
perinatal vertical
parenteral
body secretions
132
incubation period for HepB
45-160 days
133
HepB increases risk for
hepatocellular carcinoma
134
what marker is pathognomonic for HepB
HBsAg
135
what is protective/vacinnated marker for HepB
HSsAB
136
Hep D infection requires what for replication
HBsAg
137
where is Hep E common
- young adults in developing countries
| - infected pregnant women
138
transmission of HepE
fecal-oral
139
autoimmune hepatitis? what is elevated
1. serum transaminases
2. hypergammglobulinemia
3. autoantibodies
140
type 1 autoimmune hepatitis, what is detected?
antinuclear antibody ANA
| Anti-smooth muscle antibody
141
management for autoimmune hepatitis
corticosteroids
| immunosuppressive drugs
142
Do hepA patients get jaundice
it is unuusal
143
someone has high heart rate and loosing blood, management
fluid
144
Heterotaxy
abnormal assembly of the thoracic and abdominal organs from the normal arrangement known as
