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