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Pediatrics Rotation > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

what plays an essential role in infant brain development

A

essential fatty acids

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2
Q

The most common energy depletion state? characterize it

A

Marasmus: protein and nonprotein deficiencies

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3
Q

Kwashiorkor

A

protein-deficient

- generalized edema, abdominal distension, changes in skin pigmentation, and thin, sparse hair

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4
Q

Vitamin B1 (thiamine) deficiency can cause

A

Beriberi:

cardiac failure, peripheral neuropathy, hoarseness or aphonia, Wernicke’s encephalopathy

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5
Q

Vitamin C deficiency

A

scruvy

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6
Q

Niacin deficiency

A

Pellagra:

Diarrhea, dermatitis, dementia

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7
Q

what is property of undigested sugars

A

osmotically active: draw water into intestinal lumen

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8
Q

what is the stool like in carbohydrate malabsorption

A

watery and acidic

- reducing substances (unabsorbed sugars)

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9
Q

what test can be done to confirm carbohydrate malabsorption

A

Clinitest

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10
Q

causes of carbohydrate malabsorption

A
  1. isolated congenital enzyme deficiency

2. mucosal atrophy

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11
Q

3 causes of protein malabsorption

A
  1. congenital enterokinase deficiency
  2. Protein losing enteropathies
  3. inflammatory disorders
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12
Q

fecal levels of what can be used to document enteric protein los

A

alpha1-antitrypsin levels

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13
Q

Decreased lipase activity in gut results in

A
  1. steatorrhea

2. decrease absorption of DAKE

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14
Q

causes of fat malabsoprtion

A

exocrine pancreatic insufficiency

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15
Q

Schwachman-Diamond syndrome

A

pancreatic exocrine insufficiency
FTT
short stature
neutropenia

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16
Q

difference between enteropathy and enterocolitis in protein intolerance

A

enteropathy: progressive onset
enterocolitis: acutely

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17
Q

what is gluten found in

A

wheat, rye, barley and oats

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18
Q

primary symptoms of celiac disease

A
  • diarrhea
  • vomiting
  • bloating
  • anorexia
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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

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20
Q

Name a cause of short bowel syndrome

A
  • congenital lesions of gut
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21
Q

after gut resection, what is commonly seen

A

carbohydrate and fat malabsorption with steatorrhea

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22
Q

Distal small bowel resection limits what aborption

A

Vitamin B12 and bile acid absorption

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23
Q

Management of small bowel resection

A
  • total parenteral nutrition
  • Early enteral feedings
  • Small bowel transplantation ( last resort)
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24
Q

Predominant cause of GERD during childhood

A

Inappropriate transient lower esophageal sphincter relaxation

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25
Q

is emesis benign or pathologic for babies

A

benign

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26
Q

Sandifer syndrome

A

torticollis with arching of the back caused by painful esophagitis

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27
Q

how do older children present with GERD

A

midepigastric pain (“heartburn”)

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28
Q

acid reflux does what to the pulmonary system

A

bronchopulmonary constriction

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29
Q

Barrett’s esophagus

A

normal stratified squamous epithelium of esophagus

into columnar epithelium

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30
Q

is Barium upper GI study good? what does it do?

A

poor test for GERD

- anatomy of esophagus, stomach, and duodenum

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31
Q

how does Scintigraphy work

A

radioactive marker (technetium 99m) and food

  • measure rate of gastric emptying
  • if detected in lung then aspiration occurred
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32
Q

Gold standard to diagnose GERD

A

pH probe measurement

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33
Q

If aspiration is strongly suspected in GERD, what management can be done

A

bronchoscopy with alveolar lavage

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34
Q

what medication can be given for GERD

A

Metoclopramide

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35
Q

Surgery options for GERD

A

Nissen fundoplication

- in infants: nissen and gastrostomy tube

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36
Q

hypertrophic pyloric stenosis

A

thickening of circular pylorus muscle

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37
Q

who usually hypertrophic pyloric stenosis

A

Caucasians, first-born male child

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38
Q

clinical feature of hypertrophic pyloric stenosis

A

nonbilious milky projectile vomit

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39
Q

PE for hypertrophic pyloric stenosis

A

“olive” mass

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40
Q

electrolyte imbalance in hypertrophic pyloric stenosis

A

hypochloremic
hypokalemic
metabolic alkalosis

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41
Q

what are 2 diagnostic tools for hypertrophic pyloric stenosis

A

ultrasound ( best method)

UGI: “string sign”

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42
Q

what gender usually gets malrotation of gut

A

male

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43
Q

lack of fixation of small bowel results in peritoneal bands? what is the problem

A
  • Ladd’s band

compress duodenum

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44
Q

clinical feature of malrotation

A

Bilious vomiting

sudden onset of abdominal pain in an otherwise healthy infant

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45
Q

diagnostic tool of choice for malrotation

A

upper intestinal contrast imaging

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46
Q

Management of malrotation

A

surgical emergency

fluid restriction

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47
Q

when does duodenal atresia form

A

8-10 weeks gestation

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48
Q

most common cause of obstruction

A

intestinal astresia

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49
Q

who usually gets duodenal obstruction

A

Down syndrome

males

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50
Q

clinical feature of duodenal obstruction

A

polyhydramnios

scaphoid abdomen with epigastric distension

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51
Q

how do you evaluate duodenal obsturction

A
  • Abdominal radiography: “double bubble”

- intestinal contrast studies

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52
Q

what causes jejunoileal atresia

A

mesenteric vascular accident during fetal life

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53
Q

Intussusception

A

telescoping or invagination of a more proximal portion of intestine into a more distal portion

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54
Q

what age range gets Intussusception

A

5-9 months

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55
Q

most common location of intussusception

A

ileocolic intussusception

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56
Q

what is common cause of Intussusception in older children

A

lead point: Meckel’s diverticulum, polyp

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57
Q

clinical feature of Intussusception

A
  • sudden onset of crampy or colicky abdominal pain
  • “current jelly” stool
  • sausage-shaped mass
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58
Q

Gold standard diagnosis for Intussusception

A

air or contrast enema

- “coil spring” sign

59
Q

Management of Intussusception

A

contrast enema

operative reduction

60
Q

Most common pediatric emergency operation

A

appendicitis

61
Q

age for appendicitis

A

10-12 years

62
Q

clinical features of appendicitis

A
  1. periumbilical pain
  2. then right lower quadrant pain
    tenderness at McBurney’s point
63
Q

acute pancreatitis

A

acute inflammatory process of the pancreas

64
Q

causes of acute pancreatitis

A
  • trauma (most common)
  • infections
  • idiopathic (2nd)
65
Q

clinical feature of pancreatitis

A
  • periumbilical or epigastric pain, may radiate to the back
  • Gray-Tuner sign: bluish discoloration of flanks
  • Cullen sign: bluish discoloration of periumbilical area
66
Q

what is elevated in pancreatitis

A
  • serum amylase: remains elevated longer

- serum lipase ( more specific)

67
Q

what is a common method used for diagnosing pancreatitis

A

abdominal ultrasound

68
Q

common complication of pancreatitis

A

pseudocyst: collection of fluid rich in pancreatic enzymes that arise from pancreatic tissue

69
Q

Cholecystitis

A

inflammation of gallbladder with transmural edema

70
Q

acute acalculous cholecystitis

A

no gallstones

71
Q

Cholecystitis may occur in children with what predisposing condition

A

sickle cell disease

72
Q

what can cause acute acalculous cholecystitis

A

infection (Salmonella, Shigella, E. coli)

73
Q

PE for Cholecystitis

A

Murphy’s sign: palpation of right upper quadrant during inspiration elicits intense pain, causes patient to stop inspiratory stridor

74
Q

how is diagnosis confirmed for Cholecystitis

A

abdominal ultrasound

75
Q

define chronic abdominal pain

A

abdominal pain that occurs each month for at least 3 consecutive months

76
Q

encopresis? associated with?

A

developmentally inappropriate release of stool

- associated with severe constipation

77
Q

breastfed or formula babies, which one defecate more frequently

A

breastfed

78
Q

most common form of constipation during childhood

A

Functional fecal retention

79
Q

what is a common cause of functional fecal retention

A

traumatic event

80
Q

most common cause of organic constipation

A

Hirschsprung’s disease

81
Q

Management of functional fecal retention

A
  1. stool evacuation
  2. Mineral oil (soften stool)
  3. education
82
Q

Ulcerative colitis

A

mucosa
localized to colon
begins at rectum, continuous

83
Q

disease of the rectum only

A

ulcerative proctitis

84
Q

disease affecting the entire colon

A

pancolitis

85
Q

Complications of severe UC

A

Toxic megacolon: fever, abdominal distension, septic shock

increase risk of colon cancer

86
Q

Crohn’s disease

A

any segment of GI tract
“skip lesions”
transmural

87
Q

most children have crohn’s disease located where

A

terminal ileum

88
Q

extraintestinal manifestations of UC

A

pyoderma gangrenosum

89
Q

Serologic testing for UC

A

anti-neutrophil cytoplasmic antibody

90
Q

serologic testing for Crohn’s disease

A

Anti-Saccharomyces cerevisiae antibody

91
Q

Pharmacotherapy for IBD

A
  1. Sulfasalazine
  2. corticosteroids
  3. Immunosuppressive agents
  4. Metronidazole
92
Q

Surgery treatment for UC

A

total proctocolectomy

recurrence rate is high

93
Q

Hematemesis

A

blood vomit

94
Q

Hematochezia

A

bloody stool

95
Q

Melena

A
  • dark, tarry stools

- upper GI bleed proximal to the ligament of Treitz

96
Q

what drug can constrict varicies

A

Octreotide

97
Q

what should be considered in any newborn with rectal bleeding, feeling intlerance, or abdominal distension

A

Necrotizing enterocolitis

98
Q

Most common lower GI bleeding beyond infancy

A

Juvenile polyps

99
Q

clinical feature of Meckel’s diverticulum

A

painless acute rectal bleeding

100
Q

AST or ALT which one is specific for liver disease

A

ALT

101
Q

name 3 hepatocellular enzymes

A

AST
ALT
lactate dehydrogenase

102
Q

Biliary enzymes

A
  1. Alkaline phosphatase
  2. GGTP: gamma glutamyl transpeptidase
  3. 5’NT 5’-nucleotidase
103
Q

what enzyme creates conjugated bilirubine

A

UDP-glucuronyl transferase

104
Q

Cholestatic jaundince

A

retention of bile within the liver

- increase direct component of bilirubin

105
Q

how does jaundice appear

A

begins cranially and extends caudally

106
Q

can you tell how much bilirubin is present by looks of baby

A

NO,

always get lab bili lab values

107
Q

Inspissated bile syndrome

A

associated with hemolysis or hematoma

- unconjugated hyperbilirubinemia

108
Q

3 types of UDP-glucuronyl transferace deficiency

A
  1. Gilbert’s syndrome
  2. Crigler-Najjar type 1
  3. Crigler-Najjar type 2
109
Q

Gilbert’s syndrome

A

half of UDP-glucuronyl transferace activity is absent

110
Q

Crigler-Najjar type 1

A

autosomal recessive

almost all UDP-glucuronyl transferace activity absent

111
Q

Crigler-Najjar type 2

A

autosomal dominant

90 of UDP-glucuronyl transferace activity absent

112
Q

cholestasis

A

retention of bile

- prolonged elevation of conjugated bilirubin

113
Q

clinical features of cholestais

A
  1. jaundice
  2. acholic or light stool
  3. dark urine
  4. hapatomegaly
  5. bleedings
  6. FTT
114
Q

Most common cause of cholestasis in new born

A

neonatal hepatitis

115
Q

presenting features of neonatal hepatitis in first week of life

A

jaundice and hepatomegaly

116
Q

Management of neonatal hepatitis

A

supportive

  • nutritional
  • Ursodeoxycholic acid
117
Q

Biliary atresia

A

progressive fibrosclerotic that impacts extrahepatic biliary tree

118
Q

at what age does biliary atresia show up

A

4-6 weeks

119
Q

progression of biliary atresia

A

progression is rapid

  • bile duct obliteration and cirrhosis
  • by 4 months
120
Q

what confirms diagnosis of biliary atresia

A

Intraoperative cholangiogram with laparotomy

121
Q

treatment of choice to establish bile flow in biliary atresia? best done when

A
  • Kasi portoenterostomy

- 50-70 day of age

122
Q

Alagille syndrome

A

autosomal dominant

- paucity of intrahepatic bile ducts and multiorgan involvement

123
Q

cardiac problem in Alagille syndrome

A

pulmonary outflow obstruction

124
Q

eye anomaly in alagille syndrome

A

posterior embryotoxon

125
Q

majority of viral hepatitis caused by what in children and adolescents

A

A and B

126
Q

most viral hepatitis infections during infancy and childhood symsptoms

A

asymptomatic

127
Q

management of viral hepatitis

A

supportive

128
Q

how is Hep A transmitted

A

fecal-oral

129
Q

how long in intubation phase for Hep A

A

2-6 weeks

130
Q

serology for HepA

A

elevated IgM anti-HAV

elevated IgG anti-HAV

131
Q

transmission of Hep B

A

perinatal vertical
parenteral
body secretions

132
Q

incubation period for HepB

A

45-160 days

133
Q

HepB increases risk for

A

hepatocellular carcinoma

134
Q

what marker is pathognomonic for HepB

A

HBsAg

135
Q

what is protective/vacinnated marker for HepB

A

HSsAB

136
Q

Hep D infection requires what for replication

A

HBsAg

137
Q

where is Hep E common

A
  • young adults in developing countries

- infected pregnant women

138
Q

transmission of HepE

A

fecal-oral

139
Q

autoimmune hepatitis? what is elevated

A
  1. serum transaminases
  2. hypergammglobulinemia
  3. autoantibodies
140
Q

type 1 autoimmune hepatitis, what is detected?

A

antinuclear antibody ANA

Anti-smooth muscle antibody

141
Q

management for autoimmune hepatitis

A

corticosteroids

immunosuppressive drugs

142
Q

Do hepA patients get jaundice

A

it is unuusal

143
Q

someone has high heart rate and loosing blood, management

A

fluid

144
Q

Heterotaxy

A

abnormal assembly of the thoracic and abdominal organs from the normal arrangement known as

Pediatrics Rotation (19 decks)

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