Gastroenterology Flashcards
What is “functional constipation”
children without an organic etiology for their constipation. Often the result of holding feces if having a BM is painful.
Rome III diagnostic criteria for functional constipation
Must have the following criteria 1x per week for at least two months:
Two of the following in a child with a dev age of 4 yrs:
- Two or fewer defecations in the toilet per week.
- At least one episode of fecal incontinence per week.
- History of retentive posturing or excessive volitional stool retention.
- History of painful or hard bowel movements.
- Presence of a large fecal mass in the rectum.
- History of large diameter stools that may obstruct the toilet.
At what transition periods is the developing child prone to constipation?
toilet training and the start of school
How do you diagnose fecal impaction?
identifiying a large and hard mass in the abdomen or a dilated rectum filled with stool. You do not need an x-ray!
What are the recommended methods of disimpaction?
oral (PEG) or rectal (enemas) medication. Digital disimpaction is not recommended
What is the maintenance dose of PEG?
0.4 g/kg/day to 1.0 g/kg/day
What is the disimpaction dose of PEG?
1 g/kg/day – 1.5 g/kg/day for 3 days
What can you use to treat constipation in infants < 18 months of age?
PEG (0.8 g/kg/day), lactulose, glycerin suppositories
How long do you treat for constipation?
Children with constipation should be treated for at least six months, and should have regular bowel movements without difficulty before considering a trial of weaning maintenance therapy.
Features of UC
Rectum involved, involves gut continuously, bowel wall may be normal, mucosa is hemorrhagic, strictures/fistulas are rare
Features of CD
Segmental involvement / skip lesions, TI is thick/inflammated, transmural inflammation, mucosa looks cobblestone, strictures/fistulas are common
What infection mimicks crohn’s disease?
yersinia
Investigations to do in IBD
CBC (microcytic anemia, thrombocytosis),
ESR, CRP,
albumin,
fecal calprotectin (stool test specific for gut inflammation),
P-ANCA (UC), ASCA (crohn’s)
Imaging for Crohn’s?
MRI-enterography, MR pelvis for peri-anal/fistulas, used to do UGI+small bowel follow-through
After how many weeks of life should a jaundiced baby have conjugated and unconjugated bili testing done?
2 weeks
Definition of acute liver failure?
INR >= 1.5 with encephalopathy
OR
INR >= 2.0 without encephalopathy
After you have attempted to correct INR with 1 dose of vit K IV
What is the only clotting factor made outside of the liver?
factor 8 (made in endothelium)
How does alpha-1-antitrypsin present in children?
liver cirrhosis
How do you prevent Hep B in at risk newborns?
- vaccine within 12 hours
- immunoglobulin within 7 days
When can you return to school if you have Hep A?
7-10 days from first day of jaundice
Breast milk protein?
Higher in whey protein (70%) than casein (30%) than bovine sources (18, 82% respectively)
contraindications to breastfeeding?
HIV infection, chemotherapy / cytotoxic drugs, radiation therapy, active TB or if the infant has galactosemia
who should get 800 IU of vit d per day?
- living north of latitude 55 degrees, October-April
- living in community with high prevalence of vitamin D deficiency
- children with dark skin
soy based phytoestrogens are contraindicated in what situation?
congenital hypothyroidism (phytoestrogens can inhibit thyroid peroxidase, potentially lowering free thyroxine concentrations, which could lead to abnormal thyroid function)
how do you manage mild dehydration?
replace with ORS 50 mL/kg over 4 hours, replace losses
how do you manage moderate dehydration?
rehydrate with ORS 100 mL/kg over 4 hours, replace losses
how do you manage protein-losing enteropathy?
hydrolyzed formula
how do you test for fat malabsorption
fecal elastase
how do you test for carbohydrate malabsorption
stool reducing substances
how do you test for protein malabsorption?
stool alpha-1-antitrypsin
what is acrodermatitis enteropathica?
inability to absorb sufficient zinc (genetic)
what is kwashiorkor?
hypoalbuminemia, edematous malnutrition due to inadequate protein intake. noted to have sparse yellow/red-tinged hair.
what is marasmus?
severe protein-energy malnutrition, emaciated, < 70% of ideal weight, face like “old man”
what should you supplement in a vegan breastfeeding mom?
B12
What key nutrient is missing in goat’s milk?
folate
does iron fortified formula increase risk of constipation?
nope!
when should you recommend soy milk?
rarely! galactosemia, or for religious reasons
what is a sign of vitamin c deficiency (scurvy)
bleeding gums
sign of zinc deficiency
peri-oral / bum rash, diarrhea
when do you remove a button battery?
within 48 hours, ASAP!
what contains gluten
wheat, rye, barley
pathologic findings of celiac
villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis
non-GI manifestations of celiac disease
- dermatitis herpetiformis
- osteoporosis
- short stature
- delayed puberty
- iron-deficient anemia
- hepatitis
- arthritis
- epilepsy with occipital calcifications
conditions associated with celiac
type 1 DM, IgA deficiency, down syndrome, turner syndrome, williams syndrome, other autoimmune conditions, first degree relative with celiac (1:20)
diagnosis celiac
anti-TTG, IgA (+/- deaminated gliadins), biopsy
osmotic laxatives
lactulose, mineral oil
stool softener
docusate
prokinetic laxatives
dulcolax, senokot, prucalopride
first line tx for pinworms
mebendazole
Most likely cause of persistent unconjugated hyperbilirubinemia at 21 days of life…
Gilbert’s
what to screen for in an infant with e.coli sepsis
galactosemia
gilbert’s - inheritance
autosomal dominant
gilbert’s - mutation in…
CGG repeats in glucoronyl transferase UDP1A1
most common indication for liver transplant in children
biliary atresia
which type of PFIC presents with elevated GGT?
type 3 (not type 1/2)
most common metabolic etiology of hepatitis
A1AT deficiency (if unwell, think of galactosemia!)
definition of fulminant hepatic failure
INR >2, or INR > 1.5 + encephalopathy
elevated ALP in healthy child
familial hyperphosphatasemia (benign)
ALP normal, other liver enzymes elevated
Think of Wilson’s disease
ALP abnormally low
think of Zinc deficiency! (co-factors)
coagulation factor not made in liver
factor VIII (8)
treatment of Hep B
- interferon-alpha
- other options: lamivudine (nucleoside analogue)
side effect of interferon alpha (tx for hep b)
neutropenia, fever, myalgia, h/a
most common type of gallstone
cholesterol
