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Peds II Exam 1 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

bloody vomit

A

maternal ingestion, esophageal varices, foreign body

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2
Q

Bilious vomit

A

URGENT EVAL; obstruction – malrotation w/ or w/o volvulus, congenital intestinal atresia

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3
Q

Happy spitter

A

GER; no complications, declines w/ age, growing well, comfortable, healthy (reflux common <6 months)

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4
Q

Unhappy spitter

A

GERD; complications; FTT, esophagitis, respiratory complications

fussy, irritable, dystonic neck posturing, feeding refusal; occult blood in stool

consider food protein intolerance

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5
Q

Dx for GERD

A

hemoccult

endoscopy, uppter GI, w/ SEVERE SX!

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6
Q

Prognosis for GERD

A

usually resolves by 9-12 months- no longer laying down when being fed

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7
Q

Tx for GERD

A

1st line- lifestyle; upright positioning for 30 min after feeds; trial of hypoallergenic diet; don’t overfeed, avoid tobacco exposure, thickened feeds (2-3 tsp cereal)

2nd line- used for refractory pts or those w/ complicated disease (CF, esophogitis on endoscopy)
Drugs: short term PPI (omeprazole) vs H2 blocker (ranitidine)

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8
Q

PPI

A

omeprazole

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9
Q

H2 blocker

A

ranitidine

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10
Q

Tx for GER

A

no tx required; educaiton and reasurrance; usually resolves by 6 months

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11
Q

Infantile hypertrophic pyloric stenosis etiology

A

genetic predisposition and environmental factors (macrolide abx during first few weeks of life)

M>F (1st more male)

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12
Q

Associated w/ hypertrophic pyloric stenosis

A

macrolide use

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13
Q

Presentation of pyloric stenosis

A

3-6 weeks olds
foreceful PROJECTILE vomiting after feeding
“hungry vomiter”
FTT and dehydration`

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14
Q

PE for pyloric stenosis

A

olive-like mass in RUQ (indicates hypertrophy)

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15
Q

Test of choice for pyloric stenosis

A

Ultrasound – elongation and thickening of the pylorus

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16
Q

2nd line test for PS

A

Upper GI (UGI) Barium Contrast study – “string sign” (narrowed lumen);

ordered when US is non-diagnostic

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17
Q

String sign

A

PS (narrowed lumen) on UGI

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18
Q

Tx for PS

A

pyloromyotomy (surgery)
IV fluid
electrolyte resuscitation

GOOD PROGNOSIS

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19
Q

Congenital intestinal atresia

A

one or more segments of bowel may be absent and/or obstructed at birth

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20
Q

Most common site for atresia

A

duodenum

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21
Q

Atresia most common in

A

pts w/ CF and down syndrome

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22
Q

Dx of congenital atresia

A

prenatal u/s (usually diagnosed after birth though via symptoms)

  • Abdominal Plain Film Xray – duodenal atresia (“double bubble sign”); jujunoileal/colonic atresias (dilated loops of bowel w/ air fluid levels)
  • Upper GI and Contrast Enema – used for confirmation or to further identify obstruction
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23
Q

Presentation of congenital atresia

A

depends on degree of obstruction (partial vs. complete)

Vomiting (may be bile stained) w/i first 48 hours of life
Abdominal distention
Failure to pass meconium (+/-) – BAD SIGN, think bowel obstruction

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24
Q

double bubble

A

congnital atresia

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25
Q

strings sign

A

PS

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26
Q

olive like mass

A

PS

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27
Q

Management of congenital atresia

A

feedings withheld (IV fluid, correct electrolytes)
broad spectrum abx to prevent pos op infection
SURGERY

GOOD PROGNOSIS

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28
Q

Volvulus

A

small bowel twists around superior mesenteric artery; risk of small bowel ischemia!

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29
Q

Presentation of midgut malrotation

A

vomiting (bilious-green or fluorescent yellow)
abdominal pain
hemodynamic INSTABILITY
+/- hematochezia (sign of ischemia)

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30
Q

PE for midgut malrotation

A

abdominal distention and tenderness

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31
Q

Dx for malrotation

A

abdominal x-ray (r/o bowel perforation)

UGI - gold standard! - displaced duodenum, duodenal obstruction; “CORKSCREW APPEARANCE” of duodenum

U/S, barium enema - useful adjunct to UGI, not best for confirming malrotation

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32
Q

Tx for malrotation

A

Ladd Procedure - bowel untwitched and reposition to create adhesions to hold bowel in place

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33
Q

Prognosis of malrotation

A

resolution in 90%

1% recurrence

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34
Q

Corkscrew on UGI

A

malrotation

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35
Q

Ladd procedure

A

malrotation

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36
Q

most common cause of abdominal emergency in kids < 2 yo

A

intussuception

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37
Q

Who is at risk for intussusception?

A

kids 6 mo - 36 mo
idiopathic
“lead point” - lesion/variation in intestine; dragged by peristalsis into a distal segment (meckel’s diverticulum, tumor, polyp, cyst, chron’s, celiac, CF, viral infection)
Rotashield

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38
Q

Presentation of intussusception

A

sudden, intermittent, severe, crampy abdominal pain
unconsolable crying, DRAWS LEGS TO CHEST
vomiting common

Triad: (<15% of pts):
ab. pain
ab. mass
“currant jelly” stools (blood & mucous)

palpable sausage-shaped mass (swollen bowel)

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39
Q

olive mass

A

PS

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40
Q

Sausage-shaped mass

A

intussusception

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41
Q

Most common cause of intussusception

A

meckel’s diverticulum

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42
Q

Dx of intussusception

A

U/S - initial test of choice - “target sign” “coiled spring”

Hydrostatic/pneumatic enema: diagnostic and therapeutic (TOC if no perforation)

Surgery if reduction unsuccessful

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43
Q

Corkscrew appearance

A

malrotation

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44
Q

Target sign

A

intussusception

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45
Q

coiled spring

A

intussusception

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46
Q

Currant jelly

A

intussuception

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47
Q

Therapeutic TOC for intussusception

A

hydrostatic/pneumatic enema

48
Q

Most common pediatric surgical emergency

A

appendicitis

49
Q

Etiology of appendicitis

A

obstruction of appendiceal lumen leading to inflammation

50
Q

Who is at risk for appendicitis

A

peaks in 2nd decade of life

rare before 5 yo

51
Q

Presentation of appendicitis

A

anorexia
migrating ab. pain (periumbilical to RLQ)
vomiting (after pain)
fever +/-
signs of peritoneal irritation (guarding, rebound tenderness, + Rovsing, obturator or Ileopsoas signs)

52
Q

Tx for appendicitis

A

if class presentation, proceed to surgery w/o imaging

Imaging:

  • U/S (no radiation)
  • CT scan
  • WBC >10,000 increases liklihood
53
Q

Tx for appendicitis

A

surgical consult
pre-op managment (fluids, electrolytes, abx)
Surgical resection - appendectomy

NOT (nonoperative treatment) - abx for early appendicitis

54
Q

Diarrhea

A

> 3 loos watery stools/day x 5 days

55
Q

Most common cause of diarrhea

A

viral (rotavirus, norovirus)

56
Q

Acute diarrhea

A

abx assocaited (c. diff)
bacterial (salmonella, e.coli, campylobacter, yersinia)
viral (rota, noro, adeno)
Parasitic (giardia lamblia, e. histolytica, cyrpto)

57
Q

C.diff

A

Dx: stool culture for c.diff toxin
Tx: flagyl

58
Q

Bacterial

A

Dx: stool culture; blood/mucous - think E.coli O157:H7
Tx: supportive, sometimes abx, no anti-motility

59
Q

Viral

A

Dx: viral antigen stool test?
Tx: supportive

60
Q

Parasitic

A

Dx: stool O&P x 3; giardia has stool antigen test
Tx: flagyl

61
Q

Chronic diarrhea causes

A

celiac
allergic
malabsorption (CF)
toddler’s diarrhea

62
Q

Celiac disease

A

immune mediated inflammatory disease of small intestine caused by gluten sensitivity

63
Q

Dx for celiacs

A

IgA antibodies to tissue transglutaminase (TTG), small bowel bx

64
Q

S/sx of celiacs

A

FTT, anemia, possible foul smelling stools

65
Q

Tx for celiac

A

gluten free diet

66
Q

Allergic chronic diarrhea

A

food protein allergy (milk,soy)

microscopic blood and mucous in stools, gassy, fussy
Tx: dietary elimination, hydrolyzed or free AA based formula (nutramigen)

67
Q

Toddler’s diarrhea

A

6 mos- 5 yo; self-limited

68
Q

Red flag workup for diarrhea

A

CBC, CMP, celiac testing, urine Cx, stool testing, imaging

**routine stools are NOT recommended for most cases of diarrhea

69
Q

Tx for acute diarrhea

A

hydration always
abx sometimes - only if you rule out e.coli
anti-motility rare

70
Q

IBD etiology

A

interaction of genetic, environmental and immune factors

peak incidence 15-30 YO

71
Q

2 types of IBD

A

crohn and ulcerative colitis

72
Q

Smoking and IBD

A

2x increased risk for CD

50% decreased risk for UC

73
Q

Presentation of IBD

A

diarrhea, ab pain +/- hematochezia
Growth failure, DELAYED PUBERTY (nutrient deficiencies, anemia)

Extraintestinal manifestions:

74
Q

Dx for IBD

A

CBC, CMP, ESR, CRP, serum Fe, vit D, B12, stool study, c.diff

75
Q

Chrohns Disease

A

transmural inflammation - mouth to anus (can include all GI tract)
SKIP LESIONS
COBBLESTONE APPEARANCE
perianal fissures, fistulas

76
Q

Dx of Chrohn’s

A

Colonoscopy

or wireless capsule endoscopy

77
Q

Ulcerative colitis

A

rectum and large colon;
mucosal layer only
starts at rectum and proceeds proximally to colon
bloody diarrhea common
DIFFUSE/CONTINOUS EDEMA, ERYTHEMA, FRIABILITY, ULCERATION OF COLON

78
Q

Risk w/ UC

A

colon cancer

79
Q

Tx of IBD

A

“step up” for most pts
“top-down” for high risk pts

5 components:

  • Medications
  • Surgery
  • Nutritional rehab
  • behavioral health support
  • colorectal cancer screening in older pts

tx depends on severity of disease

80
Q

Medications for IBD

A
  • Aminosalicylates: 5 ASA (sulfasalazine, mesalamine)
  • immunemodulating (mercaptopurine, azathioprine, methotrexate) or biologics (infliximad/remicade)
  • steroids (acute flare)
    +/- Abx
    Surgery- refractory cases
    monitor growth, nutrition, infection, psych issues, cancer
81
Q

Aminosalicylates

A

Sulfasalazine, Mesalamine

82
Q

Immunemodulating agents

A

Mercaptopurine
Azathioprine
MTX

83
Q

Biologics

A

infliximad/remicade

84
Q

Meckel’s Diverticulum etiology

A

Vitelline duct leads to formation of diverticulum (outpouching)
Gastric acid produced and cases damage
bleeding occurs from mucosal ulceration

85
Q

Rule of 2’s

A

2% of population
2:1 M:F RATIO
2% develop complication (before 2 yo)
2 feet from ileocecal valve

86
Q

Most common congenital anomaly of GI tract

A

Meckel’s diverticulum

87
Q

Presentation of meckel’s diverticulum

A

Painless rectal bleeding
obstruction (volvulus or intussusception)
Diverticulitis (can mimic appendicitis)

88
Q

Lab/dx for meckel’s

A

Technetium-99 scan (Meckel’s scan)

89
Q

Tech 99/meckel’s scan

A

nuclear medicine scan that identifies ectopic gastric mucosa: lights up where there is gastric tissue that shouldn’t be there

90
Q

Tx for meckel’s

A

surgical resection – GOOD PROGNOSIS

91
Q

Constipation

A

regular passage of firm or hard stools or infrequent passage of stool – if impacted, ecnopresis can occur (incontinence of stool)

92
Q

cause of constipation

A

multifactorial
r/o anatomic or biochemical cause
95% functions, 5% organic

93
Q

Functional constipation

A

psych

diet

94
Q

Organic constipation

A 
anal stenosis
hypothyroidism
celiacs
hirshsprung's 
hypercalcemia
CF
95
Q

Functional constipation

A

voluntary withholding of stoop (avoid due to negative experience)
Stool incontinence: encopresis

96
Q

Periods kids are most likely to develop constipation

A

intro to solid foods or cow’s milk
toilet training
start of school (5-6)

97
Q

Other functional causes

A

lack of fiber
dairy excess
poor water intake

98
Q

Fiber intake kids >2 YO

A

Age + 5-10 g/day

99
Q

Fiber for infants <2YO

A

5g/day

100
Q

Findings suggestive of organic cause of diarrhea

A 
failure to pass meconium
FTT
abdominal distention or obstructive sx
lumbosacral problems, neuro abnormalities
anterior placed anus/other alterations
occult blood in stool
101
Q

Sx of constipation

A

+/- fecal leakage
abdominal discomofort (generalized or LLQ)
hypoactive BS if impacted
anal fissures

102
Q

Red flags for constipation

A 
wt loss, poor weight gain/growth
anorexia, fever, hematochezia
hx of delayed passing of meconium (CF)
acute onset
failure to respond to conservative tx
103
Q

Labs for constipation

A

xray to r/o impaction

CBC, CMP, TSH, celiac, chloride sweat test

104
Q

Managment of constipation

A 
fluids
gradual increase of daily fiber
decrease dairy (<16 oz/day)
juice - apple, prune or pear
If encopresis, relieve impaction if present (polyethylene glycol/Miralax)
105
Q

Meds for constipation

A

Miralax, lactulose, enemas, suppositories

106
Q

Hirchsprung disease aka

A

congenital aganglionic megacolon

107
Q

What is hirchsprung

A

absence of ganglion cells in mucosal and muscular lays of the colon – leads to spasm and abnormal motility – colon fails to relax and may lead to obstruction

108
Q

Epidemiology of hrichsprung

A

M>F
80% present <6 wks old
patients w/ Down Syndrome have higher risk

109
Q

Presentation of hirschprung

A

failure to pass meconium in first 48 hours
Bilious voming!
Abdominal distention

late presentation rare: pass meconium but develop sx later – chronic constipation and FTT

later dx = less severe disease

110
Q

Bilious vomiting

A

Malrotation

Hirschprung

111
Q

Nonbilious projectile vomiting

A

PS

112
Q

PE for hirschprung

A

ab distention
Tight anal sphincter
“squirt sign”

113
Q

Labs/dx for hirschprung

A

Contrast enema - unprepped to localize “transition zone” - change from narrowed aganglionic segment to the dilated proximal colon

Rectal bx – GOLD STANDARD - confirms absence of ganglion cells

114
Q

Tx for hirschprung

A

surgical resection of aganglionic segment of colon

115
Q

Prognosis for hirschsprung

A

good; may have some abnromal bowel function

fecal incontinence, constipation

Peds II Exam 1 (4 decks)

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