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Gastroenterology đŸ§» Flashcards

1
Q

Name some diarrhea red flags

A

Fever

Blood in stool

Dehydration

Leukocytosis

Persistent symptoms

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2
Q

What is the big deal if a child holds their poop in

A

Stool may become impacted, and then encopresis may occur (poop builds up until it leaks out involuntarily)

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3
Q

What are the 2 main types of inflammatory bowel disease?

A

Crohn

Ulcerative colitis

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4
Q

What is the most common congenital anomaly of the GI tract?

A

Meckel’s diverticulum

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5
Q

How do you treat constipation?

A

Fluids

Gradual increase in fiber

Juice for infants

If encopresis, relieve impact ion if present

Constipation meds miralax, lactulose, enemas, suppositories, etc

Counseling and positive reinforcement

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6
Q

When is diarrhea considered “chronic”

A

If it goes on for more than 1 month

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7
Q

What is the fiber recommendation for a children under 2?

A

5g/day

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8
Q

What causes damage when someone has a meckel’s diverticulum?

A

Gastric acid is produced there and causes damage and bleeding

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9
Q

What is the most common cause of infectious diarrhea?

A

VIRAL ****

(Norovirus, rotavirus, adenovirus, calcivirus)****

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10
Q

Which imaging study is diagnostic AND therapeutic for intussusception?

A

Hydrostatic/pneumatic enema

Unfolds telescoping 90% of the time

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11
Q

What is the first line treatment for GERD?

A

Lifestyle modifications

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12
Q

How do you diagnose a Meckel’s diverticulum?

A

Technetium-99 scan (Meckel’s scan)**

Nuclear medicine scan identifies gastric mucosa in the places it’s NOT suppsed to be!

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13
Q

What is the clinical presentation of appendicitis?

A

Anorexia

Migrating abdominal pain (belly button to RLQ)

Pain increases with movement

Vomiting

Fever

Peritoneal signs- guarding, rebound tenderness, rovsing, obturator, iliopsoas signs

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14
Q

What will you see on ultrasound of a baby with pyloric stenosis?

A

Elongation and thickening of the pylorus

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15
Q

How old are babies that get infantile hypertrophic pyloric stenosis?

A

3-6 weeks old

VERY YOUNG

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16
Q

What are the clinical presentations of meckels diverticulum?

A

PAINLESS rectal bleeding ***

Obstruction (volvulus or intussusception)

Diverticulitis

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17
Q

What should you be thinking if the baby does not pass meconium

A

Bowel obstruction

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18
Q

What are the RED FLAGS for a patient with constipation?

A

Weight loss/ FTT

Anorexia

Fever

Hematochezia

Vomiting

History of delayed meconium passage

Acute onset

Failure to respond to conservative measures

(This was in red)

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19
Q

Who is more likely to be affected by Hirschsprung disease?

A

Males

Down syndrome pts

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20
Q

Where do you need to start with imaging if you suspect midgut malrotation?

A

Abdominal X-Ray -rule out bowel perforation

If not perforated, then you’re good to go ahead and get an upper GI contrast study - gold standard for mm

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21
Q

What is another name for Hirschsprung Disease?

A

Congenital Aganglionic Megacolon*******

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22
Q

What condition do “unhappy spitters” have?

A

GERD

Happy spitters have GER

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23
Q

Is reflux in babies common?

A

Yes common in infants 6 months and less

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24
Q

How do you diagnose Hirschsprung disease?

A

Contrast enema

Rectal biopsy- GOLD STANDARD

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25
What will you see on an abdominal x ray if the baby has intestinal atresia in the jejunoileal/colonic areas
Dilated loops of bowel with air-fluid levels
26
What kind of a diet would cause a kid to develop functional constipation’/
No fiber Too much dairy Not enough water
27
Can congenital intestinal atresia be detected on ultrasound before the baby is born?
Yes
28
What is the initial test of choice when you suspect intestinal intussusception ?
Abdominal ultrasound
29
What are some of the complications of infantile hypertrophic pyloric stenosis that may occur as the disease progresses
FTT Dehydration
30
What is the classic clinical presentation of midgut malrotation +/- volvulus
Vomiting- bilious green or fluorescent yellow Abdominal pain Hemodynamic instability Hematochezia (sign of bowel ischemia)
31
How does smoking affect the risk for Crohn disease and UC?
2x increase risk for Crohn 50% decrease in risk of UC
32
What happens if your patient has intussusception and the hydrostatic enema didnt do anything
Must intervene surgically
33
Would you expect growth failure and delayed puberty to be signs of an inflammatory bowel disease?
Why yes you would
34
What will you see on the upper GI contrast study if the patient has midgut malrotation?
Corkscrew appearance of duodenum** Duodenal obstruction Displacement of the duodenum
35
What is the rule of 2’s regarding Meckel’s diverticulum?
2% of the population 2:1 M:F ratio 2% develop complications (usually before age 2) 2 feet from the ileocecal valve
36
What is a 2nd test you can order to diagnose pyloric stenosis if the ultrasound was non-diagnostic?
Upper GI Barium contrast study
37
What are you thinking: -bile stained vomiting in first 48 hrs of life - Abdominal distention - failure to pass meconium
Congenital intestinal atresia
38
What will you find on physical exam on a baby with infantile hypertrophic pyloric stenosis
An “Olive like” mass in RUQ
39
What is the FIRST line treatment for relieving a fecal impaction for a constipated kid with encopresis?
Polyethylene glycol (Miralax) ************THIS HAD A BLUE STAR*******
40
What pat of the GI tract is affected by Crohn disease?
TRANSMURAL inflammation from your mouth to your asshole The ~entire!~ GI tract may be affected
41
What are some possible causes of chronic diarrhea?
Celiac disease Allergies Malabsorption (ex Cystic fibrosis) Toddlers diarrhea (fruit juice)
42
What kind of vomiting will a baby with infantile hypertrophic pyloric stenosis have?
Nonbilious (obstruction is before biliary grr)**** Projectile vomiting**** RIGHT AFTER eating****
43
What will you see on an abdominal x ray if a baby has intestinal atresia in the ~duodenum~?
Double Bubble Sign ******** Due to gas and dilation in both stomach and duodenum
44
You’re working in the ER and a 12 year old rolls in and you take one look at him and say, “slam dunk its appendicitis” Can you send him to surgery without even doing any imaging?
Yes
45
Do we do surgery for kids with IBD
Yes for refractory cases
46
When are kids most likely to start refusing to poop and causing themselves to get functional constipation?
Intro to solid foods or cows milk Toilet training Starting kindergarten
47
What is the surgical treatment for midgut malrotation?
**Ladd procedure** Bowel is untwisted and repositioned in abdomen which creates “adhesions” that hold the bowel in place
48
What is the most common cause of intestinal emergency in kids under 2
Intussusception
49
What should you be worried about if a baby is irritable, has dystonic neck posturing, refusing feeding, FTT, respiratory complications and may have occult blood in stool?
GERD
50
What are some diarrhea red flags? (This might be more than something viral)
Fever Severe abdominal pain Blood in stool Recent antibiotics Persistent symptoms Dehydration Leukocytosis Growth and development affected
51
Who are the “hungry vomiters”?
Babies with infantile hypertrophic pyloric stenosis
52
How do you diagnose celiac disease?
IgA antibodies to tissue transglutaminase Small bowel biopsy
53
Leakage of retained stool seen commonly in kids with chronic constipation=?
Encopresis
54
What is the definition of diarrhea?
>3 loose watery stools/day đŸ§»đŸšœđŸ’§
55
What is the most common pediatric surgical emergency?
Appendicitis
56
What would you see if you looked at the intestines of someone affected by Crohn disease?
Cobblestone appearance*** Skip lesions* Perianal fissures/fistulas
57
What are some of the medications that may be used for treating inflammatory bowel diseases?
Aminosalicylates: 5-ASA (Sulfasalazine, Mesalamine) Immunomodulating agents (Mercaptopurine, azathioprine, methotrexate) or Biologics (Remicade, Inflixamad) Steroids- especially in acute flare +/- antibiotics
58
Who is most likely to get infantile hypertrophic pyloric stenosis? Males/females First born/second born
First born males
59
Is constipation a common problem for kids
Yes, it affects 30%of children
60
What kind of tissue is in meckel’s diverticulum?
Intestinal epithelium Gastric epithelium (WTF wait what you mean you have stomach tissue in your small intestine that is producing gastric acid in a totally inappropriate spot?!?!?!?!)
61
What is the treatment for a meckels diverticulum?
Surgical resection (excellent prognosis)
62
What are some possible causes for organic constipation (aka the kid isn’t holding it in on his own and its not his diet)
Anal stenosis Hypothyroidism Celiac disease Hirschsprungs HYPERkalemia Cystic fibrosis
63
What does encopresis mean?
SEEPING STOOL*****
64
What will you find on physical exam of a pt with Hirschsprung disease?
Abdominal distention TIGHT ANAL SPHINCTER***** Postive squirt sign 👉
65
Continuous, red, friability in rectum and large colon=
Ulcerative colitis
66
What age group is most likely top get appendicitis?
10-20 yr olds RARE before 5
67
Is it possible for inflammatory bowel diseases like Crohn and UC to affect places other than the intestines?
Yes. Mouth, skin, joints, liver, eye, etc
68
TRANSMURAL inflammation from mouth to anus, skip lesions=
Crohn disease
69
Embryonic remnant of the vitelline duct that can cause GI bleed=
Meckel’s diverticulum
70
When are most cases of Hirschsprung disease discovered?
Before 6 weeks of age
71
What is the prognosis for GERD?
Usually goes away in 9-12 months because the baby is sitting up when its fed
72
What kind of vomiting will a bay with congenital intestinal atresia have?
Bile-stained within the first 48 hours of life
73
Is the classic triad of intestinal intussusception seen in every patient?
No, less than 15% of patients with intussusception have the triad
74
Why is bilious vomit an emergency?
It indicates an OBSTRUCTION Malrotation, or congenital intestinal atresia
75
Which one is an emergency: Bloody vomit Bilious vomit
Bilious
76
What can cause midgut malrotation?
Incomplete rotation of the midget during embryonic development
77
What the HELL is Hirschsprung disease?
There are NO ganglion cells in the colon which causes: Spasm and abnormal motility Colon does not relax= obstruction Rectum and sigmoid colon are constricted Areas behind the constriction get swollen
78
What are skip lesions and what type of IBD are they associated with?
Areas in the intestine that look totally NORMAL (not really a lesion at all) Associated with Crohn
79
What kinds of lifestyle mods may be helpful for GERD?
UPRIGHT positioning for 30 min after feeding (sitting STRAIGHT up, not in a bouncer or whatever) Hypoallergenic diet Don’t overfeed Avoid cigarette smoke Thickened milk with cereal
80
What will you see on contrast enema in Hirschsprung disease?
A “transition zone” where the narrowed aganglionic segment dilated to the proximal colon
81
What will you see on rectal biopsy of Hirschsprung disease?
Absence of ganglion cells
82
What causes the bleeding when someone has a meckels diverticulum?
Mucosal ulceration
83
How do you manage congenital intestinal atresia?
Withhold feeding Antibiotics Surgery
84
Are routine stool cultures recommended for most cases of diarrhea?
NO *****
85
How do you treat acute diarrhea?
HDYRATION ALWAYS Antibiotics sometimes Anti-motility agents rarely
86
What the F is a squirt sign?
If a finger is inserted into the rectum of a pt with hirschsprungs, the obstruction is relieved and there is an explosive release of gas and stool when the finger is removed đŸ„œ
87
Periumbiuliucal pain, +rovsings, obturator, Psoas, McBurney’s point tenderness =
Appendicitis
88
What is the recommended fiber intake for kids over 2?
(Childs age) + 5-10g So a 10 year old should be getting 15-20g of fiber/day
89
What is the classic presentation of Hirschsprung disease?
Newborn failing to pass meconium in first 48 hours of life***** Bilious vomiting Abdominal distention
90
How do older children present with Hirschsprung disease?
Chronic constipation FTT (The later the diagnosis, the less severe the disease)
91
One or more segments of bowel may be absent or obstructed at birth=?
Congenital intestinal atresia
92
Is the treatment of inflammatory bowel diseases like crohn and UC a “one size fits all” approach?
NO “Choice of treatment varies based on the severity of disease” This was written twice in blue
93
Which part of the bowel is most commonly affected by congenital intestinal atresia?
Duodenum
94
What will you see on an UGI Barium contrast study in a baby with pyloric stenosis
“String sign” Which is the narrowed lumen of the pylorus
95
Should we give kids with diarrhea Imodium?
Not recommended
96
What would you expect to see if you looked at the rectum and colon of someone with UC?
CONTINOUS (no skip lesions) edema, erythema, friability, and ulceration
97
What are the thoughts on giving antibiotics to well-appearing children who have acute bloody diarrhea?
Should NOT be used unless a specific pathogen has been isolated (don’t want to induce HUS)
98
What part of the GI tract is affected by ulcerative colitis?
Rectum and large colon Mucosal layer ONLY (Inflammation STARTS at the rectum and moves proximally into the colon)
99
What is the gold standard test to detect midgut malrotation
Uppper GI contrast study
100
What kids of findings suggest that constipation is from an organic cause and not functional?
Failure to pass meconium FTT Abdominal distention Lumbosacral problems Neurological abnormalities Anteriorly placed anus ? Occult blood in stool
101
What is the DEFINITIVE MANAGEMENT of pyloric stenosis?
Surgery- “pyloromyotomy”
102
What are you supposed to feed a baby that is allergic to milk or soy?
A hydrolyzed or free amino acid based formula (Ex: Nutramigen)
103
Why don’t we pump kids with IBD full of steroids
Concern for bone density, growth and development
104
What is the most common cause of a “lead point” that causes intestinal intussusception
Meckels diverticulum
105
What is congenital intestinal atresia?
One or more segments of bowel are absent or obstructed at birth
106
There is an association between infantile hypertrophic pyloric stenosis and ______________
Macrolide antibiotics during the first few weeks of life | Azithromycin, erythromycin, clarithromycin in case you forgot
107
Which is bad: | GER or GERD
GERD is bad GER is normal happy babies spitting up
108
6 month old with abdominal pain and currant jelly stools=
Intussusception
109
What will you see on ultrasound if patient has intussusception?
Target Sign Coiled Spring ********************
110
What is the cause of 95% of pediatric constipation?
Functional constipation (psychological or diet reasons)
111
How do you treat Hirschsprung disease?
Surgical resection of the aganglionic segment of colon. Overall a good prognosis
112
Abnormal position of the intestines in the abdomen that increase the risk of volvulus
Midgut malrotation
113
What are some possible signs and symptoms that a kid might have celiac disease, other than diarrhea?
FTT* Anemia Foul smelling stools
114
What is the classic triad of intestinal intussusception?
Abdominal pain Abdominal mass (sausage shaped) Currant jelly stools (blood + mucus) ************this was red and had a blue star
115
What is a major risk of a malrotation?
Volvulus- where the small bowel twists around the superior mesenteric artery= HUGE RISK of small bowel ischemia!!! EMERGENCY!!!!*******
116
What is this: | “Vitelline duct (embryonic remnant) leads to formation of a congenital outpouching of the small intestine”
Meckel’s diverticulum
117
After surgery for midgut malrotation, is recurrence common?
No
118
Which rotavirus vaccine was taken off the market due to a 22x risk of intussusception
Rotashield | 🛡
119
What kinds of things in a kid’s diet might cause diarrhea?
Fruit juice- Functional “Toddler’s” diarrhea Milk/soy enteropathy (allergy)
120
What kinds of medications are used for GERD in kids who don’t get better with lifestyle mods?
PPI (Omeprazole) H2 blocker (Ranitidine)
121
Congenital aganglionic megacolon, rectal biopsy is the gold standard=
Hirschsprung
122
What is this: | “Immune mediated inflammatory disease of the small intestine caused by gluten sensitivity”
Celiac disease
123
What should you do if your patient has GER?
Nothing, because it is a normal physiologic process that declines with age without ANY complications or consequences
124
If you see a test question that has a 1st born 3 week old baby boy, who is always hungry, and projectile vomits immediately after eating, what is the answer
Infantile hypertrophic pyloric stenosis
125
Intestinal atresia is more common in patients with these two conditions:
Cystic fibrosis Down syndrome
126
What causes intestinal intussusception?
Idiopathic 75% of the time “Lead point” 25% - lesion/variation in the intestine gets dragged by peristalsis into a distal segment.
127
What is the TEST OF CHOICE for diagnosing infantile hypertrophic pyloric stenosis?
Ultrasound
128
How do you diagnose crohn disease
Colonoscopy*
129
5 week old, hungry, with projectile vomiting=
Pyloric stenosis
130
Is there an increased risk of colon cancer if you have UC?
Yes
131
Whyyyyyyyyy do you need to evaluate a child with constipatin
You need to rule out an anatomic or biochemical cause

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