Gastroenterology Flashcards
Rome IV criteria for Constipation
2 or more of the following occurring at least once per week for a minimum of 1 month with insufficient criteria for a diagnosis of irritable bowel syndrome:
1. 2 or fewer defecations in the toilet per week in a child of a developmental age of at least 2 years 2. At least 1 episode of fecal incontinence per week 3. History of retentive posturing or excessive volitional stool retention 4. History of painful or hard bowel movements 5. Presence of a large fecal mass in the rectum 6. History of large diameter stools that can obstruct the toilet
Rome IV criteria for Cyclical Vomiting Syndrome
Must include all of the following:
1. The occurrence of 2 or more periods of intense, unremitting nausea and paryoxysmal vomiting, lasting hours to days within a 6-month period 2. Episodes are stereotypical in each patient 3. Episodes are separated by weeks to months with return to baseline health between episodes 4. After appropriate medical evaluation, the symptoms cannot be attributed to another condition
Rome IV criteria for Functional Dyspepsia
Must include 1 or more of the following bothersome symptoms at least 4 days per month
1. Postprandial fullness 2. Early satiation 3. Epigastric pain or burning not associated with defecation 4. After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
Criteria fulfilled for at least 2 months before diagnosis
Rome IV Criteria for Irritable Bowel Syndrome
Must include all of the following:
1. Abdominal pain at least 4 days per month associated with one or more of the following: a. Related to defecation b. A change in frequency of stool c. A change in form (appearance) of stool 2. In children with constipation, the pain does not resolve with resolution of the constipation (children in whom the pain resolves have functional constipation, not irritable bowel syndrome) 3. After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
Criteria fulfilled for at least 2 months before diagnosis
Rome IV Criteria for Abdominal Migraines
Must include all of the following occurring at least twice:
1. Paroxysmal episodes of intense, acute periumbilical, midline or diffuse abdominal pain lasting 1 hour or more (should be the most severe and distressing symptom) 2. Episodes are separated by weeks to months 3. The pain is incapacitating and interferes with normal activities 4. Stereotypical pattern and symptoms in the individual patient 5. The pain is associated with 2 or more of the following a. Anorexia b. Nausea c. Vomiting d. Headache e. Photophobia f. Pallor 6. After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
Criteria fulfilled for at least 6 months before diagnosis
Rome IV Criteria for Infant Colic
For clinical purposes, must include all of the following:
A. An infant who is <5 months of age when the symptoms start and stop
B. Recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers
C. No evidence of infant failure to thrive, fever or illness
Must also include:
1. Caregiver reports infant has cried or fussed for 2 or more hours per day during 3 or more days in 7 days in a telephone or face-to-face screening interview with an researcher or clinician 2. Total 24 hour crying plus fussing in the selected group of infants is confirmed to be 3 hours or more when measured by at least one prospectively kept, 24-hour behaviour diary
Fussing: intermittent distressed vocalization and has been defined as “[behaviour] that is not quite crying but not awake and content either”
What is the most helpful test for confirming Eosinophilic Esophagitis?
Upper endoscopy with biopsy: esophageal biopsy containing >15 intraepithelial eso/HPF specimens
- Gold standard: Upper endoscopy
Endoscopic clues in esophagus: linear furrowing, “trachealization” (rings), white papules, pallor, friability, stricture
- +absence of pathologic GERD as evidenced by a normal pH monitoring study of the distal esophagus OR lack of response to high-dose PPI medication (GERD can cause high eosinophils in the esophagus) (should be on PPI x 8 weeks prior to scope ideally)
- May have high serum eosinophil and total IgE level
- Skin prick testing for aeroallergens (useful if considering dietary management)
How to treat EoE?
- Initial Treatment: high dose PPI
- No Canadian guidelines for treatment
- Lack of response is almost diagnostic of EE
- Should not be considered primary therapy
- Corticosteroids (induces remission in 90%)
- Systemic: severe dysphagia causing dehydration & weight loss (fairly unusual)
- Topical (swallowed) fluticasone/budesonide ¬6-8 weeks - MOST effective treatment: dietary management (consult a dietician)
- Successful in 70-98%
- Elimination of IgE mediated allergens (guided by SPT results), 6-food elimination diet (dairy, eggs, wheat, soy, peanuts, fish/shellfish) or use of amino-acid based formula
- Dilatations (last resort): for symptomatic strictures causing food impaction
Name 6 GI symptoms of Celiac Disease
- Failure to thrive
- Abdominal pain/cramping
- Diarrhea
- Anorexia
- Oral sores (aphthous stomatitis)
- Constipation
What are 9 non-GI manifestations of Celiac Disease?
- Dermatitis herpetiformis
- Alopecia
- Erythema nodosum
- Hepatitis
- Iron deficiency anemia
- Dental enamel erosions
- Poor growth
- Delayed puberty
- Arthritis
- Epilepsy with occipital calcifications
What screening tests should you use to diagnose Celiac Disease?
- Tissue transglutimase antibodies and IgA
- IgA Endomysial antibody (EMA)
- Deaminated gliadin peptide (DGP IgA and IgG)
- Esophogastroduodenoscopy and biopsies
What are some complications of Crohn’s Disease?
- Steroid side effects: growth failure, osteoporosis, immunocompromise, hypertension
- Strictures: obstruction
- Fistulas/abscesses
What are the clinical signs of Toxic Megacolon?
A. Radiographic evidence of transverse colon diameter ≥56 mm (or >40 mm in those <10 years) B. Evidence of systemic toxicity: 1. Fever >38 C 2. Tachycardia 3. Dehdyration 4. Electrolyte disturbances (Na, K, Cl) 5. Altered level of consciousness or coma 6. Hypotension or shock
What are 3 long term consequences of UC?
- Toxic Megacolon
- Colorectal adenocarcinomas
- Primary sclerosing cholangitis
What is the primary problem in Gilbert Syndrome?
Gene defect in promoter region of UGT1A1; normal enzyme activity but decreased number. This produces hyperbilirubinemia (unconjugated) induced by stress, dehydration, fasting, menstruation, exercise or illness
