GASTROENTEROLOGY Flashcards
Cholelithiasis in children is usually due to:
Hemolytic dyscrasia
If you are suspecting biliary atresia, what is the gold standard for diagnosis of this disease?
Direct Cholangiography
- prolonged elevation of the serum levels of conjugated bilirubin beyond the 1st 14 days of life
- Mechanical Obstruction of bile flow
- Biliary Atresia
- Functional impairment of hepatic excretory function and bile secretion
NEONATAL CHOLESTASIS
cone-shaped fibrotic mass cranial to the bifurcation of the portal vein, may be seen in patients with biliary atresia
Triangular Cord sign
gold standard for the diagnosis of biliary atresia. To determine the presence and site of obstruction
Cholangiography
Biliary atresia vs neonatal hepatitis
The most common cause of viral gastroenteritis in infants is:
Rotavirus
By definition acute diarrhea DOES NOT last longer than ___days?
14
ACUTE DIARRHEA definition
- excessive loss of fluid and electrolyte in the Stool
- sudden onset of excessively loose stools of >10 mL/kg/day in infants and >200 g/24 hr in older children, which lasts <14 days
Patients presenting with non-inflammatory diarrhea
DRUGS USED IN CHOLERA
- Tetracycline 12.5 mg/kg/dose 4x day PO qid for 3 days (max 2 g/day); not for <9 yrs old; or
- Doxycycline 5 mg/kg PO single dose (max 200 mg/day)
- Alternatives: TMP-SMX 8-10 mg/kg/day bid PO; Erythromycin 40 mg/kg/day every 6 hours max. 2g/day; or Furazolidone 5-8 mg/kg/day max 400 mg/day
What is the mechanism behind the bleeding diarrhea in shigella?
invasion of the intestinal epithelium
Bloody diarrhea
Abdominal cramps, tenesmus, abundant pus and WBC in stool
Shigella
Bloody diarrhea
High fever, headache, drowsiness, confusion, meningismus, seizures, abdominal distention History of eating eggs, poultry, unpasteurized milk
Salmonella
severe abdominal pain, high fever, emesis, anorexia, generalized toxicity, painful defecation, urgency
Shigellosis
WHO recommendation for all patients with bloody diarrhea irrespective of age
Ciprofloxacin 30 mg/kg/day in 2 divided doses
improves immune response to Shigella
Zinc 20 mg/day for 14 days
Most common cause of intestinal obstruction between 3 months - 6yrs.old; M > F
INTUSSUSCEPTION
Barium enema. what condition is this seen?
INTUSSUSCEPTION
coiled-spring sign (thin rim of barium trapped around the invaginating part within the intussuscipiens; edematous mucosal folds of the returning limb of intussusceptum outlined by the contrast)
UTZ. What condition is this seen?
INTUSSUSCEPTION
tubular mass & a doughnut or target sign (98-100% sensitivity)
- Ultrasound is confirmatory: pyloric thickness >4mm or length >14mm
- Barium: elongated pyloric channel, a bulge of the pyloric muscle into the antrum (shoulder sign) & streaks of barium in the narrowed channel (double tract sign)
PYLORIC STENOSIS
- Hallmark: bilious vomiting without abdominal distention usually noted on the 1st day of life
- Polyhydramnios in 50% due to failure of absorption of amniotic fluid in the distal intestine
- Jaundice in 1/3 of patients
DUODENAL ATRESIA
Most common cause of lower intestinal obstruction in neonates; M>F
HIRSCHSPRUNG DISEASE
Arrest of neuroblast migration from the proximal to distal bowel – absence of ganglion cells in the bowel wall beginning in the internal anal sphincter
HIRSCHSPRUNG DISEASE
gold standard for dx of HIRSCHSPRUNG DISEASE
rectal suction biopsy
Absence of Meissner & Auerbach plexus & hypertrophied bundles with high concentrations of acetylcholinesterase between the muscular & submucosa layers
HIRSCHSPRUNG DISEASE
Patients presenting as obstruction
According to the Rome criteria for functional constipation in children less than 4 years of age, how many criteria must be met in order to diagnose functional constipation?
2
delay or difficulty in defecation present for 2 wk or longer and significant enough to cause distress to the patient.
Constipation
o voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 yr has been reached
Encopresis
Chronic constipation: ROME III Criteria
DIFFERENCE BETWEEN OSMOTIC & SECRETORY DIARRHEA:
Mechanisms of diarrhea
Liquid alkali produces what type of necrosis
liquefaction necrosis
Acidic agents produces what type of necrosis
coagulation necrosis
Dilution by water/milk is recommended in caustic ingestions. True or false.
TRUE
• Abdominal x ray:
o Sentinel loop
o Dilated transverse colon (cutoff sign)
o Ileus o
Blurring of the left psoas margin
o Peripancreatic extraluminal gas bubbles
Acute pancreatitis
HBsAg (+), Anti-HBc (+), IgM Anti-HBc (+), Anti-HBs (–)
acute hepatitis B infection
First clinical evidence of HBV infection is elevation of
ALT levels which occurs about 6-7 wks after exposure
most valuable single serologic marker of acute HBV infection because it is present as early as HbsAg and continues to be present later in the course of the disease when HBsAg has disappeared
Anti-HBcAg
inner portion of the virion that encodes the viral DNA
HBcAg
serves as a marker of active viral replication; identification of infected people at increased risk of transmitting HBV
HBeAg
first serologic marker to appear & its rise coincides with the onset of symptoms; detection of acutely or chronically infected people; antigen used in hepatitis B vaccine
HBsAg
identification of people who have resolved infections with HBV; determination of immunity after immunization
Anti-HBs
identification of infected people with lower risk of transmitting HBV
Anti-HBe
identification of people with acute, resolved, or chronic HBV infection
Anti-HBc
identification of people with acute or recent HBV infections (including HBsAg-negative people during the “window” phase of infection)
IgM anti-HBc
Hepa profile and interpretations.
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