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Gastroenterology II Flashcards

1
Q

Bristol Stool - Type 1

A

separate hard lumps (like nuts)

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2
Q

Bristol Stool - Type 2

A

sausage-shaped but lumpy

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3
Q

Bristol Stool - Type 3

A

sausage like with cracks on surface

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4
Q

Bristol Stool - Type 4

A

smooth and soft sausage or snake

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5
Q

Bristol Stool - Type 5

A

soft blobs w/ clear-cut edges

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6
Q

Bristol Stool - Type 6

A

fluffy pieces w/ ragged edges - a mushy stool

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7
Q

Bristol Stool - Type 7

A

entirely liquid - no solid pieces

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8
Q

6 causes of diarrhea

A
  • abnorm. cell transport (dysentery)
  • decr. surface area- flat villi
  • incr. motility
  • incr. osmotically active molecules
  • incr. permeability (damage)
  • toxins or cytokines
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9
Q

causes of acute diarrhea

A
  • infection: viral, bacterial, parasite
  • antibiotics (loss of normal flora)
  • food allergen
  • toxin
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10
Q

MC age range for chronic nonspecific diarrhea

A

-MC 6mo - 2yr

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11
Q

s/s of chronic nonspecific diarrhea

A
  • 3-6 loose, often mucous per day

- not sick - still thriving

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12
Q

contributing factors to chronic nonspecific diarrhea

A
  • high carb, high juice diet

- high incident of functional bowel dz in family

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13
Q

tx of chronic nonspecific diarrhea

A

-dietary intervention:
high fat
lower carb
moderate fiber

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14
Q

diarrhea common after GI infection (post-infectious)

A

diarrhea of malnutrition or starvation

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15
Q

diarrhea of malnutrition or starvation secondary to this

A

malabsorption

  • changes in intestinal flora (give probiotics)
  • decreased disaccharidise activity
  • altered motility
  • diminished pancreas fx, bile acid production
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16
Q

causes of acute diarrhea w/ blood or mucus

A
  • bacterial enteritis (shiga toxin, salmonella, shigella, e coli)
  • intussusception
  • hemolytic uremic syndrome (HUS)
  • pseudomembranous colitis
  • IBD
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17
Q

clinical definition of constipation

A

2 or fewer stools/week or hard and pellet-like stools at least 2 weeks

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18
Q

DDx for constipation

A
  • functional constipation (MC & benign)
  • intestinal malformation
  • peripheral nerve problem
  • muscular (cerebral palsy, MD)
  • endocrine issue (altered fluid absorption in bowel)
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19
Q

functional constipation

A

passing stool uncomfortable - child withholds stool - infrequent passing of large stools - more withholding - encopresis

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20
Q

encopresis

A

large retained bulk of stool allowing passage of liquid stool only

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21
Q

Tx of functional constipation

A

clean from below, then above

  • mineral oil enema
  • oral osmotic agents/fiber
  • dietary change: limit dairy, processed foods; more whole foods and fiber
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22
Q

Hirshprung disease

A

failure of ganglion cells to migrate to distal bowel - segment dysfunctional w/ spasm or obstruction

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23
Q

when to suspect Hirshprung

A

stool not passed w/in first 24 hours of life or hx of reduced stool frequency

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24
Q

Dx of Hirshprung

A
  • anal manometry to diagnose

- rectal biopsy confirms

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25
Tx of Hirshprung
surgical resection
26
pathologic causes of constipation
- anorectal malformation: deformity of failure to pass meconium - cystic fibrosis: lack of normal pancreatic enzymes produces abnormal stool
27
anorectal malformation Tx
urgent colostomy then surgical reconstruction after 1 y/o
28
GI bleeding - | causes of blood in emesis
blood in stomach powerful emetic - maternal blood from breastfeeding - gastritis, food allergy, NSAIDs - AV malformation, esophageal varices
29
GI bleeding - | causes of rectal bleeding
- ingested blood, rectal fissure - rectal fissure, food allergy, bacterial dysentery - rectal polyp, Meckel diverticulum, IBD
30
non-GI sources of ingested blood
- oral cavity - pulmonary - nasal bleeding - pneumonia
31
how to confirm blood
hemoccult
32
Tx of GI bleeding
- determine source of blood - diet change/PPI if gastritis suspected (food allergy) - Gastroenterologist if serious bleed suspected
33
when teething behavior and first tooth appear
behaviour: 4-7mo tooth: 4-8mo
34
how to treat teeth present at birth
wiggle them out or see pediatric dentist
35
Tx of teething pain
oral pain relievers better than topical
36
when absence of teeth a concern
12mo - hypothyroidism, rickets, genetic disorder
37
predictor of infant protective oral flora
maternal oral flora
38
failure of midline facial structures to fuse
cleft lip and palate
39
causes of cleft lip/palate
- strong genetic component - EtOH and tobacco - medications
40
Tx of cleft lip/palate
surgical intervention usually starting by 3mo of age
41
common infection in young infants caused by candida albicans
oral thrush
42
cause of oral thrush
- muted B cell response to infection - typical in newborn/young infant - S/E of steroids
43
oral thrush Tx
- topical anti fungal - Nystatin or Clotrimazole | - oral anti fungal for persistent/severe infections
44
when to Tx gastroesophageal reflux
- increasing irritability - symptoms of aspiration - inadequate weight gain from loss of calories - age > 18 mo
45
Tx of gastroesophageal reflux
``` mild: - elevate head w/ feeding - sm. freq. feedings w/ freq. burping - thickened feedings - H2 blocker/PPI aspiration or no weight gain: - oral meds - GI referral - surgical intervention - Nissen fundoplication (surgical tx) ```
46
causes of GER in older children
- reduced tone in LES - transient relaxation of LES - abnormal gastroesophageal junction - increased intra-abdominal pressure
47
S/s of GER in older child
recurrent/persistent abdominal or retrosternal pain
48
Dx of GER in older child
- barium swallow - pH probe - endoscopy w/ biopsy
49
acid related injury of esophagus, stomach, or duodenum
peptic disease
50
risk factors of peptic disease
- H. pylori (>50%) - NSIADs - IBD, pancreatitis, malrotation, biliary disease
51
S/s fo peptic disease
- epigastric and retrosternal pain | - often relieved by eating - but only for a short time
52
Tx of peptic disease
- PPI - treat H. pylori - endoscopy for non-responders
53
VACTERL
esophageal atresia / tracheoesophageal fistula | assoc. syndromes - vertebral anomalies - anal - cardiac - tracheoesophageal fistula (TEF) - renal - limb
54
clinical clue to esophageal atresia / tracheoesophageal fistula
single artery in umbilicus - choking w/ every feeding
55
S/s of esophageal atresia / tracheoesophageal fistula
- drooling infant - poor feeding - high aspiration risk
56
Tx of esophageal atresia / tracheoesophageal fistula
surgery to repair TEF allows food to pass - poorly functioning esophagus
57
hypertrophic gastric outlet muscle - progressive gastric obstruction
pyloric stenosis
58
S/s of pyloric stenosis
- forceful vomiting - severely hungry, irritable - dehydrated and hypoglycemic
59
Dx of pyloric stenosis
abdominal US
60
Tx of pyloric stenosis
- hydrate and stabilize | - pyloromyotomy: surgery to reduce pyloric muscle
61
malrotation of bowel during development leads to increased risk of this
midgut volvulus - twisting of small bowel
62
S/s of volvulus
more common vomiting and abdominal pain
63
Dx of volvulus
- AXR shows obstruction | - UGI w/ barium shows absence of C-loop of duodenum
64
Tx of volvulus
GI consult - surgical resection of any necrotic bowel
65
one or more segments of bowel missing completely
intestinal atresia
66
S/s of intestinal atresia
- polyhydramnios in utero - abdominal distention - bilious vomiting as neonate
67
Tx of intestinal atresia
surgical correction required
68
abdominal wall defect - contents not covered by peritoneum and outside cavity
gastroschisis (assoc. w/ atresia)
69
abdominal wall defect at umbilicus - bowel in umbilicus during development - contents covered w/ peritoneum and amniotic membranes
omphalocele (assoc. w/ Beckwith Widemann syndrome)
70
abnormal or absent anal opening at birth
anorectal malformation
71
anorectal malformation Tx
colostomy then later correction
72
remnant of fetal emphalomesenteric duct - outpouching of distal ileum
Meckel Diverticulum
73
S/s of Meckel Diverticulum
MASSIVE painless GI bleed d/t acid secretion by ectopic gastric mucosal tissue
74
Dx of Meckel Diverticulum
Meckel scan - labeled technetium shows acid producing mucosa
75
Tx of Meckel Diverticulum
resection of abnormal tissue
76
telescoping bowel into downstream bowel
intussusception
77
S/s of intussusception
- sudden onset of severe crampy pain about every 15 min - pain becomes more constant - edematous bowel
78
Dx of intussusception
abdominal US
79
Tx of intussusception
air enema or surgical reduction/resection
80
MC surgical emergency in childhood
appendicitis
81
S/s of appendicitis
1. periumbilical pain followed by NAV 2. pain localizes to RLQ 3. voluntary then involuntary guarding
82
Tx of appendicitis
surgery
83
failure of development of diaphragm - abdominal organs reside in chest leading to pulmonary hypoplasia
congenital diaphragmatic hernia

Pediatrics (13 decks)

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