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Pediatrics > Gastroenterology Pt. 2 > Flashcards

Gastroenterology Pt. 2 Flashcards

1
Q

What is the age of onset for inflammatory bowel disease?

A

Bimodal: Peak at 15-20 years of age and a second peak after 50 years of age

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2
Q

What are the clinical features of Ulcerative colitis?

A

Inflammation is diffuse, limited to the mucosa, and localized to the colon

UC usually begins in the rectum and extends proximally in a contiguous fashion

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3
Q

What is the clinical presentation of Mild, Moderate, and Severe disease?

A

Mild: Rectal bleeding, diarrhea, abdominal pain

Moderate: Nocturnal stooling, cramping, and tenesmus

Severe disease: More than 6 stools per day, fever, anemia, leukocytosis, and hypoalbuminemia

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4
Q

What are complications of severe UC?

A
  • Toxic megacolon: fever, abdominal distension, septic shock
  • Increased risk of colon cancer
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5
Q

What are the differences between Crohn’s disease (CD) and UC?

A
  • CD may involve any segment of the GI tract
  • In CD, inflammation is eccentric and segmental
  • Inflammation is transmural and may lead to sinus tracts, fistulas, and crypt abscesses
  • Most children have disease involving the terminal ileum
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6
Q

In Crohn’s disease, _______ disease often precedes the development of intestinal disease

A

Perianal disease

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7
Q

What labs are indicated in evaluation of inflammatory bowel disease?

A
  • CBC (shows anemia or leukocytosis)
  • ESR is elevated
  • Serum albumin and serum transaminases to assess nutritional status and liver disease
  • Serum antibody tests
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8
Q

What imaging can be used to evaluate IBD?

What confirms the diagnosis of CD?

A

Abdominal US and CT imaging to visualize thickened bowel walls

Colonoscopy with biopsies of the colon and terminal ileum

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9
Q

What pharmacotherapy is indicated for IBD?

A
  • Sulfasalazine for mild disease
  • Corticosteroids
  • Immunosuppressive agents (useful in inducing long term remission)
  • Metronidazole is used in threatment of CD
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10
Q

UC can be cured with a ______ ________

A

total proctocolectomy

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11
Q

Define the following…

  • Hematemisis
  • Hematochezia
  • Melena
A
  • Hematemisis: Vomiting of fresh or old blood, which may have “coffee ground” appearance from denaturing of hemoglobin
  • Hematochezia: Bright red blood passed per rectum
  • Melena: Dark tarry stools indicating upper GI bleed proximal to ligament of Treitz
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12
Q

Occult bleeding from the GI tract is confirmed by positive ______ _______ of stool

A

guaiac testing

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13
Q

What is Guaiac testing of stool?

A

Guaiac is a colorless dye that changes color from the peroxidase activity of hemoglobin in the presence of hydrogen peroxide

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14
Q

What can cause a false positive guaiac test?

A
  • Ingested iron
  • Rare red meats
  • Beets
  • Foods with a high peroxidase content (cantaloupe, broccoli, cauliflower)
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15
Q

What are some causes of upper GI bleeding in children?

A
  • Newborns may swallow maternal blood during delivery or while nursing from a bleeding nipple
  • Gastritis or ulcers may occcur as a result of severe stress of illness
  • Mechanical injury to the mucosa from vomiting
  • Varices (less common)
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16
Q

How is ongoing upper GI bleed assessed?

A

Nasogastric tube aspirate

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17
Q

When would plain film radiography be useful in an upper GI bleed?

A

May be useful if a foreign body or perforation is suspected

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18
Q

What is the management for upper GI bleed?

A
  • Stabilization of hypvolemia and anemia (IV access)
  • Medical therapy to control bleeding: Octreotide; antibiotics for H. pylori; H2 blockers, PPI for ulcers
  • Endoscopic therapy indicated for active bleeding or if rebleeding is likely
  • Arteriographic embolization
  • Surgical treatment
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19
Q

________ _______ should be considered in any newborn who presents with rectal bleeding, feeding intolerance, or abdominal distension

A

Necrotizing enterocolitis

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20
Q

What is the most common cause of significant lower GI bleeding beyond infancy?

A

Juvenile polyps

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21
Q

What is Meckel’s diverticulum?

A

An outpouching of the bowel in the terminal ileum that occurs in 2% of infants; Important cause of lower GI bleed in infants and children

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22
Q

How does Meckel’s diverticulum lead to lower GI bleeding?

A

Diverticulum contains ectopic gastric mucosa that produces acid; this acid damages adjacent intestinal mucosa causing painless, acute rectal bleeding

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23
Q

What is hemolytic uremic syndrome?

A

A vasculitis characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure; intestinal ulceration and infarction of the bowel may cause bleeding

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24
Q

What is Henoch-Schonlein purpura?

A

An IgA-mediated vasculitis that presents with a palpable, purpuric rash on the buttocks and lower extremities, large joint arthralgias, renal involvement and GI bleeding from complications such as bowel perforation

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25
Q

What hepatocellular enzymes can be elevated with liver injury? Which is most specific for liver disease?

A
  • AST
  • ALT (most specific for liver disease)
  • LDH
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26
Q

What biliary enzymes are elevated in biliary disease?

A
  • Alkaline phosphatase
  • Gamma glutamyl transpeptidase (GGTP)
  • 5’-nucleotidase (5NT) - more specific than GGTP for biliary tract damage
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27
Q

What can lead to elevated bilirubin?

A
  • Increased heme load
  • Decreased capacity for excretion
  • Obstruction to bile flow
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28
Q

How is synthetic function of the liver assessed?

A
  • Protein production (prealbumin, albumin, PT)
  • Serum chemistries (glucose, cholesterol)
  • Toxin clearance (lactate, ammonia)
29
Q

Wht is cholestatic jaundice and what values are associated with it?

A

Retention of bile within the liver; occurs when the direct component of bilirubin is > 2 mg/dL or > 15% of the total bilirubin

30
Q

Jaundice typically begins ______ and extends ______ as bilirubin increases

A

begins cranially and extends caudally

31
Q

What lab evaluation is necessary in all patients with suspected jaundice?

A

Measurement of direct and total bilirubin

32
Q

What imaging can be ordered in patients with jaundice?

A

Imaging often includes abdominal US with doppler evaluation of the hepatic vessels

33
Q

What is inspisated bile syndrome?

A

Associated with hemolysis or with a very large hematoma

Biliary system overwhelmed by increased bilirubin; unconjugated hyperbilirubinemia predominates early, conjugated hyperbilirubinemia develops as hepatocellular function increases to meet demand

34
Q

What are the three types of UDP-glucuronyl transferase deficiency?

A
  • Gilbert’s syndrome: 50% of enzyme activity is absent
  • Crigler-Najjar type 1: Autosomal recessive disoder in which 100% of enzyme activity is absent
  • Crigler-Najjar type 2: Autosomal dominant disorder in which 90% of enzyme acitivty is absent
35
Q

What are possible causes of cholestasis disease of infancy?

A
  • Infections
  • Metabolic derangements
  • Extrahepatic mechanical obstruction
  • Intrahepatic mechanical obstruction
  • Idiopathic
  • α1-antitrypsin deficiency
  • TPN associated disease
36
Q

What are the clinical features of cholestasis?

A
  • Jaundice
  • Acholic or light stools
  • Dark urine
  • Hepatomegaly
  • Bleeding
  • FTT
37
Q

What is neonatal hepatitis?

A

Idiopathic hepatic inflammation during the neonatal period

Most common cause of cholestasis in the newborn

38
Q

What are the clinical features of neonatal hepatitis?

What are the presenting features in the first week of life?

A
  • Symptoms range from transient jaundice to liver failure
  • Presenting features in 1st week of life: Jaundice and hepatomegaly in 50% of patients
39
Q

What is the management for neonatal hepatitis?

A

Management is supportive

  • Nutritional support (TPN if growth is problematic)
  • Ursodeoxycholic acid (enhances bile flow)
  • Liver transplantation in cases of severe liver failure
40
Q

What is biliary atresia?

A

Progressive fibrosclerotic disease that affects the extrahepatic biliary tree

41
Q

Two thirds of patients with biliary atresia present between the ages of __ and __ weeks with jaundice, dark urine, and acholic stools

A

4-6 weeks

42
Q

How are bilirubin levels affected in biliary atresia?

A

Moderately elevated

43
Q

What imaging is used in biliary atresia to rule out other causes of cholestasis?

What imaging technique can confirm the diagnosis of biliary atresia?

A

Abdominal US, radionucleotide imaging and liver biopsy rule out other causes of cholestasis

Intraoperative cholangiogram with laparotomy to examine the biliary tree confirms diagnosis

44
Q

What is the Kasai portoenterostomy? When is success highest with this procedure?

A

The treatment of choice to establish bile flow in patients wtih biliary atresia

Success is highest if the procedure is performed by 50-70 days of age

45
Q

What is Alagille syndrome?

A

Autosomal dominant disorder characterized by paucity of intrahepatic bile ducts and multiorgan involvement

46
Q

What are the clinical features of Alagille syndrome?

A
  • Features of cholestatic liver disease
  • Pruritis (can be debilitating)
  • Cardiac disease often include pulmonary outflow obstruction
  • Renal disease
  • Eye anomalies include posterior embyotoxon
  • Growth failure and short stature
  • Pancreatic insufficiency
47
Q

Most viral hepatitis infections during infancy and childhood are _______

A

asymptomatic

48
Q

What type of virus is Hepatitis A?

A

Picornavirus

49
Q

How is hepatitis A transmitted?

A

Transmission is by the fecal-oral route through contaminated foods and water or by contact with contaminated individuals

50
Q

What is the incubation period for hepatitis A? Who is more likely to have symptomatic infection?

A

Incubation period is 2-6 weeks

Older children and adults are more likely to have symptomatic infection

51
Q

What serology indicates HAV infection?

A

Elevated IgM anti-HAV: presents early and can persist for 6 months after infection

Elevated IgG anti-HAV: also occurs early in infection and confers lifelong immunity

52
Q

How is hepatitis B infection transmitted?

A

Transmission is by

  • Perinatal vertical exposure from infected mother to fetus
  • Parenteral route through exposure to infected blood products
  • Tattooing needles
  • IV drug use
  • Exposure to infected body secretions
53
Q

How long is the incubation period for hepatitis B? What are the acute symptoms?

A

Incubation period is 45-160 days

Acute symptoms range from asymptomatic infection to nonspecific systemic illness

54
Q

Chronic HBV infection is most common in _____ _______

A

young infants

55
Q

Chronic HBV infection increases the risk for …..

A

hepatocellular carcinoma

56
Q

What is the significance of the following antigens/antibodies in HBV infection…

  • HBV surface antigen:
  • HBV surface antibody:
  • HBV core antibody:
  • HBV envelope antigen:
  • HBV envelope antibody:
A
  • HBV surface antigen: pathognomonic for active disease
  • HBV surface antibody: protective and results from vaccination or natural infection
  • HBV core antibody: Persists lifelong and results from natural infection (not vaccine)
  • HBV envelope antigen: rises early in active infection
  • HBV envelope antibody: Rises late in infection
57
Q

What is used to diagnose HBV as well as assess response to therapy?

A

HVB PCR

58
Q

What type of virus is Hepatitis C?

A

An RNA virus in the flavivirus family

59
Q

How is Hepatitis C virus transmitted?

A

Perinatal vertical route from mother to fetus

Parenteral exposure

60
Q

Chronic HCV infection occurs in __% of patients

A

80%

61
Q

How is HCV diagnosed?

A

HCV PCR or by demonstrating HCV antibody in the blood (non-chronic)

62
Q

What does Hepatitis D virus require for replication?

A

HBsAg

63
Q

Hepatitis E is responsible for __% of acute hepatitis in young adults in developing countries and is associated with ___% mortality in infected pregnant women

A

50%; 20%

64
Q

What is autoimmune hepatitis?

A

Destructive and progressive liver disease characterized by elevated serum transaminases, hypergammagloulinemia, and circulating autoantibodies

65
Q

What are the two categories of autoimmune hepatitis?

A
  • Type 1 disease (more common): Characterized by presence of antinuclear antibody (ANA) or anti-smoth muscle antibody
  • Type 2 disease: Characterized by anti-liver kidney microsome antibody or anti-liver cytosol type 1 antibody
66
Q

Autoimmune hepatitis occurs predominantly in _______

A

females

67
Q

What are the clinical features of autoimmune hepatitis?

A
  • 50% of patients present with acute hepatitis
  • Jaundice (mild to moderate)
  • Nonhepatic signs include fatigue, anorexia, arthritis, rash, nephritis, and vasculitis
68
Q

_____ _______ is generally preformed to evalutate for cirrhosis, to grade disease activity, and to exclude other diagnoses in patients with autoimmune hepatitis

A

liver biopsy

69
Q

What is the management for autoimmune hepatitis?

A
  • Generally supportive
  • Corticosteroids for inital control of hepatic inflammation
  • Immunosuppressive agents (azathioprine or 6-mercaptopurine)
  • Liver transant for severe liver disease

Pediatrics (24 decks)

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