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Board Exam Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Sandifer Syndrome

A
  1. characterized by arching of the back done to prevent the refluxant from going into the pharynx or mouth
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2
Q

Define intussusception

A

Invagination of the bowel; peaks at 5-10 month old

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3
Q

S/s for intussesception (5)

Physical (1)

A

s/s

  1. intermittent colicky abdominal pain
  2. non bilious vomiting
  3. bloody mucous stool (stool + guaiac)
  4. currant jelly stool
  5. screaming and drawing up the legs with episodes of calm in between

Physical
1. sausage mass in RUQ with emptiness in the RLQ (dance sign)

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4
Q

Management of intussusception

A

Air barium enema to reduce “dance sign” – RLQ concavity due to missing bowel (dx and tx); observe child for 24-36h after

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5
Q

Physiologic GER

A

Normal in infancy, infrequent episodic vomiting after feeds, caused by over-feeding or lack of burping, painless, effortless with no growth abnormalities

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6
Q

Pathologic GERD

Dx (1)

A

frequent vomiting that causes FTT, esophagitis, aspiration pneumo, sandifer syndrome (turning head/arching back), related to other neurologic disease
DX with esophageal pH monitoring, pH <4 = reflux

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7
Q

What is the tx for GER/GERD? (4)

A
  1. Empiric therapy should be tried based on symptoms
  2. Most physiologic GER will resolve
  3. Thicken formula, position in a prone position after feeding, small/freq feeding, probiotics
  4. Do not use routinely acid suppression therapy (antacids, H2 blockers, PPI recommended for children not infants as first line agent for short time only), nissen fundoplication if severe
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8
Q

What are the clinical characteristics of lactose intolerance? define, tx, dx

A
  1. Clinical syndrome in which abdo pain, diarrhea, nausea, flatulence, and bloating occur after ingesting lactose. Lactose is found in milk products
  2. Can be due to primary or secondary lactose deficiency
  3. TX: limit lactose ingestion, oral lactose supplements
  4. DX: Lactose/sucrose, breath hydrogen ion testing, lactose tree trial resolves sx
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9
Q

Describe cow’s milk protein intolerance and cow’s milk protein allergy

A
  1. CMPI = non-IgE mediated, CMP is not broken down
  2. CMP = IgE mediated, causes antibody production, can have Gi sx (bloody stool, diarrhea, vomiting, food refusal), skin sx (atopy, hives), respiratory (cough, wheeze) or anaphylaxis.
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10
Q

Dx for Cow milk protein intolerance

Course for CMPI and CMPA

A
  1. dx with food challenge, clinical improvement on CMP free diet
  2. CMPI resolves by 1-3 years
  3. CMA will continue for life
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11
Q

What is toddler’s diarrhea (2)

Tx (1)

A
  1. Chronic diarrhea with no def cause in a child 6-24 mo. with normal growth.
  2. usually caused by increased carbs, decreased fats, decreased protein diet which causes osmotic diarrhea
  3. Tx = normalize diet, eliminate sorbitol containing fluids and remove offending foods/fluids
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12
Q

What are the s/s of appendicitis? (5)

A
  1. pain precedes vomit - usually only one or two times
  2. vague periumbilical pain that moves to RLQ
  3. Can be complicated by variable bowel changes, anorexia, and fever, if perforates, pain will improve but fever will develop and abdomen will tense
  4. guarding/rebound tenderness over McBurney’s point
    • Rovsing, obturator, markle jar heel, heel strike or psoas
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13
Q

What is dx of appendicitis? (2)

A
  1. with u/s, CT scan is gold standard

2. May have increased WBC count

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14
Q

What is Rovsing sign

A

pressure on LLQ causes pain in RLQ

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15
Q

What is Psoas?

A

pt is on left side, extend, flex right leg/hip, causes pain = +
OR
have pt supine and place hand above R knee, direct child to raise leg against pressure, dropping the leg will elicit pain

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16
Q

What is obturator sign?

A

Internally rotate right leg/hip causes pain = +

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17
Q

What is Markel jar heel test?

A

Stand on toes, drop heels = pain

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18
Q

What is the clinical course of celiac disease?

Define 2, dx 1

A
  1. Most common malabsorption syndrome, inflammatory reaction caused by gluten = intestinal damage
  2. Impaired growth, diarrhea, steatorrhea, abdo distension, wasting, fatigue, delayed puberty, anemia, dermatitis herpeticum, enamal hypoplasia
  3. Endoscopy/biopsy = definitive dx
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19
Q

What labs are needed for celiac disease?

Tx?

A

Preferred tests are
1. Anti-tissue transglutaminase antibodies (tTG) - IgA, Total IgA level

Tx = restrict gluten

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20
Q

What are the clinical characteristics and treatment for infantile colic?
Define 2, TX 2

A
  1. Persistent crying in an infant < 3 mo of age
  2. Cries 3 hrs/day 3 days/week, is inconsolable and keeps legs stiff and fists clenched
  3. TX is supportive, colic will resolve after time
  4. Diet alternations, limit overstimulation, use crib vibrator, infant massage as needed, provide support to parents, swaddle
21
Q

What is the clinical course of ulcerative colitis?

define, s/s

A
  1. Inflammation of the colon form of IBD

2. S/S bloody diarrhea, weight loss, delayed growth, anorexia, arthritis, LLQ abd. pain, oral ulcers, skin lesions

22
Q

What is the clinical course of ulcerative colitis?

dx, tx

A
  1. DX = ESR, CRP, CBC, stool culture, colonoscopy, perinuclear cytoplasmic antigen, endoscopy = def dex
  2. TX = elemental diet, aminosalicylates, steroids, immune modulators, surgery, monitor nutrition and growth, refer to opthal
23
Q

What is Meckel Diverticula? (3)

A
  1. Ectopic gastric mucosa within the diverticulum
  2. Common source of sig. lower GI bleeding
  3. Usually painless but can cause large blood loss
24
Q

What is giardia and what is the management of giardiasis?

Define, incidence, incubation, s/s, tx

A
  1. Flagellate protozoan, found in contaminated water and food - fecal oral spread
  2. Seen in child care and deviation disability settings
  3. Incubation 1-4 weeks, may be asymptomatic
  4. S/s = cramps, flatulence, bloating, anorexia, wt loss, diarrhea is watery/greasy/foul can be debilitating and long term
  5. metronidazole 15mg/kg/day for 5 days, alt = nitazoxanide, tinidazole
25
Q

Peptic Ulcer Disease

Primary vs. Seconday

A
  1. Can be idiopathic or caused by stress, meds, or illness; idiopathic (primary) = duodenum
  2. Secondary = stomach, H. pylori and CMV can be cause
26
Q

Peptic Ulcer Disease

Major (2) /Minor criteria (8)

A 
Major = abdomen pain and recurrent vomit
Minor = hematemesis, heartburn, anorexia, nausea, increased bleching/hiccups, FH, anemia, guiac +
27
Q

Peptic Ulcer Disease

Dx and Tx

A 
Dx = endoscopy = standard + biopsy
TX = antacids, 1st line --- amox, clarithromycin, omeprazole
28
Q

Describe pinworms of enterobius vermicularis

6 – define, incidence, s/s, dx, tx

A
  1. Pinworms - nematodes = white, threadlike, 1 cm
  2. Preschool most common, Often occur in families
  3. Cause perianal/vaginal itching (esp. nocturnal), nervous, irritable or hyperactive; insomnia d/t itching
    * urethritis/vaginitis/salpingitis rare complications
  4. Dx: adhesive cellaphone or scotch tape (no stool exam needed)
  5. TX = mebendazole 100mg/dose once, repeat in 2 weeks, or pyrantel pamoate 11mg/kg, repeat in 2 weeks (alt: Albendazole 400mg once then again in 2 weeks)
  6. wash hands, sheets, bedding, keep nails clean and short; TREAT ALL FAMILY MEMBERS b/c reinfection is common
29
Q

What is the clinical course and tx for pyloric stenosis?

Define cause, incidence/occurence, s/s, dx and xray, tx

A
  1. Thickening of the pylorus muscle leading to obstruction = pyloric olive = RUQ hard mobile mass
  2. Presents within 3wks-4mo of age, M>F (esp. first born), Caucasian, and use of Erythromycin in first week of life
  3. Vigorous, projectile nonbilious vomiting after eating with wt loss, constipation, dehydration, metabolic alkalosis, perstaltic waves from left to right across abdomen, and palpable pyloric olive after vomiting in RUQ under liver edge
  4. Dx: abdominal ultrasong; String sign on xray = elongated pyloric channel and delayed emptying seen on Upper GI
  5. Surgically corrected
30
Q

What is the clinical course of Crohn’s disease?

A
  1. Chronic IBD, causes skip areas, can affect entire GI tract
  2. Hx = weight loss, delayed growth, large joint pain, RLQ abd pain, bloating after meals, diarrhea, jaundice, mouth sores +FH
  3. Clinical exam = perianal skin tags, anal fissures, and fistulas, clubbing, erythema nodosum
  4. Extraintestinal signs can be seen - eye involvement
31
Q

How is Crohn’s Dx and TX?

A
  1. Dx= screen with ESR and CRP, nutrition labs, CBC, LFT, stool culture, bone age, Upper GI, CT with contrast, endoscopy = definitive dx, fecal calprotectin
  2. TX = antidiarrheals, corticosteroids, aminosalicylates, immune modulators, probiotics, antibiotics, surgery PRN, refer to opthal
32
Q

What is the clinical course of Hirschsprung’s disease? (3)

A
  1. Aganglionic megacolon
  2. No stool in first 48 hours of life, severe constipation, FTT, abd. distention, abnormal rectal anatomy, ant. scrotal placement, vomiting, abnormal stool quality, empty ampulla upon exam with exposure evacuation upon removal
  3. Less common today - consider with intractable constipation
33
Q

What are signs of mild dehydration (4)

A
  1. 3-5% weight loss
  2. thirst
  3. Cap refill >2 sec
  4. slight decrease in urine
34
Q

What are signs of moderate dehydration (9)

A
  1. 5-10% wt loss
  2. slight increase in HR
  3. > 10mmHg change BP
  4. Irritable/thirsty
  5. dry membranes/tears
  6. norm/sunken fontanel
  7. decrease cap refill 2-4 sec
  8. decrease urine output >8-12 hours
  9. SG >1.02
35
Q

What are signs of severe dehydration (8)

A
  1. 10-15% wt loss
  2. increased HR
  3. Orthostatic BP - shock
  4. Increased irritable/lethargic
  5. intense thirst, dry membranes
  6. Sunken eyes/fontanelle
  7. cap refill > 4 sec
  8. Oligoria/anuria
36
Q

What are signs of shock (6)

A
  1. 15% wt loss
  2. Increased HR, weak
  3. Unresponsive, weak
  4. dizzy
  5. cap refill >4
  6. col/acrocyanotic anuria
37
Q

Pancreatitis (tests, s/s)

A
  1. Amylase, lipase, fecal elastase

2. acute abdominal LUQ associated with back pain, fever, vomiting

38
Q

Mercury poisoning s/s (5)

A
  1. Painful red fingers and toes
  2. Maculopapular rash
  3. HTN
  4. Peripheral neuropathy
  5. Kidney dysfunction
39
Q

Methemoglobinemia

A

Presence of methemoglobin in blood; can occur from benzocaine and turns blood brown

40
Q

Replacement volumes for v/d (4)

A
  1. Mild: 50cc/kg
  2. Moderate: 80-100cc/kg; 100mL/kg of oRT is given over 4h
  3. Replace ongoing loss: 5-10cc for each diarrhea; 2cc/kg for each emesis
  4. If no dehydration, do not do ORT or restrict milk; do bland diet
    * Rehydrate 5-10mL q 5 min
41
Q

Hepatitis A (5)

A
  1. Increased incidence of symptomatic at 5-14 y/o
  2. Fever, malaise, abd pain, jaundice, later pruritis, dull RUQ pain during exercise
  3. During jaundice phase, urine darkens and stools become clay colored
  4. Dx: IgM or IgG to indicate current or resolved
  5. Contagious: 2 weeks before to 1 week after onset
42
Q

How to calculate % dehydration

A

((pre-illness weight - illness weight)/pre-illness weight)100

43
Q

anti-HBs

A

positive immune status after vaccination to HepB

44
Q

Dx for dysphagia

A

video fluoroscopy

45
Q

Zofran dosing for dehydration (3)

A
  1. 8-15kg –> 2mg
  2. 15-30kg –> 4mg
  3. > 30kg –> 8mg
46
Q

Ascaris Lumbricoides (Roundworm)

A
    • Malnutrition but most are asymptomatic
  2. Worms in stool or vomit; may have a lot of them
  3. bowel or biliary obstruction or bile duct obstruction
  4. Dx: worms on microscopy and marked eosinophila
  5. Tx: Albendazole 400mg once or Mebendazole 100mg BID for 3 days or 500mg once
47
Q

Tapeworm tx

A

Praziquantel 5-10mg/kg once

48
Q

Encopresis Tx (3)

A

1st: Catharsis (empty colon)
Day 1,4,7,10 –> Fleet enema
Day 2,5,8,11 –> Bisacodyl suppository
Day 3,6,9,12 –> Bisacodyl tablet

2nd: Return to clinic and do f/u abd u/s to confirm catharsis
3rd: Once empty –> mineral oil or stool softener as maintenance

Board Exam Review (15 decks)

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