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1
Q

Toddler’s Diarrhea

A

1-3 yrs
>2 loose stools per day, 4 per week
NO FTT
Rx = take out juice

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2
Q

What are viruses that cause acute diarrhea

A

rotavirus, norovirus, adenovirus

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3
Q

CP of meckel’s diverticulum

A

painless GI bleed in a toddler

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4
Q

Which liver Bld test is more sensitive of hepatocellular injury???

A

ALT

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5
Q

Which are true liver function tests

A

Albumin and PT

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6
Q

CP of TEF

A

oral secretions
resp distress with feeds
aspiration
50% have Hx of polyhydramnios

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7
Q

CP of pyloric stenosis

A
  1. 1 wk to 5 mo ( peak 3weeks)
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8
Q

What are risk factors for pyloric stenosis

A 
male
first born
caucasian
\+ FHx
erthromycin exposure
BW - Hypochloremic hypokalemic  met alkalosis
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9
Q

What are some risk factors for H pylori gastritis

A

low SES
crowding
poor hygiene

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10
Q

CP of duodenal atresia and what other abnormalities is it associated with?

A

CP: bilious emesis, abdo distension, failure to pass MEC

Associated with - T21, CHD, TEF, malrotation and or renal abnormalities
50% have polyhydramnios

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11
Q

What might cause delay in passage of meconium

A 
CF
Duodenal atresia
prematurity
Hirschsprung
imperforated anus - can have fistula so could "appear" to stool
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12
Q

What is Meckel’s diverticulum and how does it present

A

Remnant of yolk sac because of failure of involution of vitelline duct = ectopic gastric mucosa

Rules of 2:
2% of infants
2 inches in size
2 feet from ileocecal v
in less than 2yrs

CP: Painless hematoschezia, intussusecption or volvulus

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13
Q

What are common causes of intussusception?

A 
Meckel's
hypertrophied Peyer patch post viral URTI
Lymphoma
Polyp
HSP
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14
Q

What metabolic abnormalities can cause an Ileus

A

High Ca
Low K
Acidosis
uremia

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15
Q

What is superior mesenteric artery syndrome?

A

SMA collapses onto and compresses the duodenum

Causes: Rapid wgt loss
CP: vomiting and severe abd pain

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16
Q

How do you diagnose small intestinal overgrowth?

A

Gold standard - duodenal aspirate with 10 ^5 CFU/Ml or more of colonic flora

Other tests - Some breath tests

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17
Q

Risk factors for celiac disease

A 
Females
Family Hx
Associated with - 
T21, 
turner, 
Williams, AI thyroiditis, 
Type 1 DM, IgA def
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18
Q

What are symptoms and signs of celiac disease

A

Sympt: FTT/wght loss, Diarrhea, irritability, vomiting, anorexia, Foul smelling stools, abdo pain, rectal prolapse

Signs: Hgt and wght less than 25 %, wasted muscles, abdo distension, edema, finger clubbing

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19
Q

What syndromes are associated with an imperforated anus

A

50% have other abnormalities: Renal, MSK, Cardiac, GI and CNS
VACTERL
T21

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20
Q

Rectal prolapses causes

A 
idiopathic
CF
Infection
malnutrition
IBD
Chronic constipation
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21
Q

Causes of pancreatitis

A

Idiopathic
Infectious - enterovirus, EBV, Hep A/B, influenza, Mycoplasma, mumps
Trauma
Drugs - Tylenol, alcohol, steroid, valproic acid, furosemide
Obstruction - annular pancreas, pancreas divisum, biliary tract malformation, gall stones
Systemic - CF, DM, SLE, hyperlipidemia

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22
Q

What is Rx for H.Pylori

A

Amoxicillin + Clarithromycin x 14 days + PPI x 1 mo
Amoxicillin + Metronidazole x 14 days + PPI x 1 mo
Clarithromycin + Metronidazole x 14 days + PPI x 1 mo

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23
Q

What are clinical presentation of Wilsons

A

LIVER: asymptomatic hepatomegaly (with or without splenomegaly), subacute or chronic hepatitis, and fulminant hepatic failure
BRAIN: intention tremor, dysarthria, dystonia, lack of motor coordination, deterioration in school performance, or behavioral changes.
EYE: Kayser-Fleischer rings are always present in patients with neurologic symptoms
PSYCH: depression, anxiety, or psychosis
HEME: Hemolytic anemia
KIDNEY: Fanconi syndrome, progressive renal failure
Rarely: arthritis, cardiomyopathy, and hypoparathyroiditis

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24
Q

what are clinical findings of portal HTN

A

Acites
Hepatorenal disorder
splenomegaly
inc collateral criculation- esophageal varices and anorectal varices
dilitation of paraumbilical vein = caput medusa

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25
CP of AI hepatitis
acute - malaise, NV, jaundice, pale stools and dark urine | Insidious - fatigue, relapsing jaundice, HA, wgt loss
26
Complications of Crohn`s disease
``` Perianal disease enteroenteral fistula poor growth and delayed puberty osteopenia chronic hepatitis sclerosing cholangitis nephrolithiasis ```
27
What are the triad of abdo compartment syndrome?
resp distess oliguria hypotension poor perfusion to lower limbs
28
what are electrolyte abnormalities found with pyloric stenosis
met alkalosis hypochloremia hypokalemia
29
how common is unconjugated hyperbilirubinemia in babies with pyloric stenosis
10 % to 25 %
30
what is a very worrisome lab finding in pyloric stenosis?
acidic urine
31
what syndromes have been associated with pyloric stenosis?
``` eosinophilic gastroenteritis T 18 Cornelia de lange Smith Lemli Opits Zellweger syndrome Apert syndrome ```
32
How do you manage pyloric stenosis rehydration?
D5 NS at 1.5 x maintenance
33
what are causes of secretory diarrhea?
IBD - inflammation Toxins - E.Coli, Vibrio Cholera Hormones - Vasoactive intestinal peptide, neuroblastoma
34
what are cause of osmotic diarrhea
pulls H2O into stools PEG lactose intol lactase def
35
what on exam would make you think of Hirshsprung
``` palpable stool in abdo tight rectum on rectal exam no stool in rectal vault explosive stool when done DRE Stools much smaller than would expect ```
36
what are false negative when testing stools for bld
delayed transit time or bacterial overgrowth | gives bacteria time to degrade Hb
37
what are false positives when testing stools for bld
red meat | peroxidase containing foods - broccoli, cauliflower...
38
Dx test for lactase def / lactose intolerance
H2 breath test - lactase
39
what test is useful for ? bacterial overgrowth?
lactulose breath test - early breath hydrogen peak, usually occurring within 30 minutes of lactulose ingestion
40
what test on stool can help Dx a carb malabsorption issue?
stool PH will be acidic
41
How do you diagnose Choledocholithiasis?
magnetic resonance cholangiopancreatography
42
if you see a pt with FTT and bone marrow dysfunction, what syndrome should you rue out?
Shwachman syndrome
43
what is the second most common cause of pancreatic insufficiency after CF?
Shwachman–Diamond syndrome
44
Infant presents with steatorrhea, growth failure, deficiencies of fat-soluble vitamins A, D, E, and K . Dx
Shwachman–Diamond syndrome
45
what disorders my have delayed teeth eruption?
``` idiopathic T 21 hypopituitarism hypothyroidism rickets gaucher ```
46
how do you manage oral thrush
can start as early as DOL 7 if asymptomatic - monitor or post feed Nystatin 200 000 units QID if immonocompromised - fluconazole
47
what are complications of GERD
``` apnea, ALTE aspiration chronic cough/wheeze chronic esophagitis hoarseness/vocal cord nodules feeding issues AOM sinusitis lymphoid hyperplasia tonsil cobblestoning ```
48
what is the most common TEF
esophageal atresia with distal TEF - air in abdo esophageal atresia and no TEF - next most common. No AIR IN ABDO
49
what are complications of TEF
``` poor esophageal tone poor motility GERD stricture recurrent fistula leakage *** often associated with tracheomalacia ```
50
which infections must be rules out when investigating for IBD
Yersinia C.Diff Salmonella
51
how does biliary atresia present?
``` week 1-2 conjugated bili FTT ascites portal HTN splenomegaly muscle wasting ```
52
if baby presents with jaundice and hepatomegaly, what is your DDX
neonatal hepatitis alpha 1 antitrypsin metabolic
53
what are the CP of Alagille syndrome
``` progressive destruction of bile duct ++ pruritis ++ cholesterol prominent forehead deep set eye, hypertolrism long nose eye issues periph pulm stenosis pancreatic insuff butterfly vertebrae renal isses ```
54
how do you Dx biliary atresia?
BIOPSY**** | hepatobiliary scintigraphy not specific
55
how do you manage Biliary atresia?
KAsai procedure at 2month most still need transplant Vit ADEK Formula - medium chain TGL so don't need bile to get absorbed ? ursodeoxycholic acid to improve bile flow
56
if a baby is felt to have CMPA, which formula is not a good option?
soy because 30% cross-reactivity
57
what are risk factors for developament of C.diff colitis
``` abx course bowel disease - UC, Crohn's... GI sx prolonged NG insertion repeated enemas renal failure ```
58
how do you manage hepatic encephalopathy?
lactulose NG enemas avoid sedation might need I&V
59
how do you manage ascites?
restrict fluid intake 50-60% | restrict Na intake
60
how do you DX Wilson's disease?
``` low ceruloplasmin level high urine Copper Kayser-Fleischer rings hemolysis BX +copper ```
61
what is the treatment of Wilson's
penicillamine | Zinc salts
62
what investigations can help Dx autoimmune hepatitis
high Ig G ANA anti-smooth muscle Liver-kidney microsomal Ab
63
how do you Dx primary sclerosing cholangitis?
associated with UC p-ANCA + ERCP or MRCP during ERCP - can do dilation need transplant
64
what is the MC cause of spontaneous bacterial peritonitis?
pneumococcal infection
65
what are the ABx choices for peritonitis
cefotaxime | flagyl if ? perforation
66
what ulcers are most often associated with NSAIDS
gastric ulcers
67
what is the mgnt of peptic ulcers
PPI better at ulcer healing
68
what causes Zollinger-Ellison Syndrome
Gastrinoma (neuroendocrite T) | PUD + diarrhea
69
what other disorders are associated with Zollinger-Ellison Syndrome
MEN1 - multiple endocrine neoplasia | NF and TS
70
how do you Dx protein loosing enteropathy
fecal alpha 1 antitrypsin - for intestinal losses whereas albumin is too general. Will also loose IG.
71
how much bowel can you lose before it leads to malabsorption?
> 50%
72
what is absorbed in your duodenum and prox jejunum?
``` Ca Mg PO4 Iron Folic acid ```
73
what is absorbed in your distal ileum?
Vit B12
74
what is absorbed in the prox small bowel
carbs protein H2O soluble vit
75
what are non GI features of Celiac
``` DERM: dermatitis herpetiformis H&N: dental enamel hypoplasia bones: SHORT, osteopenia, osteoporosis CNS: Sz with occipital calcification GI: hepatitis Heme: Fe def anemia general: delayed puberty, FTT ```
76
what is the DDX for terminal ileitis?
``` Crohn's lymphoma yersinia TB chronic granulomatous disease eosinophilic gastroenteropathy ```
77
what are organic causes of constipation
``` High Ca low K low thyroid celiac lead/mercury poisoning UC meds CNS - CP, NTD, hirschsprung ```
78
what are causes of bloody diarrhea
``` E.Coli shigella campylobacter (salmonella, yersinia - not always) c. diff - only 5% ```
79
when do you do a Ph probe test in GERD
1. assessing efficacy of acid suppression during treatment, 2 evaluating apneic episodes in conjunction with a pneumogram 3. evaluating atypical GERD presentations such as chronic cough, stridor, and asthma
80
what are side effects of azathioprine
GI upset | ? increased risk of malignancy
81
what is the best test for adiposity?
BMI
82
Peutz-jegger syndrome
AD hamartoma - lips and bowel Colonoscopy yearly
83
what is the best test for pancreatitis?
lipase
84
what are RF for adenocarcinoma in apt with UC
disease > 10 yrs onset < 15 yrs pancolitits PSC
85
what skin finding is more common in Crohn's
erythema nododssum tender red shins
86
what skin finding is more common in UC
pyoderma gangrenosum necrotic deep ulcers legs

Gastroenterology (3 decks)

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