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Gastroenterology > General > Flashcards

General Flashcards

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
Q

CP of AI hepatitis

A

acute - malaise, NV, jaundice, pale stools and dark urine

Insidious - fatigue, relapsing jaundice, HA, wgt loss

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26
Q

Complications of Crohn`s disease

A 
Perianal disease
enteroenteral fistula
poor growth and delayed puberty
osteopenia
chronic hepatitis
sclerosing cholangitis
nephrolithiasis
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27
Q

What are the triad of abdo compartment syndrome?

A

resp distess
oliguria
hypotension
poor perfusion to lower limbs

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28
Q

what are electrolyte abnormalities found with pyloric stenosis

A

met alkalosis
hypochloremia
hypokalemia

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29
Q

how common is unconjugated hyperbilirubinemia in babies with pyloric stenosis

A

10 % to 25 %

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30
Q

what is a very worrisome lab finding in pyloric stenosis?

A

acidic urine

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31
Q

what syndromes have been associated with pyloric stenosis?

A 
eosinophilic gastroenteritis
T 18
Cornelia de lange
Smith Lemli Opits
Zellweger syndrome
Apert syndrome
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32
Q

How do you manage pyloric stenosis rehydration?

A

D5 NS at 1.5 x maintenance

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33
Q

what are causes of secretory diarrhea?

A

IBD - inflammation
Toxins - E.Coli, Vibrio Cholera
Hormones - Vasoactive intestinal peptide, neuroblastoma

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34
Q

what are cause of osmotic diarrhea

A

pulls H2O into stools
PEG
lactose intol
lactase def

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35
Q

what on exam would make you think of Hirshsprung

A 
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
Q

what are false negative when testing stools for bld

A

delayed transit time or bacterial overgrowth

gives bacteria time to degrade Hb

37
Q

what are false positives when testing stools for bld

A

red meat

peroxidase containing foods - broccoli, cauliflower…

38
Q

Dx test for lactase def / lactose intolerance

A

H2 breath test - lactase

39
Q

what test is useful for ? bacterial overgrowth?

A

lactulose breath test - early breath hydrogen peak, usually occurring within 30 minutes of lactulose ingestion

40
Q

what test on stool can help Dx a carb malabsorption issue?

A

stool PH will be acidic

41
Q

How do you diagnose Choledocholithiasis?

A

magnetic resonance cholangiopancreatography

42
Q

if you see a pt with FTT and bone marrow dysfunction, what syndrome should you rue out?

A

Shwachman syndrome

43
Q

what is the second most common cause of pancreatic insufficiency after CF?

A

Shwachman–Diamond syndrome

44
Q

Infant presents with steatorrhea, growth failure, deficiencies of fat-soluble vitamins A, D, E, and K . Dx

A

Shwachman–Diamond syndrome

45
Q

what disorders my have delayed teeth eruption?

A 
idiopathic
T 21
hypopituitarism
hypothyroidism
rickets
gaucher
46
Q

how do you manage oral thrush

A

can start as early as DOL 7
if asymptomatic - monitor or
post feed
Nystatin 200 000 units QID

if immonocompromised - fluconazole

47
Q

what are complications of GERD

A 
apnea, ALTE
aspiration
chronic cough/wheeze
chronic esophagitis
hoarseness/vocal cord nodules
feeding issues
AOM
sinusitis
lymphoid hyperplasia
tonsil cobblestoning
48
Q

what is the most common TEF

A

esophageal atresia with distal TEF - air in abdo

esophageal atresia and no TEF - next most common. No AIR IN ABDO

49
Q

what are complications of TEF

A 
poor esophageal tone
poor motility
GERD
stricture
recurrent fistula
leakage
*** often associated with tracheomalacia
50
Q

which infections must be rules out when investigating for IBD

A

Yersinia
C.Diff
Salmonella

51
Q

how does biliary atresia present?

A 
week 1-2
conjugated bili
FTT
ascites
portal HTN
splenomegaly
muscle wasting
52
Q

if baby presents with jaundice and hepatomegaly, what is your DDX

A

neonatal hepatitis
alpha 1 antitrypsin
metabolic

53
Q

what are the CP of Alagille syndrome

A 
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
Q

how do you Dx biliary atresia?

A

BIOPSY**

hepatobiliary scintigraphy not specific

55
Q

how do you manage Biliary atresia?

A

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
Q

if a baby is felt to have CMPA, which formula is not a good option?

A

soy because 30% cross-reactivity

57
Q

what are risk factors for developament of C.diff colitis

A 
abx course
bowel disease - UC, Crohn's...
GI sx
prolonged NG insertion
repeated enemas
renal failure
58
Q

how do you manage hepatic encephalopathy?

A

lactulose NG
enemas
avoid sedation
might need I&V

59
Q

how do you manage ascites?

A

restrict fluid intake 50-60%

restrict Na intake

60
Q

how do you DX Wilson’s disease?

A 
low ceruloplasmin level
high urine Copper
Kayser-Fleischer rings
hemolysis
BX +copper
61
Q

what is the treatment of Wilson’s

A

penicillamine

Zinc salts

62
Q

what investigations can help Dx autoimmune hepatitis

A

high Ig G
ANA
anti-smooth muscle
Liver-kidney microsomal Ab

63
Q

how do you Dx primary sclerosing cholangitis?

A

associated with UC
p-ANCA +
ERCP or MRCP
during ERCP - can do dilation

need transplant

64
Q

what is the MC cause of spontaneous bacterial peritonitis?

A

pneumococcal infection

65
Q

what are the ABx choices for peritonitis

A

cefotaxime

flagyl if ? perforation

66
Q

what ulcers are most often associated with NSAIDS

A

gastric ulcers

67
Q

what is the mgnt of peptic ulcers

A

PPI better at ulcer healing

68
Q

what causes Zollinger-Ellison Syndrome

A

Gastrinoma (neuroendocrite T)

PUD + diarrhea

69
Q

what other disorders are associated with Zollinger-Ellison Syndrome

A

MEN1 - multiple endocrine neoplasia

NF and TS

70
Q

how do you Dx protein loosing enteropathy

A

fecal alpha 1 antitrypsin - for intestinal losses whereas albumin is too general. Will also loose IG.

71
Q

how much bowel can you lose before it leads to malabsorption?

A

> 50%

72
Q

what is absorbed in your duodenum and prox jejunum?

A 
Ca
Mg
PO4
Iron
Folic acid
73
Q

what is absorbed in your distal ileum?

A

Vit B12

74
Q

what is absorbed in the prox small bowel

A

carbs
protein
H2O soluble vit

75
Q

what are non GI features of Celiac

A 
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
Q

what is the DDX for terminal ileitis?

A 
Crohn's
lymphoma
yersinia
TB
chronic granulomatous disease
eosinophilic gastroenteropathy
77
Q

what are organic causes of constipation

A 
High Ca
low K
low thyroid
celiac
lead/mercury poisoning
UC
meds
CNS - CP, NTD, hirschsprung
78
Q

what are causes of bloody diarrhea

A 
E.Coli
shigella
campylobacter
(salmonella, yersinia - not always)
c. diff - only 5%
79
Q

when do you do a Ph probe test in GERD

A
  1. assessing efficacy of acid suppression during treatment,
    2 evaluating apneic episodes in conjunction with a pneumogram
  2. evaluating atypical GERD presentations such as chronic cough, stridor, and asthma
80
Q

what are side effects of azathioprine

A

GI upset

? increased risk of malignancy

81
Q

what is the best test for adiposity?

A

BMI

82
Q

Peutz-jegger syndrome

A

AD
hamartoma - lips and bowel
Colonoscopy yearly

83
Q

what is the best test for pancreatitis?

A

lipase

84
Q

what are RF for adenocarcinoma in apt with UC

A

disease > 10 yrs
onset < 15 yrs
pancolitits
PSC

85
Q

what skin finding is more common in Crohn’s

A

erythema nododssum
tender
red
shins

86
Q

what skin finding is more common in UC

A

pyoderma gangrenosum
necrotic
deep ulcers
legs

Gastroenterology (3 decks)

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