General Flashcards
Toddler’s Diarrhea
1-3 yrs
>2 loose stools per day, 4 per week
NO FTT
Rx = take out juice
What are viruses that cause acute diarrhea
rotavirus, norovirus, adenovirus
CP of meckel’s diverticulum
painless GI bleed in a toddler
Which liver Bld test is more sensitive of hepatocellular injury???
ALT
Which are true liver function tests
Albumin and PT
CP of TEF
oral secretions
resp distress with feeds
aspiration
50% have Hx of polyhydramnios
CP of pyloric stenosis
- 1 wk to 5 mo ( peak 3weeks)
What are risk factors for pyloric stenosis
male first born caucasian \+ FHx erthromycin exposure BW - Hypochloremic hypokalemic met alkalosis
What are some risk factors for H pylori gastritis
low SES
crowding
poor hygiene
CP of duodenal atresia and what other abnormalities is it associated with?
CP: bilious emesis, abdo distension, failure to pass MEC
Associated with - T21, CHD, TEF, malrotation and or renal abnormalities
50% have polyhydramnios
What might cause delay in passage of meconium
CF Duodenal atresia prematurity Hirschsprung imperforated anus - can have fistula so could "appear" to stool
What is Meckel’s diverticulum and how does it present
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
What are common causes of intussusception?
Meckel's hypertrophied Peyer patch post viral URTI Lymphoma Polyp HSP
What metabolic abnormalities can cause an Ileus
High Ca
Low K
Acidosis
uremia
What is superior mesenteric artery syndrome?
SMA collapses onto and compresses the duodenum
Causes: Rapid wgt loss
CP: vomiting and severe abd pain
How do you diagnose small intestinal overgrowth?
Gold standard - duodenal aspirate with 10 ^5 CFU/Ml or more of colonic flora
Other tests - Some breath tests
Risk factors for celiac disease
Females Family Hx Associated with - T21, turner, Williams, AI thyroiditis, Type 1 DM, IgA def
What are symptoms and signs of celiac disease
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
What syndromes are associated with an imperforated anus
50% have other abnormalities: Renal, MSK, Cardiac, GI and CNS
VACTERL
T21
Rectal prolapses causes
idiopathic CF Infection malnutrition IBD Chronic constipation
Causes of pancreatitis
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
What is Rx for H.Pylori
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
What are clinical presentation of Wilsons
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
what are clinical findings of portal HTN
Acites
Hepatorenal disorder
splenomegaly
inc collateral criculation- esophageal varices and anorectal varices
dilitation of paraumbilical vein = caput medusa
CP of AI hepatitis
acute - malaise, NV, jaundice, pale stools and dark urine
Insidious - fatigue, relapsing jaundice, HA, wgt loss
Complications of Crohn`s disease
Perianal disease enteroenteral fistula poor growth and delayed puberty osteopenia chronic hepatitis sclerosing cholangitis nephrolithiasis
What are the triad of abdo compartment syndrome?
resp distess
oliguria
hypotension
poor perfusion to lower limbs
what are electrolyte abnormalities found with pyloric stenosis
met alkalosis
hypochloremia
hypokalemia
how common is unconjugated hyperbilirubinemia in babies with pyloric stenosis
10 % to 25 %
what is a very worrisome lab finding in pyloric stenosis?
acidic urine
what syndromes have been associated with pyloric stenosis?
eosinophilic gastroenteritis T 18 Cornelia de lange Smith Lemli Opits Zellweger syndrome Apert syndrome
How do you manage pyloric stenosis rehydration?
D5 NS at 1.5 x maintenance
what are causes of secretory diarrhea?
IBD - inflammation
Toxins - E.Coli, Vibrio Cholera
Hormones - Vasoactive intestinal peptide, neuroblastoma
what are cause of osmotic diarrhea
pulls H2O into stools
PEG
lactose intol
lactase def
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
what are false negative when testing stools for bld
delayed transit time or bacterial overgrowth
gives bacteria time to degrade Hb
what are false positives when testing stools for bld
red meat
peroxidase containing foods - broccoli, cauliflower…
Dx test for lactase def / lactose intolerance
H2 breath test - lactase
what test is useful for ? bacterial overgrowth?
lactulose breath test - early breath hydrogen peak, usually occurring within 30 minutes of lactulose ingestion
what test on stool can help Dx a carb malabsorption issue?
stool PH will be acidic
How do you diagnose Choledocholithiasis?
magnetic resonance cholangiopancreatography
if you see a pt with FTT and bone marrow dysfunction, what syndrome should you rue out?
Shwachman syndrome
what is the second most common cause of pancreatic insufficiency after CF?
Shwachman–Diamond syndrome
Infant presents with steatorrhea, growth failure, deficiencies of fat-soluble vitamins A, D, E, and K . Dx
Shwachman–Diamond syndrome
what disorders my have delayed teeth eruption?
idiopathic T 21 hypopituitarism hypothyroidism rickets gaucher
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
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
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
what are complications of TEF
poor esophageal tone poor motility GERD stricture recurrent fistula leakage *** often associated with tracheomalacia
which infections must be rules out when investigating for IBD
Yersinia
C.Diff
Salmonella
how does biliary atresia present?
week 1-2 conjugated bili FTT ascites portal HTN splenomegaly muscle wasting
if baby presents with jaundice and hepatomegaly, what is your DDX
neonatal hepatitis
alpha 1 antitrypsin
metabolic
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
how do you Dx biliary atresia?
BIOPSY**
hepatobiliary scintigraphy not specific
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
if a baby is felt to have CMPA, which formula is not a good option?
soy because 30% cross-reactivity
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
how do you manage hepatic encephalopathy?
lactulose NG
enemas
avoid sedation
might need I&V
how do you manage ascites?
restrict fluid intake 50-60%
restrict Na intake
how do you DX Wilson’s disease?
low ceruloplasmin level high urine Copper Kayser-Fleischer rings hemolysis BX +copper
what is the treatment of Wilson’s
penicillamine
Zinc salts
what investigations can help Dx autoimmune hepatitis
high Ig G
ANA
anti-smooth muscle
Liver-kidney microsomal Ab
how do you Dx primary sclerosing cholangitis?
associated with UC
p-ANCA +
ERCP or MRCP
during ERCP - can do dilation
need transplant
what is the MC cause of spontaneous bacterial peritonitis?
pneumococcal infection
what are the ABx choices for peritonitis
cefotaxime
flagyl if ? perforation
what ulcers are most often associated with NSAIDS
gastric ulcers
what is the mgnt of peptic ulcers
PPI better at ulcer healing
what causes Zollinger-Ellison Syndrome
Gastrinoma (neuroendocrite T)
PUD + diarrhea
what other disorders are associated with Zollinger-Ellison Syndrome
MEN1 - multiple endocrine neoplasia
NF and TS
how do you Dx protein loosing enteropathy
fecal alpha 1 antitrypsin - for intestinal losses whereas albumin is too general. Will also loose IG.
how much bowel can you lose before it leads to malabsorption?
> 50%
what is absorbed in your duodenum and prox jejunum?
Ca Mg PO4 Iron Folic acid
what is absorbed in your distal ileum?
Vit B12
what is absorbed in the prox small bowel
carbs
protein
H2O soluble vit
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
what is the DDX for terminal ileitis?
Crohn's lymphoma yersinia TB chronic granulomatous disease eosinophilic gastroenteropathy
what are organic causes of constipation
High Ca low K low thyroid celiac lead/mercury poisoning UC meds CNS - CP, NTD, hirschsprung
what are causes of bloody diarrhea
E.Coli shigella campylobacter (salmonella, yersinia - not always) c. diff - only 5%
when do you do a Ph probe test in GERD
- assessing efficacy of acid suppression during treatment,
2 evaluating apneic episodes in conjunction with a pneumogram - evaluating atypical GERD presentations such as chronic cough, stridor, and asthma
what are side effects of azathioprine
GI upset
? increased risk of malignancy
what is the best test for adiposity?
BMI
Peutz-jegger syndrome
AD
hamartoma - lips and bowel
Colonoscopy yearly
what is the best test for pancreatitis?
lipase
what are RF for adenocarcinoma in apt with UC
disease > 10 yrs
onset < 15 yrs
pancolitits
PSC
what skin finding is more common in Crohn’s
erythema nododssum
tender
red
shins
what skin finding is more common in UC
pyoderma gangrenosum
necrotic
deep ulcers
legs
