GI- 10% Flashcards
what age group is appendicitis MC in
10-30yo
what is duodenal atresia commonly associated with
down syndrome
polyhydramnios
what are the first signs of duodenal atresia
abd distention + BILIOUS vomiting shortly after birth
what do you see on an AXR of a pt w duodenal atresia
double bubble sign- distended duodenum
tx of duodenal atresia
decompress GI tract, lytes + fluids, surgery
what is esophageal atresia commonly associated w
TEF
polyhydramnios
dx of esophageal atresia
NG tube + CXR (10-15cm down)
what type of contrast should be used in fluoroscopy for pt with esophageal atresia
water-soluble
should be removed promptly
no barium- caustic
what is the normal timeline for GER in newborns
start 2-3wks s/p birth
peaks 4-5mo
most improve completely by 9-12mo
what 2 factors contribute to GER in newborns
underdeveloped LES
lower diaphragm
tx of GER
burping, hold upright x30min s/p feeds
thicken formula w infant cereal
if feeding problems/severe sx- antacids, PPIs, H2 antagonists
why is PPI use limited in newborns with GERD
decreased calcium + magnesium absorption
problems w bone metabolism
inc GI infxns
acute interstitial nephritis
what types of hepatitis can develop into chronic hepatitis (>6mo)
B C D
hep A transmission
fecal-oral route
hep A presentation
less severe in kids prodromal phase (fever) --> icteric phase
diagnosis of acute vs recovered hep a
acute- IgM
past exposure- IgG
prognosis of hep A
self-limiting, usu recover w.i wks
mortality is low, fulminant hep uncommon
hep B transmission
blood, sex, perinatal
HBsAg
surface antigen
only positive in acute or chronic (infxn present)
HBsAb
surface antibody
only positive if immunized or resolved infxn
not in current infxn
HBcAb
core antibody
IgM (acute)
IgG (chronic or resolved)
NEVER present in immunized
HBeAg
envelope antigen
in acute or chronic replicative (inc infectivity, higher chance of developing chronic)
HBeAb
envelope antibody
only in chronic non replicative (dec infectivity)
HBV DNA
active replication
tx of acute HBV
supportive
tx of chronic HBV
alpha-interferon 2b, lamivudine, adefovir, tenofovir, entecavir
HBV vaccine is CI if…
allergic to bakers yeast
hepatitis E transmission
fecal-oral route, waterborne, pigs (raw meat)
tx of hep e
none- self-limiting
who has the highest mortality rate when infected w hep e
3rd trimester pregnant moms - inc risk of fulminant
hirschprungs disease patho
congenital absence of ganglion cells d/t neural crest migration failure –> functional obstruction d/t failure of relaxation
where is hirschsprungs MC
distal colon + rectum
when should meconium be passed
w.i 48hrs
hirschsprungs presentation
no mec in 48hrs
bilious vomiting
abd distention
FTT
hirschsprungs dz can lead to what
enterocolotiis- V/D, signs of toxic megacolon
hirschsprungs screening test
elevated pressure (anorectal manometry)
what can be see on contrast enema in pt w hirschsprungs
transition zone- caliber changes
what do you see on AXR in pt w hirschsprungs
dec or absent air in rectum, dilated bowel loops
NONSPECIFIC
what is the definitive diagnostic for hirschsprungs
rectal bx
what is the treatment for hirschsprungs
surgery
in what populations is hirschsprungs more common
males
down syndrome
indirect vs direct inguinal hernia causes
indirect- congenital patent process vaginalis
direct- weak floor of inguinal canal
where are indirect vs direct inguinal hernias located
indirect- lateral to inferior epigastric artery
direct- medial
which type of inguinal hernia is MC in young kids
indirect
how do you tell the difference btw strangulated and incarcerated inguinal hernia
incarcerated- painful + irreducible, +/- n/v
strangulated- systemic toxicity, ischemia
tx of inguinal hernia
surgery
emergent if strangulated
what is hesselbachs triangle
RIP rectus abdominus (medial), epigastric vessels (lateral), poupart's ligament (inferior)
when is intussusception MC
males, 6-18mo
where is intussusception MC
ileocolic jxn
what are lead points for intussusception
meckel diverticulum enlarged mesenteric LN hyperplasia of peyer's patches benign/malignant tumor submucosal hematoma (HSP) foreign body
triad of sx of intussusception
vomiting, colicky abd pain, blood in stool (currant jelly)
+/-lethargy
what is dance’s sign
in intussusception- sausage-shaped mass in RUQ/hypochondrium + empty RLQ
dx of intussusception + tx
barium contrast enema (dx + tx), air insufflation
hydrate
+/- surgery
if bili is increased w/o increased LFTs what should you suspect
familial bili disorder
path of dubin-johnson vs crigler-najjar syndromes
both hereditary
DJ- conjugated (direct) hyperbili d/t decreased hepatocyte excretion
CN- unconjugated (indirect) hyperbili d/t UGT deficiency
what is UGT
glucuronosyltransferase - enzyme converts indirect bili –> direct bili for excretion
type I vs type II crigler-najjar syndrome
type I- no UGT (more severe) type II (arias syndrome)- very little UGT
presentation of dubin-johnson vs crigler-najjar (I+II) syndromes
DJ- usu asx; may have mild icterus + constitutional sx
CN I- neonatal jaundice w severe progression in 2nd week –> kernicterus –> hypotonia, deaf, lethargic, oculomotor palsy; death usu by 15mo
CN II- usu asx
diagnosis of dubin-johnson vs crigler-najjar syndromes
DJ- inc direct, dark liver!!! (on bx), normal LFTs
CN- inc indirect, normal LFTs
how can you tell between crigler-najjar type I + II
bili >20 = type I
dubin johnson tx
none needed
crigler-najjar tx
type I- phototx, plasmapheresis if acute elevation, liver transplant (definitive)
type II- usu none needed, can use phenobarbital to inc UGT
lactose intolerance patho
intolerance to milk sugar (lactose)
transient after gastroenteritis or in kids w celiac dz d/t vilous atrophy (dec lactose in brush border)
lactose intolerance sx
inc gas, abd distention watery diarrhea (non-bloody, non-mucous)
test of choice for lactose intolerance
hydrogen breath test - positive = LI
what type of diets are likely to cause niacin deficiency
high in corn
what is niacin
B3
sx of niacin deficiency
pellagra (3Ds- diarrhea, dementia, dermatitis)
what age + gender is most likely to develop pyloric stenosis
3-6wks old (rare after 12wks)
males
sx of pyloric stenosis
projectile NONBILIOUS vomiting after feeds w hunger right after
palpable pyloric olive
poor wt gain
visible peristaltic waves
what is the preferred imaging for pyloric stenosis
ultrasound- thickened stomach muscle
what is the caterpillar sign
seen in pyloric stenosis on KUB- distended hypertrophic stomach
tx of pyloric stenosis
pyloromyotomy
fluid resuscitation PRN
umbilical hernia patho + tx
failure of fibromuscular ring closure
surgery if >5yo
vitamin A functions
vision immune embryo development hematopoiesis skin + cell health
sources of vitamin A
kidney, liver, egg yolk, butter, green leafy veggies
sx of vitamin A deficiency
vision- night blindness, xeropthlamia
impaired immunity (poor healing), dry skin, poor growth, taste loss, squamous metaplasia (conjunctiva, respiratory epithelium, urinary tract)
bitot’s spots
what are bitot’s spots
in vit a def: white spots on conjunctiva D/T squamous metaplasia of corneal epithelium
excess vit a can cause
teratogenic, alopecia, ataxia, visual changes, skin disorders, hepatotox
vitamin C sources
raw citrus, green veggies
sx of vitamin C deficiency
scurvy! - 3 Hs = hyperkeratosis (follicular papillose surrounded by hemorrhage), hemorrhage (vascular fragility, recurrent bleeding in gums, skin, joints, impaired healing), hematologic (anemia, glossitis, malaise, weakness, inc bleeding time)
sources of vitamin D
fortified milk + sun
babies get from mom if breast fed, formula supplemented
sx of vitamin d def
rickets (kids)
osteomalacia (adults)
tx for vit d deficiency
ergocalciferol
rickets
softening of bones, bowing of limbs, fxs, costochondral thickening (rachitic rosary), dental problems, music weakness, development delays
