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GI Flashcards

1
Q

Clinical sx of fat soluble vitamin deficiency

A 
A = night blindness, xerophthalmia, keratomalacia, follicular hyperkeratosis
D = osteopenia, rickets, craniotabes, rachitic rosary
E = sensory/motor neuropathy, ataxia, hemolytic anemia
K = hemorrhagic disease
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2
Q

4 types of polyps

A
  • Malignant
  • Hamartomatous (benign)
  • Hyperplastic
  • Inflammatory
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3
Q

Juvenile polyposis syndrome: (a) criteria x2, (b) inheritance pattern, (c) importance of dx, and (d) name a classic syndrome

A

(a) 5 or more polyps in colon/rectum PLUS at least 2 affected family member
(b) autosomal dominant
(c) risk of malignant potential
(d) Peutz-Jeghers

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4
Q

How to differentiate a coin on XR between being in esophagus vs trachea?

A
  • Esophagus: en face in AP

- Trachea: en face in lateral

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5
Q

What organs are involved with (a) fat, (b) protein, and (c) carbohydrate metabolism?

A

(a) Biliary, pancreas, ileum
(b) Pancreas, small intestine
(c) Duodenum

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6
Q

What is celiac disease?

A

Autoimmune enteropathy - systemic Ab against gluten

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7
Q

Extra-intestinal manifestations of celiac disease (x10)

A
  • Dermatitis herpetiformis
  • Dental hypoplasia
  • Osteopenia
  • Short stature
  • Delayed puberty
  • Iron deficiency anemia
  • Arthritis/arthralgia
  • Epilepsy with bilateral occipital calcifications
  • Peripheral neuropathy
  • Isolated hepatitis
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8
Q

If suspecting celiac disease in a child <2 years, what test do you do?

A

DGP = deamidated gliadin peptide

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9
Q

IBD picture that INVOLVES the terminal ileum

A

Crohn’s

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10
Q

IBD picture that INVOLVES granuloma formation

A

Crohn’s

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11
Q

IBD associated with PSC

A

UC

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12
Q

During what point in IBD treatment do you include steroids?

A

To induce remission

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13
Q

What management medication is used exclusively in (a) Crohn’s and (b) UC?

A

(a) Enteral nutrition

(b) 5-ASA

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14
Q

DDx for organic constipation causes

A
  • GI: Hirschprung’s, Celiac d/z, CF
  • Endo: Hypothyroidism, hyperCa, hypoK
  • Neuro: CP, neural tube defects
  • Meds/ingestions: lead
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15
Q

Two investigations to consider if GERD is not improving despite dietary modifications + medical therapy?

A
  • Endoscopy

- 24h pH / impedance probe

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16
Q

Process of diagnosis required for EoE

A
  • First EGD: >15 eos/HPF
  • x8 weeks of PPI
  • Repeat EGD: If continues to be high = dx!
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17
Q

Ddx for dysphagia

A
  • Painful swallowing = candida, reflux esophagitis

- Difficulty swallowing = EoE, anatomical obstruction (sling, ring, stricture), achalasia, esophageal motility d/o

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18
Q

Although tx for EoE is unclear - what to consider for (a) young child and (b) older child

A

(a) amino acid diet

(b) steroids

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19
Q

What should you advise mothers to take in setting of milk elimination diet?

A

1000mg Ca

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20
Q

In maternal diary elimination diet - what is the expected washout period for immediate + late symptoms?

A
  • Immediate = 5 days

- Late = 2 weeks

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21
Q

DDx for upper GI bleeding in children/adolescents

A
  • Vascular: AVM, varices
  • GI: MW tear, hemobilia, esophagitis/gastritis (NSAIDs, H. pylori, ulcers)
  • Trauma: FB, ingestion
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22
Q

First line treatments for H.pylori

A
  • PAC = PPI, amox, clarithro

- PAM = PPI, amox, metro

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23
Q

Infectious causes of bloody diarrhea

A
  • Shigella
  • Salmonella
  • E.coli
  • Yersinia
  • Campylobacter
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24
Q

Criteria for Functional Constipation - Rome Criteria

A

> 1 month of at least 2 of the following:

  • <2 BM’s per week
  • Painful/straining with hard BM’s
  • Large diameter BM’s (blocking toilet)
  • At least 1 episode/week of fecal incontinence
  • Evidence of excessive stool retention, retentive posturing or volitional with-holding
  • Large fecal mass in rectum
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25
Criteria for infantile colic
- Symptoms must start + stop while infant is <5 months old - Recurrent/prolonged episodes of infant crying, fussing, or irritable without any obvious cause - >3 hours/day for at least 3 days per week for at least 1 week in duration - No FTT, fever, or illness
26
Criteria for Cyclic Vomiting Syndrome
- At least 2 episodes of severe nausea + hyperemesis lasting hours to days - Return to usual health in between episodes - Episodes are stereotypical - No attributable to another medical condition
27
Criteria for IBS
-Symptoms at least 4 times per month with at least one of the following: changes in stool form, changes in frequency, and related to defecation
28
Criteria for functional abdominal pain
- Symptoms at least 4 times per month - Episodic or continuous abdo pain - No other medical explanation available
29
Two main locations for peptic ulcers and characteristics of disease in those locations (primary vs secondary, acute vs chronic)
- Duodenum: by the bulb, primary, chronic | - Stomach: lesser curvature, secondary, acute
30
Example of a hyper-secretory state that causes PUD
Zollinger-Ellison Syndrome
31
Clinical presentation of PUD
- Bleeding: hematemesis, melena, iron deficiency anemia - Pain: epigastric (dull, ache, improves with food), resolves with anti-acid, nocturnal - GI: nausea, fullness
32
Complication of PUD - that would present with emesis
Gastric outlet obstruction secondary to inflammation + edema
33
H. pylori - when (in relation to PPI and Abx) and how to do test of cure?
- When: 4-6 weeks post-Abx, 2 weeks post-PPI | - UBT or stool antigen
34
Complication of H. pylori (apart from PUD)
Gastric cancer
35
Initial test for celiac disease
TTG-IgA with total IgA
36
Ddx for hepatomegaly (x5 main categories)
- Inflammation - Storage: glycogen (GSD), protein (A1AT), lipid (NASH), iron (hemochromatosis) - Infiltrative: tumors - Biliary obstruction - Post-hepatic obstruction: right heart failure, thrombus, sinusoidal
37
Pre-hepatic causes of hyperbilirubinemia
Hemolytic: intrinsic + extrinsic causes, sepsis | Non-hemolytic: physiologic, BM jaundice, hypothyroidism
38
Hepatic causes of hyperbilirubinemia
- Infections: TORCH, viral - Inflammation: AI, NASH - Infiltrative: malignancy, metabolic - Medications
39
Post-hepatic causes of hyperbilirubinemia
- Biliary atresia - Hypoplasia - Choledochal cyst - Gallstones - PSC - Malignancy
40
In hyperbili secondary to a hepatic cause, what lab value must you have?
-Elevated ALT
41
Causes of neonatal cholestasis
- Biliary atresia - Choledochal cyst - Infections - TORCH, viral, sepsis, E.coli - A1AT - Hypothyroidism - Galactosemia - Tyrosinemia - Mitochondrial
42
If suspicious for neonatal cholestasis, what should you give right away while determining etiology?
Vitamin K - protect from ICH
43
What is Alagille Syndrome?
Intrahepatic bile duct paucity
44
DDx for acute liver failure
- Infection: viral hepatitis, viral illness (EBV, CMV, parvo, parecho, HSV, HHV-6, VZV) - Autoimmune: AI, GALD - Metabolic: Wilson disease, fatty liver, galactosemia, tyrosinemia, hereditary fructose intolerance, mitochondrial - Malignancy: HLH, leukemia, lymphoma - Vascular: shock, Budd-Chiari syndrome - Meds: tylenol overdose - Idiopathic
45
Most common neonatal cause of acute liver failure
GALD = gestational alloimmune liver disease
46
What kind of virus is hep B?
DNA
47
For prevention of hep B in an at risk infant
Vaccine + immunoglobulin within 12 hours
48
What is HBcAg and what does it represent?
= protein that the virus creates during infection | -Will only be positive if there is a TRUE infection (not vaccine)
49
What type of Hep B infection do you have if: HBsAg+, HBsAb+, HBeAg+, HBeAb-
Chronic infection
50
Complication/risk x2 for hep B
- Cirrhosis | - Hepatocellular carcinoma
51
Dx for infant without constipated stools but ++ straining/crying with passage of stool
Infant dyschezia = discoordination between relaxation of external anal sphincter + contraction of pelvic muscles
52
What kind of virus is hep C?
RNA virus
53
When do you discontinue hep C screening for at risk infant?
- At least 18 months old | - x2 negative Ab screens consecutively
54
x3 types of gallstones
- Cholesterol - Brown pigment - think enteric bacteria - Black pigment - think blood
55
Management of infant GERD
1. Dietary elimination 2. PPI 3. Reconsider dx with endoscopy and/or 24h pH impedance probe 4. Alternative strategies: surgical (fundo), transpyloric or jejunal feeding
56
What is a complication of GERD for older children that we should monitor (when?) and consider?
Barrett esophagus = precursor for gastric adenocarcinoma | -Start monitoring ~10 years of age
57
Associated conditions with Celiac Disease (includes x3 main categories)?
- Selective IgA deficiency - Autoimmune: T1DM, thyroiditis - Genetic: T21, Turner's, William's
58
If the patient is IgA deficient, what is the next best test for celiac screen?
TTG-IgG
59
Timing of follow-up BW for Celiac Disease
- TTG q6 months | - If controlled, can go to yearly
60
What type of IBD is more likely to have associated uveitis?
Crohn's
61
What type of IBD is more likely to have associated ankylosing spondylitis?
UC
62
Extra-intestinal features of IBD
- MSK: arthralgia/arthritis, ankylosing spondylitis, osteopenia, clubbing - Derm: aphthous stomatitis, erythema nodosum, pyoderma gangrenosum - Optho: iritis, uveitis, episcleritis - Heme: hypercoag, anemia - Renal: nephrolithiasis
63
What x5 features of Crohn's disease precludes a possible diagnosis for UC?
- Fistulizing disease - Large, inflamed perianal skin tags - Deep ulcerations, cobble-stoning, or stenosis in small bowel or upper GI tract - Evidence of jejunal or ileal inflammation - Granuloma
64
Initial investigations for a patient with likely IBD apart from screening BW
- Stool infectious studies - Fecal calprotectin - Small bowel imaging (US/MRE) - EGD + colonoscopy - Pre-treatment eval: infectious w/u with Mantoux, CXR
65
Side effects (x10) of CC's
- Growth delay - Hypertension - Bone loss - Hyperglycemia - Hirsutism - Acne - Weight gain - Cushinoid facies - Mood disturbance - Sleep disturbance/insomnia - Cataracts - Leukocytosis - Infection
66
What to add when patient is on MTX?
Folate
67
x6 complications of IBD that are potentially life threatening/serious?
- Colon cancer - GI hemorrhage - Perforation - Obstruction - Toxic megacolon - Fulminant colitis
68
What typically occurs earlier in life - CMPA vs FPIES?
CMPA
69
FPIES - what is the typical window of time of symptom onset from ingestion of food?
1-6 hours post-ingestion
70
Is FPIES IgE-mediated?
No
71
Recommended PEG dosing for disimpaction vs maintenance therapy?
- Disimpaction = 1.0-1.5 g/kg/day x3-6 days | - Maintenance = 0.4-1.0 mg/kg/day x at least 2 months
72
x1 serious complication of Hirschsprung Disease (+symptoms associated)?
=Hirschsprung-associated enterocolitis (HAEC) | -acute diarrhea, explosive stools, abdo distention
73
Initial steps in approach to rectal prolapse
- Assess for any associated diagnosis: constipation, diarrhea, parasitic infections, malnutrition - If <4 years old --> conservative tx until 4 years old - If >4 years old --> conservative tx x1 year - Consider CF screen
74
Initial investigations to consider if patient meets criteria for CVS?
- lytes - glucose - Cr, urea - UGI series to r/o malrotation
75
What kind of caustic injury occurs with (a) acidic vs (b) alkaline substances?
(a) coagulation necrosis - more superficial | (b) alkaline - liquefaction necrosis - rapid transmural inflammation
76
x3 polyposis syndromes
- Juvenile Polyposis Syndrome - Peutz-Jeghers Syndrome - Familial Adenomatous Polyposis
77
Juvenile Polyposis Syndrome - inheritance pattern, x1 thing at risk for, extra thing to look for on exam, diagnosis criteria?
- AD - GI malignancy - Telangiectasia - 1 of 3: 5 or more JP's in colon/rectum, JPs in other GI areas, or any number of JP's plus +fmhx
78
Peutz-Jeghers Syndrome - inheritance pattern, x2 thing at risk for, thing to look for on exam, diagnosis criteria?
- AD - malignancy, intussception - mucosal pigmentation/freckling - Diagnosis: 2 or more PJS polyps, any number of PJS polyps +fmhx, mucocutaneous pigmentation +fmhx, any numbers of polyps w/ mucosal pigmentation
79
Familial Adenomatous Polyposis - inheritance pattern, x2 malignancies at risk for, diagnosis criteria?
- AD - Colon cancer, hepatoblastoma - >100 colorectal adenomatous polyps
80
King's College Criteria for acetaminophen related acute liver failure
-Arterial pH <7.3 OR -INR >6.5 and serum Cr >300 and grade 3-4 encephalopathy
81
Laboratory definition for conjugated hyperbilirubinemia
>17 mmol/L | >20% of total
82
x8 causes of neonatal cholestasis to NOT miss!!
- Galactosemia - Tyrosinemia - Bile acid synthesis defects - Obstructive - Biliary atresia - Bacterial sepsis - Panhypopit - Gallstones
83
Most common cause of neonatal cholestasis
BA
84
First tier investigations after confirming cholestasis in a neonate
- CBC - Lytes, glucose - INR, albumin - LE's - Alpha-1 antitrypsin - NMS - Urine: UA, Cx, reducing substances - BCx - US
85
What is the most common genetic cause of liver disease in pediatrics?
Alpha-1 antitrypsin deficiency
86
Gilbert Syndrome - clinical presentation, bloodwork results, and tx
- Presentation: recurrent episodes of jaundice triggered by dehydration/fasting/exercise/illness, otherwise asymptomatic - BW: unconjugated hyperbili, normal CBC/smear/retic/LE's - No tx needed
87
What is the most common non-traumatic surgical emergency in children?
Appy
88
Alvarado score for pediatrics
- Migratory R iliac fossa pain - N/V - Anorexia - Tender to R iliac fossa (2) - Rebound tenderness to R iliac fossa - Fever - Leukocytosis (2) - Left shift Possible = 5-6 Probable = 7-8 Very probable = >9
89
Ix to consider with an appy (imaging + BW)
- CBC, UA, B-hCG - US - CT
90
Tx strategies for an appy
- Simple: laparoscopic, non-operative (IV Abx x24-72h then PO x1 week) - Perforated: non-operative, IV Abx, drainage
91
Common age range for intussception
3 months to 3 years
92
What are two predisposing factors for lymphoid hyperplasia causing intussusception?
- Recent resp illness = adeno | - Recent diarrhea illness = entero
93
Pathologic lead points in intussusception
- Meckel's** - Polyps, hamartoma - Intestinal duplication - HSP - Appendix - Hemangioma - FB - Ectopic mucosa - Malignancy
94
Most common type (or location) for intussusception
Ileocolic
95
Gold standard Ix for intussusception as well as f/u confirmatory test
- US = target sign | - Air/contrast enema
96
Absolute contraindications (x3) for non-operative reduction of intussusception
- Peritonitis - Persistent hypotension - Free air
97
Recommendations on prophylactic medications to start for CVS patients (a) <5 years old and (b) >5 years old
(a) Cyproheptadine | (b) Amitryptilline
98
What vitamin toxicity can lead to intracranial hypertension and papilledema?
Vitamin A
99
Patient known to eat hair and presents with symptoms of a partial bowel obstruction?
Trichobezoar
100
What associated anomalies are part of Alagille Syndrome - vertebrae, CVS, renal, face
- Butterfly vertebrae - PPS - Renal dysplasia - Triangular face
101
If gastric button battery + outpatient observation algorithm, when would you repeat the XR if no passage in stool?
- In 48 hours if BB >20mm | - In 10 days if BB <20mm
102
x2 possible options for treatment of EoE in a teenager
- Elimination diet | - Oral fluticasone
103
How long to treat constipation for?
x6 months
104
Primary cause of PUD
H pylori
105
Secondary causes of PUD
- Stress - Meds - Systemic macrocytosis - Short bowel syndrome - Hyper-secretory states
106
Predominant location + acute or chronic for H. pylori
Duodenal, chronic
107
Best blood test for PLE
Alpha 1 antitrypsin
108
``` C Diff treated with PO Flagyl. Now recurred with 5> stool and positive toxins (2 months later). What to do? A- Observe B- PO Flagyl C- PO Vanco D- IV flagyl, PO vanco ```
PO Flagyl - CPS Statement recommends using the same initial treatment again
109
140. What are the indications for probiotics? a. Treating C. Difficile diarrhea b. Preventing antibiotic associated diarrhea c. Reducing the intensity of viral diarrhea in immunocompromised children d. Preventing atropic dermatitis
B
110
What is NOT part of Cystic Fibrosis: (a) Gastric ulcer (b) Abnormal gallbladder function (c) Portal hypertension (d) Ileocecal mass
(a)
111
Why do we wean PPI for GERD?
Can have rebound gastric hypersecretion
112
What x3 things do PPI put you at risk for?
PNA, NEC, UTI
113
What is the magic important number you need to keep in mind to determine if conjugated bilirubin is significant?
>17 mmol/L (or 20% but not used as much)
114
Meat impaction - dx?
EoE
115
Only factor not made in liver?
8
116
Best synthetic lab function of liver
INR
117
When can you return to school with hep A?
7d since last diarrhea
118
How to remove trichobezoar?
laparotomy
119
What med can you try for post-viral gastro gastroparesis?
domperidone

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