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Royal Super 4th Year Brain > GI > Flashcards

GI Flashcards

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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
Q

Criteria for infantile colic

A
  • 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
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26
Q

Criteria for Cyclic Vomiting Syndrome

A
  • 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
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27
Q

Criteria for IBS

A

-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

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28
Q

Criteria for functional abdominal pain

A
  • Symptoms at least 4 times per month
  • Episodic or continuous abdo pain
  • No other medical explanation available
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29
Q

Two main locations for peptic ulcers and characteristics of disease in those locations (primary vs secondary, acute vs chronic)

A
  • Duodenum: by the bulb, primary, chronic

- Stomach: lesser curvature, secondary, acute

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30
Q

Example of a hyper-secretory state that causes PUD

A

Zollinger-Ellison Syndrome

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31
Q

Clinical presentation of PUD

A
  • Bleeding: hematemesis, melena, iron deficiency anemia
  • Pain: epigastric (dull, ache, improves with food), resolves with anti-acid, nocturnal
  • GI: nausea, fullness
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32
Q

Complication of PUD - that would present with emesis

A

Gastric outlet obstruction secondary to inflammation + edema

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33
Q

H. pylori - when (in relation to PPI and Abx) and how to do test of cure?

A
  • When: 4-6 weeks post-Abx, 2 weeks post-PPI

- UBT or stool antigen

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34
Q

Complication of H. pylori (apart from PUD)

A

Gastric cancer

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35
Q

Initial test for celiac disease

A

TTG-IgA with total IgA

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36
Q

Ddx for hepatomegaly (x5 main categories)

A
  • Inflammation
  • Storage: glycogen (GSD), protein (A1AT), lipid (NASH), iron (hemochromatosis)
  • Infiltrative: tumors
  • Biliary obstruction
  • Post-hepatic obstruction: right heart failure, thrombus, sinusoidal
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37
Q

Pre-hepatic causes of hyperbilirubinemia

A

Hemolytic: intrinsic + extrinsic causes, sepsis

Non-hemolytic: physiologic, BM jaundice, hypothyroidism

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38
Q

Hepatic causes of hyperbilirubinemia

A
  • Infections: TORCH, viral
  • Inflammation: AI, NASH
  • Infiltrative: malignancy, metabolic
  • Medications
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39
Q

Post-hepatic causes of hyperbilirubinemia

A
  • Biliary atresia
  • Hypoplasia
  • Choledochal cyst
  • Gallstones
  • PSC
  • Malignancy
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40
Q

In hyperbili secondary to a hepatic cause, what lab value must you have?

A

-Elevated ALT

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41
Q

Causes of neonatal cholestasis

A
  • Biliary atresia
  • Choledochal cyst
  • Infections - TORCH, viral, sepsis, E.coli
  • A1AT
  • Hypothyroidism
  • Galactosemia
  • Tyrosinemia
  • Mitochondrial
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42
Q

If suspicious for neonatal cholestasis, what should you give right away while determining etiology?

A

Vitamin K - protect from ICH

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43
Q

What is Alagille Syndrome?

A

Intrahepatic bile duct paucity

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44
Q

DDx for acute liver failure

A
  • 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
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45
Q

Most common neonatal cause of acute liver failure

A

GALD = gestational alloimmune liver disease

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46
Q

What kind of virus is hep B?

A

DNA

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47
Q

For prevention of hep B in an at risk infant

A

Vaccine + immunoglobulin within 12 hours

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48
Q

What is HBcAg and what does it represent?

A

= protein that the virus creates during infection

-Will only be positive if there is a TRUE infection (not vaccine)

49
Q

What type of Hep B infection do you have if: HBsAg+, HBsAb+, HBeAg+, HBeAb-

A

Chronic infection

50
Q

Complication/risk x2 for hep B

A
  • Cirrhosis

- Hepatocellular carcinoma

51
Q

Dx for infant without constipated stools but ++ straining/crying with passage of stool

A

Infant dyschezia = discoordination between relaxation of external anal sphincter + contraction of pelvic muscles

52
Q

What kind of virus is hep C?

A

RNA virus

53
Q

When do you discontinue hep C screening for at risk infant?

A
  • At least 18 months old

- x2 negative Ab screens consecutively

54
Q

x3 types of gallstones

A
  • Cholesterol
  • Brown pigment - think enteric bacteria
  • Black pigment - think blood
55
Q

Management of infant GERD

A
  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
Q

What is a complication of GERD for older children that we should monitor (when?) and consider?

A

Barrett esophagus = precursor for gastric adenocarcinoma

-Start monitoring ~10 years of age

57
Q

Associated conditions with Celiac Disease (includes x3 main categories)?

A
  • Selective IgA deficiency
  • Autoimmune: T1DM, thyroiditis
  • Genetic: T21, Turner’s, William’s
58
Q

If the patient is IgA deficient, what is the next best test for celiac screen?

A

TTG-IgG

59
Q

Timing of follow-up BW for Celiac Disease

A
  • TTG q6 months

- If controlled, can go to yearly

60
Q

What type of IBD is more likely to have associated uveitis?

A

Crohn’s

61
Q

What type of IBD is more likely to have associated ankylosing spondylitis?

A

UC

62
Q

Extra-intestinal features of IBD

A
  • MSK: arthralgia/arthritis, ankylosing spondylitis, osteopenia, clubbing
  • Derm: aphthous stomatitis, erythema nodosum, pyoderma gangrenosum
  • Optho: iritis, uveitis, episcleritis
  • Heme: hypercoag, anemia
  • Renal: nephrolithiasis
63
Q

What x5 features of Crohn’s disease precludes a possible diagnosis for UC?

A
  • 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
Q

Initial investigations for a patient with likely IBD apart from screening BW

A
  • Stool infectious studies
  • Fecal calprotectin
  • Small bowel imaging (US/MRE)
  • EGD + colonoscopy
  • Pre-treatment eval: infectious w/u with Mantoux, CXR
65
Q

Side effects (x10) of CC’s

A
  • Growth delay
  • Hypertension
  • Bone loss
  • Hyperglycemia
  • Hirsutism
  • Acne
  • Weight gain
  • Cushinoid facies
  • Mood disturbance
  • Sleep disturbance/insomnia
  • Cataracts
  • Leukocytosis
  • Infection
66
Q

What to add when patient is on MTX?

A

Folate

67
Q

x6 complications of IBD that are potentially life threatening/serious?

A
  • Colon cancer
  • GI hemorrhage
  • Perforation
  • Obstruction
  • Toxic megacolon
  • Fulminant colitis
68
Q

What typically occurs earlier in life - CMPA vs FPIES?

A

CMPA

69
Q

FPIES - what is the typical window of time of symptom onset from ingestion of food?

A

1-6 hours post-ingestion

70
Q

Is FPIES IgE-mediated?

A

No

71
Q

Recommended PEG dosing for disimpaction vs maintenance therapy?

A
  • 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
Q

x1 serious complication of Hirschsprung Disease (+symptoms associated)?

A

=Hirschsprung-associated enterocolitis (HAEC)

-acute diarrhea, explosive stools, abdo distention

73
Q

Initial steps in approach to rectal prolapse

A
  • 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
Q

Initial investigations to consider if patient meets criteria for CVS?

A
  • lytes
  • glucose
  • Cr, urea
  • UGI series to r/o malrotation
75
Q

What kind of caustic injury occurs with (a) acidic vs (b) alkaline substances?

A

(a) coagulation necrosis - more superficial

(b) alkaline - liquefaction necrosis - rapid transmural inflammation

76
Q

x3 polyposis syndromes

A
  • Juvenile Polyposis Syndrome
  • Peutz-Jeghers Syndrome
  • Familial Adenomatous Polyposis
77
Q

Juvenile Polyposis Syndrome - inheritance pattern, x1 thing at risk for, extra thing to look for on exam, diagnosis criteria?

A
  • 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
Q

Peutz-Jeghers Syndrome - inheritance pattern, x2 thing at risk for, thing to look for on exam, diagnosis criteria?

A
  • 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
Q

Familial Adenomatous Polyposis - inheritance pattern, x2 malignancies at risk for, diagnosis criteria?

A
  • AD
  • Colon cancer, hepatoblastoma
  • > 100 colorectal adenomatous polyps
80
Q

King’s College Criteria for acetaminophen related acute liver failure

A

-Arterial pH <7.3
OR
-INR >6.5 and serum Cr >300 and grade 3-4 encephalopathy

81
Q

Laboratory definition for conjugated hyperbilirubinemia

A

> 17 mmol/L

>20% of total

82
Q

x8 causes of neonatal cholestasis to NOT miss!!

A
  • Galactosemia
  • Tyrosinemia
  • Bile acid synthesis defects
  • Obstructive
  • Biliary atresia
  • Bacterial sepsis
  • Panhypopit
  • Gallstones
83
Q

Most common cause of neonatal cholestasis

A

BA

84
Q

First tier investigations after confirming cholestasis in a neonate

A
  • CBC
  • Lytes, glucose
  • INR, albumin
  • LE’s
  • Alpha-1 antitrypsin
  • NMS
  • Urine: UA, Cx, reducing substances
  • BCx
  • US
85
Q

What is the most common genetic cause of liver disease in pediatrics?

A

Alpha-1 antitrypsin deficiency

86
Q

Gilbert Syndrome - clinical presentation, bloodwork results, and tx

A
  • 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
Q

What is the most common non-traumatic surgical emergency in children?

A

Appy

88
Q

Alvarado score for pediatrics

A
  • 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
Q

Ix to consider with an appy (imaging + BW)

A
  • CBC, UA, B-hCG
  • US
  • CT
90
Q

Tx strategies for an appy

A
  • Simple: laparoscopic, non-operative (IV Abx x24-72h then PO x1 week)
  • Perforated: non-operative, IV Abx, drainage
91
Q

Common age range for intussception

A

3 months to 3 years

92
Q

What are two predisposing factors for lymphoid hyperplasia causing intussusception?

A
  • Recent resp illness = adeno

- Recent diarrhea illness = entero

93
Q

Pathologic lead points in intussusception

A
  • Meckel’s**
  • Polyps, hamartoma
  • Intestinal duplication
  • HSP
  • Appendix
  • Hemangioma
  • FB
  • Ectopic mucosa
  • Malignancy
94
Q

Most common type (or location) for intussusception

A

Ileocolic

95
Q

Gold standard Ix for intussusception as well as f/u confirmatory test

A
  • US = target sign

- Air/contrast enema

96
Q

Absolute contraindications (x3) for non-operative reduction of intussusception

A
  • Peritonitis
  • Persistent hypotension
  • Free air
97
Q

Recommendations on prophylactic medications to start for CVS patients (a) <5 years old and (b) >5 years old

A

(a) Cyproheptadine

(b) Amitryptilline

98
Q

What vitamin toxicity can lead to intracranial hypertension and papilledema?

A

Vitamin A

99
Q

Patient known to eat hair and presents with symptoms of a partial bowel obstruction?

A

Trichobezoar

100
Q

What associated anomalies are part of Alagille Syndrome - vertebrae, CVS, renal, face

A
  • Butterfly vertebrae
  • PPS
  • Renal dysplasia
  • Triangular face
101
Q

If gastric button battery + outpatient observation algorithm, when would you repeat the XR if no passage in stool?

A
  • In 48 hours if BB >20mm

- In 10 days if BB <20mm

102
Q

x2 possible options for treatment of EoE in a teenager

A
  • Elimination diet

- Oral fluticasone

103
Q

How long to treat constipation for?

A

x6 months

104
Q

Primary cause of PUD

A

H pylori

105
Q

Secondary causes of PUD

A
  • Stress
  • Meds
  • Systemic macrocytosis
  • Short bowel syndrome
  • Hyper-secretory states
106
Q

Predominant location + acute or chronic for H. pylori

A

Duodenal, chronic

107
Q

Best blood test for PLE

A

Alpha 1 antitrypsin

108
Q 
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
A

PO Flagyl - CPS Statement recommends using the same initial treatment again

109
Q
  1. 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
A

B

110
Q

What is NOT part of Cystic Fibrosis:

(a) Gastric ulcer
(b) Abnormal gallbladder function
(c) Portal hypertension
(d) Ileocecal mass

A

(a)

111
Q

Why do we wean PPI for GERD?

A

Can have rebound gastric hypersecretion

112
Q

What x3 things do PPI put you at risk for?

A

PNA, NEC, UTI

113
Q

What is the magic important number you need to keep in mind to determine if conjugated bilirubin is significant?

A

> 17 mmol/L (or 20% but not used as much)

114
Q

Meat impaction - dx?

A

EoE

115
Q

Only factor not made in liver?

A

8

116
Q

Best synthetic lab function of liver

A

INR

117
Q

When can you return to school with hep A?

A

7d since last diarrhea

118
Q

How to remove trichobezoar?

A

laparotomy

119
Q

What med can you try for post-viral gastro gastroparesis?

A

domperidone

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