GI Flashcards
most common cause of peptic ulcer disease in kids
H pylori»_space;> NSAID/ASA/alcohol
most common site of peptic ulcers in kids
duodenal for primary
gastric for secondary
dx and treatment of hpylori?
endoscopy/bx or urea test or H.pylori stool Ag test (for response to tx monitoring, not initial dx)
Tx: PPI, amox, clarithro
Dx in triad of jaundice, abd mass, intermitt abd pain
Most common type
complication
choledochal cyst: congenital cystic dilation of hepatic biliary tree
Most common type 1: dilation of common bile duct
complications: cholangitis or pancreatitis
Dx of pancreatitis?
Classic sign
AMylase and lipase have to be 3x ULN
classic pain radiating to back
Turner vs Cullen sign?
What are they and what is the dx
pancreatitis
Turner: flank ecchymosis
Cullen: blue umbilicus
metabolic issues causing pancreatitis (2)
hypercalcemia
hyperlipidemia
colicky abd pain (l>R), n/v, palpable renal mass, microscopic hematuria?
UPJ obstruction
type of gallstone seen in sickle cell disease?
Pigmented stone
meds that can precipitate gallstones (3)
ceftriaxone, furosemide, OCPs
transmission of acute intermittent porphyria
autosomal dominant, but variable penetrance
Dx in pt w/ severe intermittent abd pain, n/v, weakness, confusion, seizures
acute intermittent porphyria
triggers for acute intermittent porphyria and how to dx?
low carb intake, meds(sulfa, barbiturate), hormonal changes
Dx: urine porphyrin screen (porphobiligen and ALA during acute attack only) - due to decr RBC porphobilinogen deaminase or DNA testing
When to give immunoglobulin for Hep A? vs Vaccination?
IG: before travel, lasts < 12 wks or after exposure within 14 days (day care/intimate contact)
Also two vaccines which require booster 6-18 mos later for post-exposure prophylaxis too. Used for travelers, hi risk populations, now everyone!
type of virus for hep A
RNA
type of virus for Hep b
DNA
biggest concern for pediatric hep B?
vertical trm from mom - 90% if mom is HBsAg +, and 1/2 may be chronic carriers
when do Hep B core antibodies appear?
IgM then IgG, 1-4 wks after HBsAg (not Ab), and may persist for yrs
symptomatic vs convalescent phase of Hep B infx w/ regard to HBcAb and HBsAb after acute infx
in symptomatic phase: higher HBc and rising HBs
HBs > HBc in convalescent phase
lifetime risk of hepatocellular carcinoma if hep B carrier (HBsAg +)
25%
how to prevent vertical transmission of Hep B in positive mother?
vaccinate AT BIRTH with HBIG (synergistic)
Think of correlating what with consideration of alpha interferon therapy for Hep B?
ALT!! If its high, better response and expect it to fall. Also may have loss of HBsAg
hep C type of virus
RNA
type of virus Hep E?
RNA
Hep E treatment / prevention?
no vaccine yet. There is pooled immunoglobulin
most common form of viral hepatitis in children in US?
Hepatitis A
mean incubation period of Hep B?
120 days
marker of carrier state in Hep B
surface antigen
is there a chronic carrier state in Hep C?
no.
ASCA vs P-ANCA in UC vs crohn’s
ASCA more in Crohns
P anca more in UC
UGI/Small bowel follow throw in crohns
T1 nodularity, narrowing separation of bowel loops
when is peak neonatal bili and jaundice and what levels
peak bili 8-12 usually, max 15 for physiologic
occurs at day 4-6, with jaundice by day 2-3
Crigler Najjar defect?
Presentation
Tx?
UDP glucuronyl absence
presents w/ severe hyperbili, grey stool, lt urine in neonate
Tx: PB in type two, or trp
classic hyperbili/jaundice with stress / fasting
Transmission
Gilberts
autosomal dominant, incomplete penetrance or AR
most common cause of cholestatic hyperbili in newborn?
A1AT
Dx in baby with jaundice at 2 wks, acholic stool, and HSM
Extrahepatic biliary atresia
two forms of biliary atresia in baby?
embryonic: jaundice at birth and other anomalies
perinatal: most w/ obliteration of previously formed bile ducts
What is Alagille’s syndrome
presentation
genetics
liver failure from paucity of intrahepatic bile ducts and cardiac (pulm stenosis and tetralogy) and other anomalies incl butterfly vertebrae, renal, delay, triangle face
JAGGED 1 autosomal dominant with incomplete penetration
most common cause of acute liver failure in newborn
The lab finding?
neonatal hemochromatosis
Normal AST/ALT or absent b/c liver is shot.
most common place for foreign body to lodge? then?
esophaus: 60-70% below cricopharyngeal
20% at level of aortic arch
10-15% above LES
foreign bodies which might not pass all the way through if its gotten to the stomach?
longer than 5cm or wider than 2cm, may not
dx for dysphagia, droolilng, hoarseness
may have wheezing or vomiting
foreign body ingestion
foreign body in esophagus looks like what on XR? (vs trachea)
AP: face of coin
lateral film shows edge
This indicates Esophagus!
removal of foreign body/coin in esophagus for sx patient?
emergent endoscopy or foley balloon catheter extraction by radiologist
management of foreign body in lower 2/3 of esophagus in asx pt?
repeat xR in 12-24 hours, but if its still there… go get it b/c corrosive (zinc penny) so can’t stay there (ok in stomach, not esoph)
What foreign objects should be removed?
pointed or sharp objects
coins/blunt objects in stomach for up to 4-6 wks
long/large objects
condoms/balloons need surgery / not endoscopy
food or meat stuck in esophagus
who is at risk and what is the treatment
No barium study
should not stay in esoph > 12 hrs (meat enzymes eat esoph)
happens in people with esoph anomalies/motility d/os
how long can battery stay in?
hardly at all:
esoph out by 12 h
stomach out by 48, then 5 days total to get it out
alkali ingestion
causes what? damages what?
liquefaction necrosis, less bitter/colorless/odorless
Damages upper/lower esophagus
Acid ingestion causes what?
coagulation necrosis which limits penetration of acid, bitter tasting swimming pool stuff, toilet bowl cleaner
stomach/pylorus damage
Presence or absences of oral burns predicts what?
NOTHING. doesn’t tell you about likelihood of esophageal burns (50/50)
How do you manage caustic ingestions?
fluids, may need EGD within 12-24 hrs/ ENT/ Pulm consult
NO neutralizing agent or induced vomiting
long term risk after lye ingestion?
squamous cell carcinoma of esophagus 4 decades later
management of Grade 1-2A esophageal burns *not circumferential
clears, ok to d/c when taking POs, no long-term sequellae
Management of grade 2B or 3 esoph burns
high risk >70% chance of esophageal stricture
NGT feeds
steroids / Abx
genetic susceptibility for celiac?
HLA DQ2 and 8
what grain generally okay in celiac?
oat
dermatitis herpatiformis
celiac
% w/ DS who have celiac
7% *same as in DM1
fibrosing colonopathy from what?
in cf w/ too much lipase > 20,000
mec ileus in what % cf?
10-20%
diet rec for CF?
120% RDA calories, 40% long chain FA, 100% protein, 5-10x fat, lipase enzyme supp
average rate of cell turn over in intestine?
recovery after viral infx?
3-5 days, but two wks to recover
Dx of lactose intol?
How to prep for test?
breath test: 50mg lactose then look for rise in breath H2 over 20 PPM is diagnostic. Must fast 6 hrs first, No Abx 10 days first
most common presentation of eos esoph?
Work up?
dysphagia, also GERD, esophagitis
EGD, skin testing IgE RAST
endoscopic findings of EE?
furrows, vertical lines, rings, white plaques, crepe paper mucosa, strictures
Treatment of EE?
oral steroids, inhaled steroid Fluticasone, Singlulair/Montelukast, (Ketotifen, Mepolizumab)
goat milk doesnt have what?
folic acid
strict vegetarian diet leads to what def? (really a vegan thing)
B12
what should you give vegan mothers who are breast feeding and why?
B12 to prevent methylmalonic acidemia
B12 def most likely to occur in child s/p what surgery? (where its absorbed)
terminal ileum
KAsai procedure for what? Timing when?
for extrahepatic biliary atresia, should have been done by 8 wks latest
anemia,hemolysis, spinocerebellar degeneration, decr DTRs, wide gait
What vit Def?
Vit E Def
what three groups get fat soluble vitamin malabs?
CF
biliary atresia
short gut
prolonged TPN, excessive ileostomy output, cardiomyopathy
What is missing, what is the def?
Selenium def (forgot minerals)
infant who initially did well and then suddenly develops bilious emesis in first few days/months of life?
midgut volvulus distal to ampulla of Vater
in newborn with very distended abdomen whose mother had diabetes
small left colon / hypoplastic left colon syndrome
painless large maroon / burnt tarry stool, and patient with anemia?
The Rule?
Dx w/ what?
Meckel diverticulum bleed: painless rectal bleeding
Rule of 2s: 2yo, Males 2x, 2% population, w/in 2ft of ICV
Dx Meckel’s scan and H2 blocker first
treatment rec for toddler’s diarrhea and clue about the dx?
no diarrhea at night
increase fat intake to slow transit, decr carbs/total fluid
*death by sippy cup!
most common cause of rectal prolapse?
chronic constipation
how does ibuprofen cause gastric ulcers?
inhibits prostaglandin synthesis
GI med that can cause gynecomastia
reglan
chronic watery diarrhea after camping trip or bad water or daycare
Dx?
Test of Dx?
Giardia
Entero test ELISA, string test
best oral rehydration solutions contain what % gluc and what % NaCL?
2% gluc
90 mEQ NACL
what is used to find WBC in stool?
methylene blue - neutrophils
options for prophylaxis of travelers diarrhea?
bismuth subsalicylate or bactrim. Usu not needed
fever, HA, Abd pain, muscle aches, rose spots
diarrhea NON bloody?
Dx / Bug?
Tx
Salmonella –> typhoid fever
Tx: None for just diarrhea. For typhoid systemic disease: CTX and cefotax if bactrim resistance
seizures and diarrhea watery –> bloody
Tx
shigella
Bactrim
Tx of campylobacter
erythro / azithromycin
Tx for cdiff < 6 mos kid
NONE, normal carriers unless sx
bug that looks like appendicitis and tx?
Yersinia
None if limited to GI
2 Tests for sugar malabsortion causing chronic diarrhea?
- clinitest for reducing substances (all except sucrose) in stool
- Hydrogen breath test: normal gut should ferment the sugar and release H
Tests for fat malabsorption
- fecal fat 3 day
2. serum carotene and prothrombin time: indirect for Vit A and Vit K
link between neuroblastoma and diarrhea?
vasoactive intest peptide
steatorrhea and acanthocytosis (spiny RBCs), retinal damage and neuro findings
Dx?
abetalipoproteinemia
protein losing enteropathy with hypoproteinemia, hypogammaglobulinemia, steatorrhea, lymphedema, lymphopenia
intestinal lymphangiectasia
polyhydramnios and nonbilious vomiting in LBW newborn
Imaging study will show radiolucent filling defect in prepyloric region
Antral web
Risk fact for Pyloric stenosis
mother w/ PS
numbers to remember for pyloric length and thickness in ultrasound dx of pyloric stenosis
length > 14mm
thickness > 4mm
bilious vomiting, rt sided abd distension, Ladd bands constricting large/small bowel, gastric and duodenal dilation, decr intestingal air, corkscrew appearance of duodenum
Volvulus!
zofran mech of action
serotonin receptor antagonist
large cyst on floor of mouth and tx
ranula
excision
swelling of parotid gland, dry mouth, poor tears
Dx?
Mikulicz’s disease (large gland in head/neck syndrome)
Large bottles of milk replacing ducts / parotids
cause of parotitis with high fever and marked tenderness
s aureus
too few teeth or underdeveloped teeth
Dx and test
genetics
The main DDX
Ectodermal hypoplasia, x-linked, skin bx shows no sweat pores
DDX: Hallermann Streiff syndrome w/ underdeveloped small teeth but no sweat gland issues
dx with too many teeth
Gardner’s syndrome
prostaglandin analogue used in peptic ulcer disease?
misoprostol
Dx steps for H pylori
Tx
Serologic testing for H pylori IgG - SCREEN ONLY
Test w/ fecal Ag or Urea breath test
Confirmatory but invasive endoscopic bx
Tx: PPI, 2Abx (Amox/Flagyl OR Clarith/AMox) x 14 d
How to dx Zollinger Ellison
fasting gastrin level
pancreatic insuff with skeletal and bone marrow issues?
Shwachman Diamond syndrome
risk of Colon cancer in UC?
20%/10 yrs after first 10 yrs of disease
concern when child > 6 gets intussussception
lymphosarcoma - lead point
normal time to pass a stool in newborn
99% in 1st 24h, 1%in 48. If not think CF or hirsh
polyps that are and aren’t assoc w incr malignancy/
GArdners: yes
juvenile polyp: NO
geographic location for entamoeba histolytica
dx test
tx
south, indian reservation
positive serology to confirm the dx
flagyl for colitis / liver abscess
iodoquinol if asx
diagnostic test for cholestatic jaundice?
hepatobiliary scintigraphy
Diagnostic test series for suspected biliary atresia?
US –> HIDA scan –> Bx
Treatment of Wilson’s and its s/e
penicillamine
s/e: aplastic anemia
besides wilson, dz causing increased copper
chronic active hepatitis
“Diagnostic test” for pancreatitis?
more specific lab test?
US
lipase: specific
How to dx Hep A
Common group involved?
IgM Ab for recent disease x 6 mos. IgG persist for life / gives immunity
Alaskans and Native Americans NOT Asians
hep B + Hep D causes what
can create a severe acute hepatitis and resultant cirrhosis
hepatitis in Asia, Africa, Mexico?
Hep E
