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Laughing Pedi > GI > Flashcards

GI Flashcards

0
Q

most common cause of peptic ulcer disease in kids

A

H pylori&raquo_space;> NSAID/ASA/alcohol

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1
Q

most common site of peptic ulcers in kids

A

duodenal for primary

gastric for secondary

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2
Q

dx and treatment of hpylori?

A

endoscopy/bx or urea test or H.pylori stool Ag test (for response to tx monitoring, not initial dx)
Tx: PPI, amox, clarithro

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3
Q

Dx in triad of jaundice, abd mass, intermitt abd pain
Most common type
complication

A

choledochal cyst: congenital cystic dilation of hepatic biliary tree
Most common type 1: dilation of common bile duct
complications: cholangitis or pancreatitis

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4
Q

Dx of pancreatitis?

Classic sign

A

AMylase and lipase have to be 3x ULN

classic pain radiating to back

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5
Q

Turner vs Cullen sign?

What are they and what is the dx

A

pancreatitis
Turner: flank ecchymosis
Cullen: blue umbilicus

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6
Q

metabolic issues causing pancreatitis (2)

A

hypercalcemia

hyperlipidemia

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7
Q

colicky abd pain (l>R), n/v, palpable renal mass, microscopic hematuria?

A

UPJ obstruction

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8
Q

type of gallstone seen in sickle cell disease?

A

Pigmented stone

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9
Q

meds that can precipitate gallstones (3)

A

ceftriaxone, furosemide, OCPs

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10
Q

transmission of acute intermittent porphyria

A

autosomal dominant, but variable penetrance

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11
Q

Dx in pt w/ severe intermittent abd pain, n/v, weakness, confusion, seizures

A

acute intermittent porphyria

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12
Q

triggers for acute intermittent porphyria and how to dx?

A

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

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13
Q

When to give immunoglobulin for Hep A? vs Vaccination?

A

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!

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14
Q

type of virus for hep A

A

RNA

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15
Q

type of virus for Hep b

A

DNA

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16
Q

biggest concern for pediatric hep B?

A

vertical trm from mom - 90% if mom is HBsAg +, and 1/2 may be chronic carriers

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17
Q

when do Hep B core antibodies appear?

A

IgM then IgG, 1-4 wks after HBsAg (not Ab), and may persist for yrs

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18
Q

symptomatic vs convalescent phase of Hep B infx w/ regard to HBcAb and HBsAb after acute infx

A

in symptomatic phase: higher HBc and rising HBs

HBs > HBc in convalescent phase

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19
Q

lifetime risk of hepatocellular carcinoma if hep B carrier (HBsAg +)

A

25%

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20
Q

how to prevent vertical transmission of Hep B in positive mother?

A

vaccinate AT BIRTH with HBIG (synergistic)

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21
Q

Think of correlating what with consideration of alpha interferon therapy for Hep B?

A

ALT!! If its high, better response and expect it to fall. Also may have loss of HBsAg

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22
Q

hep C type of virus

A

RNA

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23
Q

type of virus Hep E?

A

RNA

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24
Q

Hep E treatment / prevention?

A

no vaccine yet. There is pooled immunoglobulin

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25
Q

most common form of viral hepatitis in children in US?

A

Hepatitis A

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26
Q

mean incubation period of Hep B?

A

120 days

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27
Q

marker of carrier state in Hep B

A

surface antigen

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28
Q

is there a chronic carrier state in Hep C?

A

no.

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29
Q

ASCA vs P-ANCA in UC vs crohn’s

A

ASCA more in Crohns

P anca more in UC

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30
Q

UGI/Small bowel follow throw in crohns

A

T1 nodularity, narrowing separation of bowel loops

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31
Q

when is peak neonatal bili and jaundice and what levels

A

peak bili 8-12 usually, max 15 for physiologic

occurs at day 4-6, with jaundice by day 2-3

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32
Q

Crigler Najjar defect?
Presentation
Tx?

A

UDP glucuronyl absence
presents w/ severe hyperbili, grey stool, lt urine in neonate
Tx: PB in type two, or trp

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33
Q

classic hyperbili/jaundice with stress / fasting

Transmission

A

Gilberts

autosomal dominant, incomplete penetrance or AR

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34
Q

most common cause of cholestatic hyperbili in newborn?

A

A1AT

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35
Q

Dx in baby with jaundice at 2 wks, acholic stool, and HSM

A

Extrahepatic biliary atresia

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36
Q

two forms of biliary atresia in baby?

A

embryonic: jaundice at birth and other anomalies
perinatal: most w/ obliteration of previously formed bile ducts

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37
Q

What is Alagille’s syndrome
presentation
genetics

A

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

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38
Q

most common cause of acute liver failure in newborn

The lab finding?

A

neonatal hemochromatosis

Normal AST/ALT or absent b/c liver is shot.

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39
Q

most common place for foreign body to lodge? then?

A

esophaus: 60-70% below cricopharyngeal
20% at level of aortic arch
10-15% above LES

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40
Q

foreign bodies which might not pass all the way through if its gotten to the stomach?

A

longer than 5cm or wider than 2cm, may not

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41
Q

dx for dysphagia, droolilng, hoarseness

may have wheezing or vomiting

A

foreign body ingestion

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42
Q

foreign body in esophagus looks like what on XR? (vs trachea)

A

AP: face of coin
lateral film shows edge
This indicates Esophagus!

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43
Q

removal of foreign body/coin in esophagus for sx patient?

A

emergent endoscopy or foley balloon catheter extraction by radiologist

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44
Q

management of foreign body in lower 2/3 of esophagus in asx pt?

A

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)

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45
Q

What foreign objects should be removed?

A

pointed or sharp objects
coins/blunt objects in stomach for up to 4-6 wks
long/large objects
condoms/balloons need surgery / not endoscopy

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46
Q

food or meat stuck in esophagus

who is at risk and what is the treatment

A

No barium study
should not stay in esoph > 12 hrs (meat enzymes eat esoph)
happens in people with esoph anomalies/motility d/os

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47
Q

how long can battery stay in?

A

hardly at all:
esoph out by 12 h
stomach out by 48, then 5 days total to get it out

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48
Q

alkali ingestion

causes what? damages what?

A

liquefaction necrosis, less bitter/colorless/odorless

Damages upper/lower esophagus

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49
Q

Acid ingestion causes what?

A

coagulation necrosis which limits penetration of acid, bitter tasting swimming pool stuff, toilet bowl cleaner
stomach/pylorus damage

50
Q

Presence or absences of oral burns predicts what?

A

NOTHING. doesn’t tell you about likelihood of esophageal burns (50/50)

51
Q

How do you manage caustic ingestions?

A

fluids, may need EGD within 12-24 hrs/ ENT/ Pulm consult

NO neutralizing agent or induced vomiting

52
Q

long term risk after lye ingestion?

A

squamous cell carcinoma of esophagus 4 decades later

53
Q

management of Grade 1-2A esophageal burns *not circumferential

A

clears, ok to d/c when taking POs, no long-term sequellae

54
Q

Management of grade 2B or 3 esoph burns

A

high risk >70% chance of esophageal stricture
NGT feeds
steroids / Abx

55
Q

genetic susceptibility for celiac?

A

HLA DQ2 and 8

56
Q

what grain generally okay in celiac?

A

oat

57
Q

dermatitis herpatiformis

A

celiac

58
Q

% w/ DS who have celiac

A

7% *same as in DM1

59
Q

fibrosing colonopathy from what?

A

in cf w/ too much lipase > 20,000

60
Q

mec ileus in what % cf?

A

10-20%

61
Q

diet rec for CF?

A

120% RDA calories, 40% long chain FA, 100% protein, 5-10x fat, lipase enzyme supp

62
Q

average rate of cell turn over in intestine?

recovery after viral infx?

A

3-5 days, but two wks to recover

63
Q

Dx of lactose intol?

How to prep for test?

A

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

64
Q

most common presentation of eos esoph?

Work up?

A

dysphagia, also GERD, esophagitis

EGD, skin testing IgE RAST

65
Q

endoscopic findings of EE?

A

furrows, vertical lines, rings, white plaques, crepe paper mucosa, strictures

66
Q

Treatment of EE?

A

oral steroids, inhaled steroid Fluticasone, Singlulair/Montelukast, (Ketotifen, Mepolizumab)

67
Q

goat milk doesnt have what?

A

folic acid

68
Q

strict vegetarian diet leads to what def? (really a vegan thing)

A

B12

69
Q

what should you give vegan mothers who are breast feeding and why?

A

B12 to prevent methylmalonic acidemia

70
Q

B12 def most likely to occur in child s/p what surgery? (where its absorbed)

A

terminal ileum

71
Q

KAsai procedure for what? Timing when?

A

for extrahepatic biliary atresia, should have been done by 8 wks latest

72
Q

anemia,hemolysis, spinocerebellar degeneration, decr DTRs, wide gait
What vit Def?

A

Vit E Def

73
Q

what three groups get fat soluble vitamin malabs?

A

CF
biliary atresia
short gut

74
Q

prolonged TPN, excessive ileostomy output, cardiomyopathy

What is missing, what is the def?

A

Selenium def (forgot minerals)

75
Q

infant who initially did well and then suddenly develops bilious emesis in first few days/months of life?

A

midgut volvulus distal to ampulla of Vater

76
Q

in newborn with very distended abdomen whose mother had diabetes

A

small left colon / hypoplastic left colon syndrome

77
Q

painless large maroon / burnt tarry stool, and patient with anemia?
The Rule?
Dx w/ what?

A

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

78
Q

treatment rec for toddler’s diarrhea and clue about the dx?

A

no diarrhea at night
increase fat intake to slow transit, decr carbs/total fluid
*death by sippy cup!

79
Q

most common cause of rectal prolapse?

A

chronic constipation

80
Q

how does ibuprofen cause gastric ulcers?

A

inhibits prostaglandin synthesis

81
Q

GI med that can cause gynecomastia

A

reglan

82
Q

chronic watery diarrhea after camping trip or bad water or daycare
Dx?
Test of Dx?

A

Giardia

Entero test ELISA, string test

83
Q

best oral rehydration solutions contain what % gluc and what % NaCL?

A

2% gluc

90 mEQ NACL

84
Q

what is used to find WBC in stool?

A

methylene blue - neutrophils

85
Q

options for prophylaxis of travelers diarrhea?

A

bismuth subsalicylate or bactrim. Usu not needed

86
Q

fever, HA, Abd pain, muscle aches, rose spots
diarrhea NON bloody?
Dx / Bug?
Tx

A

Salmonella –> typhoid fever

Tx: None for just diarrhea. For typhoid systemic disease: CTX and cefotax if bactrim resistance

87
Q

seizures and diarrhea watery –> bloody

Tx

A

shigella

Bactrim

88
Q

Tx of campylobacter

A

erythro / azithromycin

89
Q

Tx for cdiff < 6 mos kid

A

NONE, normal carriers unless sx

90
Q

bug that looks like appendicitis and tx?

A

Yersinia

None if limited to GI

91
Q

2 Tests for sugar malabsortion causing chronic diarrhea?

A
  1. clinitest for reducing substances (all except sucrose) in stool
  2. Hydrogen breath test: normal gut should ferment the sugar and release H
92
Q

Tests for fat malabsorption

A
  1. fecal fat 3 day

2. serum carotene and prothrombin time: indirect for Vit A and Vit K

93
Q

link between neuroblastoma and diarrhea?

A

vasoactive intest peptide

94
Q

steatorrhea and acanthocytosis (spiny RBCs), retinal damage and neuro findings
Dx?

A

abetalipoproteinemia

95
Q

protein losing enteropathy with hypoproteinemia, hypogammaglobulinemia, steatorrhea, lymphedema, lymphopenia

A

intestinal lymphangiectasia

96
Q

polyhydramnios and nonbilious vomiting in LBW newborn

Imaging study will show radiolucent filling defect in prepyloric region

A

Antral web

97
Q

Risk fact for Pyloric stenosis

A

mother w/ PS

98
Q

numbers to remember for pyloric length and thickness in ultrasound dx of pyloric stenosis

A

length > 14mm

thickness > 4mm

99
Q

bilious vomiting, rt sided abd distension, Ladd bands constricting large/small bowel, gastric and duodenal dilation, decr intestingal air, corkscrew appearance of duodenum

A

Volvulus!

100
Q

zofran mech of action

A

serotonin receptor antagonist

101
Q

large cyst on floor of mouth and tx

A

ranula

excision

102
Q

swelling of parotid gland, dry mouth, poor tears

Dx?

A

Mikulicz’s disease (large gland in head/neck syndrome)

Large bottles of milk replacing ducts / parotids

103
Q

cause of parotitis with high fever and marked tenderness

A

s aureus

104
Q

too few teeth or underdeveloped teeth
Dx and test
genetics
The main DDX

A

Ectodermal hypoplasia, x-linked, skin bx shows no sweat pores
DDX: Hallermann Streiff syndrome w/ underdeveloped small teeth but no sweat gland issues

105
Q

dx with too many teeth

A

Gardner’s syndrome

106
Q

prostaglandin analogue used in peptic ulcer disease?

A

misoprostol

107
Q

Dx steps for H pylori

Tx

A

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

108
Q

How to dx Zollinger Ellison

A

fasting gastrin level

109
Q

pancreatic insuff with skeletal and bone marrow issues?

A

Shwachman Diamond syndrome

110
Q

risk of Colon cancer in UC?

A

20%/10 yrs after first 10 yrs of disease

111
Q

concern when child > 6 gets intussussception

A

lymphosarcoma - lead point

112
Q

normal time to pass a stool in newborn

A

99% in 1st 24h, 1%in 48. If not think CF or hirsh

113
Q

polyps that are and aren’t assoc w incr malignancy/

A

GArdners: yes

juvenile polyp: NO

114
Q

geographic location for entamoeba histolytica
dx test
tx

A

south, indian reservation
positive serology to confirm the dx
flagyl for colitis / liver abscess
iodoquinol if asx

115
Q

diagnostic test for cholestatic jaundice?

A

hepatobiliary scintigraphy

116
Q

Diagnostic test series for suspected biliary atresia?

A

US –> HIDA scan –> Bx

117
Q

Treatment of Wilson’s and its s/e

A

penicillamine

s/e: aplastic anemia

118
Q

besides wilson, dz causing increased copper

A

chronic active hepatitis

119
Q

“Diagnostic test” for pancreatitis?

more specific lab test?

A

US

lipase: specific

120
Q

How to dx Hep A

Common group involved?

A

IgM Ab for recent disease x 6 mos. IgG persist for life / gives immunity
Alaskans and Native Americans NOT Asians

121
Q

hep B + Hep D causes what

A

can create a severe acute hepatitis and resultant cirrhosis

122
Q

hepatitis in Asia, Africa, Mexico?

A

Hep E

Laughing Pedi (24 decks)

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