GI Flashcards
Sandifer syndrome
spasmodic tordional dystonia; opsthotonic posturing, mainly involving the neck, back and upper extremities, associated with GERD
Diagnosis of reflux/aspiration
video barium swallow
milk scan (less specific, more sensitive)
Salivagram (if likely upper airway secretion aspiration)
BAL (lipid-laden macrophage = aspiration)
evaluation of elevated LFTs in obese child
Don’t forget hepatitis B and C
PSC
autoimmune hepatitis
Tx of hospitalized patients with acute severe colitis
IV steroids
Infliximab
Colectomy if no response 10-12 days after initiation
Fecal lactoferrin
iron-binding protein found inside neutrophils
Sensitive and specific for detecting IBD (but can be positive for any intestinal inflammation)
Appendicitis tx
surgery here in US
Abx only ok in europe
Ddx of infant who is not able to swallow solids
congenital esophageal stricture
Vascular ring
What is the Apt-Downey test and what is the oldest age to test it on
detects fetal hemoglobin
+ means it’s from the baby
- means its maternal
8 week old
How does secondary lactose intolerance happen in celiac disease?
atropy of lactase-containing vili
will resolve when celiac is treated (gluten-free diet)
How do you diagnose lactose intolerance
lactose breath testing
intestinal biopsy (less commonly done)
Chronic vs. acute recurrent vs. acute pancreatitis
Acute (2/3):
1. abd pain epigastric
2. serum amylase/lipase 3x ULN
3. Imaging finding consistent with pancreatitis
Acute recurrent:
At least 2 episodes of AP and 1 of the following
- Complete resolution of pain between AP episodes
- complete normalization of pancreatic enzyme measurements between AP episodes
Chronic (any below)
- Abd pain consistent with pancreatitis
- evidence of exocrine pancreatic insufficiency
- evidence of endocrine pancreatic insufficiency
- biopsy
Causes of Acute recurrent pancreatitis or chronic pancreatitis
CF
Pancreas divisum, annular pancreas
HLD, medications (VPA or 6-MP)
autoimmune pancreatitis
Primary sclerosing cholangitis
What is rectal suction biopsy used to detect?
Hirschsprung
What neonatal diseases is AFP elevated in
omphalocele, gastrocschisis, neural tube defects
High bHCG in early pregnancy ddx
trisomy 21
placental tumor
molar pregnancy
Celiac lab findings
normal pancreatic elastase and elevated fecal fat from fat malabsorption
Syndrome associated with exocrine pancreatic insufficiency
Shwachman Diamond syndrome
Juvenile polyp, signs symptoms, age onset, treatment
1-7 yo
Painless, intermittent rectal bleeding
Polyp in distal colon
Tx: resection. No further follow up for colonoscopy is indicated
UNLESS there is >5 polyps. Then Juvenile polyposis syndrome. Need colonoscopy q1-3y
Villous atrophy and intraepithelial lymphocytosis. dx?
celiac
Common causes of cholestasis in first few months of life. Labs to get
biliary atresia
idiopathic neonatal cholestasis
parenteral nutrition-associated cholestasis (TPN)
Obstruction (bile stone, choledochal cyst)
CF
Metabolic/endocrine disorder (e.g. tyrosinemia)
Panhypopituitarism
Alagille syndrome
Labs: alpha1 antitrypsin lvl, TFT, Abd US, review newborn screen
Liber biopsy for those with biliatry atresia would show
evidence of fibrosis
bile duct plugging
bile ductal proliferation
Tx of biliary atresia
Kasai hepatoportoenterostomy (HPE) – re-establish bile flow before age 90 days
May need liver transplant (cirrhosis, portal htn)
Ddx of rectal prolapse, when to be concerned
<4yo due to normal anatomy
If >4yo, usually abnormal
Usual etiology:
constipation, severe chronic cough.
Rectal poplyp
Hirschsprung
Causes of dysphagia in young people (teen and young adult)
EoE
need EGD
Tx of EoE
3-6 food elimination
topical steroids (fluticasone or oral viscous budesonide)
PPI
If doesnt respond, may need elemental formula
When does biliary atresia present?
After the first few weeks of life
Crigler-Najjar. Problem is conjugated or unconjugated hyperbilirubinemia?
unconjugated
Gilbert syndrome, conjugated or unconjugated problem hyperbilirubinemia?
unconjugated
Physiologic neonatal jaundice is caused by what immature enzyme?
bilirubin uridine diphosphate-glucoronosyltransferase BUGT
Also increased enterohepatic circulation of unconjugated bilirubin, and increased bilirubin from hemolysis of RBCs
Physiologic neonatal jaundice is caused by what immature enzyme?
bilirubin uridine diphosphate-glucoronosyltransferase BUGT
Also increased enterohepatic circulation of unconjugated bilirubin, and increased bilirubin from hemolysis of RBCs
Dx of functional constipation
2 or less defacations in the toilet per week
At least 1 episode of fecal incontinence per week, history of stool retention, hx of painful/hard bowel movements, rectal fecal mass, large-diameter stools that may obstruct the toilet
CF in infants, signs/symptoms
hepatomegaly
steatorrhea
severe diaper dermatitis
malnutrition
Superior Mesenteric artery syndrome sx
significant weight loss followed by bilious emesis
Causes of emesis you should not forget about
malrotation
volvulus (corkscrew)
duodenal atresia (double bubble)
EoE
abdominal migraine
pyloric stenosis
How does hypophosphatemia occur in refeeding syndrome?
increased phosphate use in production of ATP
Other electrolyte abnormalities in refeeding sd besides hypophos
- hypomag
- hypo K (increased insulin from sudden hyperglycemia)
- hypo-thiamine
