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Peds > GI > Flashcards

GI Flashcards

1
Q

What is eosinophilic esophagitis? Treatment?

A

Th2 inflammatory response from food antigen exposure –> difficulty swallowing
Comorbid atopy common

Cannot progress from purees to solid food –> weight loss

Treatment: Food modification, feeding therapy for maladaptive behaviors, pharmacologic PPI and topic swallowed glucocorticoids

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2
Q

What is suggested by bilious emesis (green vomit)?

A

Intestinal obstruction (e.g. intussusception, malrotation)

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3
Q

What is malrotation associated with?

A

Omphalocele, diaphragmatic hernia, heterotaxy syndrome

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4
Q

How is gut malrotation diagnosed?

A

Upper gastrointestinal series

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5
Q

Intussusception risk factors and treatment

A

Recent viral illness or rotavirus vaccination

Air or saline enema
Surgical if enema fails, signs of peritonitis, or signs of mass lesion

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6
Q

When does intussusception present?

A

6-36 months

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7
Q

Riboflavin (B2) deficiency

A

Cheilosis, glossitis, and seborrheic dermatitis

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8
Q

Niacin (B3) deficiency

A

4Ds: Diarrhea, dermatitis, dementia, death

Dermatitis is well-demarcated in sun-exposed areas, looks like sunburn

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9
Q

Signs of galactosemia

A

Jaundice and hepatomegaly
Vomiting, poor feeding/failure to thrive
Cataracts
Increased risk for E coli sepsis

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10
Q

What metabolic disease predisposes to E coli sepsis?

A

Galactosemia - excessive galactose inhibits leukocyte function and superoxide release

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11
Q

Galactosemia treatment

A

Soy-based formula

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12
Q

What metabolic disease has impaired NADPH production?

A

Glucose-6-phosphate dehydrogenase deficiency

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13
Q

Signs of biliary atresia

A

Acholic stool
Direct hyperbilirubinemia
Dark urine
Hepatomegaly

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14
Q

Meckel diverticulum produces what kind of stool?

A

Bloody, painless

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15
Q

What is Peutz-Jeghers syndrome?

A

GI tract hamartomatous polyposis

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16
Q

How to diagnose Hirschsprung disease

A

Rectal suction biopsy (gold standard)
Anorectal manometry, contrast enema (adjuncts)

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17
Q

Meconium ileus is associated with what disorder?

A

Cystic fibrosis

18
Q

How to diagnose meconium ileus

A

Water-soluble contrast enema

19
Q

What is the Meckel diverticulum rule of 2s?

A

Presentation often by age 2 (but any age)
Usually <2 inches long
Location within 2 feet of ileocecal valve

20
Q

What is most common cause of small bowel bleeding in children?

A

Meckel diverticulum - from failed closure of vitelline duct

21
Q

Why can Meckel cause bleeding?

A

Ectopic gastric mucosa –> intestinal ulceration and bleeding

Remant of the fetal vitelline duct

22
Q

How do diagnose Meckel?

A

Technetium-99m pertechnetate scan

23
Q

How to diagnose pyloric stenosis?

A

Ultrasound

24
Q

Treatment for biliary atresia

A

Kasai procedure - hepatoportoenterostomy - diverts bile to SI
Performed before age 2 months
Liver transplantation is often ultimately required

25
Q

What would liver ultrasound show in biliary atresia? What is definitive diagnosis?

A

Small/absent gallbladder
Triangular cord sign (fibrous remnants above the porta hepatis)

Definitive diagnosis: intraoperative cholangiography or liver biopsy

26
Q

What is hemophagocytic lymphohistiocytosis?

A

Systemic inflammation with:
Cholestasis –> elevated direct bilirubin + GGT
Bone marrow failure –> cytopenia and low reticulocyte count

27
Q

What is progressive familial intrahepatic cholestasis?

A

Rare genetic: elevated direct bilirubin with paradoxically normal GGT

28
Q

Why is biliary cyst dangerous?

A

30x higher risk of malignancy (cholangiocarcinoma, GB, pancreatic cancer)

Must remove with surgery, then replace with roux-en-Y hepaticojejunostomy
Follow up with serial labs +/- imaging

29
Q

Treatment for GERD in infants

A

Famotidine

30
Q

What fecal test is typically positive in IBD?

A

Fecal calprotectin - protein found within neutrophils

31
Q

Salicylate toxicity has what early sign?

A

Tinnitus

32
Q

Signs of iron toxicity

A

Abdominal pain, vomiting, diarrhea, bleeding (hematemesis, melena)
Hypovolemic shock within hours of ingestion due to volume loss

33
Q

Diagnosis of midgut volvulus in a hemodynamically stable patient

A

Upper GI series with small bowel follow-through: gold standard

34
Q

Biliary cyst is what?

A

Intra- or extrahepatic cystic dilation of biliary tree
Most common subtype (type 1) is cystic dilation of common bile duct

35
Q

How might Eastern Asians have higher indirect bilirubin at 2-4 days old?

A

Decreased UGT enzyme than others (which normally doesn’t reach adult levels until 2 weeks) –> decreased conjugation of bilirubin –> decreased hepatic bilirubin clearance

36
Q

What persona/family history is commonly seen in cyclic vomiting syndrome?

A

Personal or family history of migraines
Episodes often have identifiable trigger (eg infection, stress)

Diagnosis of exclusion

37
Q

Cyclic vomiting syndrome - treatment

A

Abortive - triptans
Supportive - antiemetics, rehydration

38
Q

PPI for infant GERD increases risk for what?

A

Pneumonia, diarrhea

39
Q

Biliary cyst is associated with what abnormality?

A

Anomalous pancreatobiliary junction - abnormality long common channel predisposes to reflux, forming biliary cyst and/or pancreatitis

40
Q

What is Reye syndrome?

A

Aspirin after viral illness –> impaired fatty acid metabolism due to mitochondrial dysfunction –> liver failure –> ammonia accumulation –> astrocyte edema

Encephalopathy, cerebral edema, vomiting –> seizure, coma, death

Total bilirubin is normal

41
Q

Intestinal atresia vs malrotation with volvulus

A

Intestinal atresia is within days of birth; use X-ray, double bubble

Volvulus is any age, but usually <4 weeks; use upper GI series, corkscrew duodenum, right-sided ligament of Treitz

42
Q

Jejunal atresia caused by…

A

Cocaine or other vasoconstrictive substances during pregnancy

Peds (25 decks)

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