GI Flashcards
What is eosinophilic esophagitis? Treatment?
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
What is suggested by bilious emesis (green vomit)?
Intestinal obstruction (e.g. intussusception, malrotation)
What is malrotation associated with?
Omphalocele, diaphragmatic hernia, heterotaxy syndrome
How is gut malrotation diagnosed?
Upper gastrointestinal series
Intussusception risk factors and treatment
Recent viral illness or rotavirus vaccination
Air or saline enema
Surgical if enema fails, signs of peritonitis, or signs of mass lesion
When does intussusception present?
6-36 months
Riboflavin (B2) deficiency
Cheilosis, glossitis, and seborrheic dermatitis
Niacin (B3) deficiency
4Ds: Diarrhea, dermatitis, dementia, death
Dermatitis is well-demarcated in sun-exposed areas, looks like sunburn
Signs of galactosemia
Jaundice and hepatomegaly
Vomiting, poor feeding/failure to thrive
Cataracts
Increased risk for E coli sepsis
What metabolic disease predisposes to E coli sepsis?
Galactosemia - excessive galactose inhibits leukocyte function and superoxide release
Galactosemia treatment
Soy-based formula
What metabolic disease has impaired NADPH production?
Glucose-6-phosphate dehydrogenase deficiency
Signs of biliary atresia
Acholic stool
Direct hyperbilirubinemia
Dark urine
Hepatomegaly
Meckel diverticulum produces what kind of stool?
Bloody, painless
What is Peutz-Jeghers syndrome?
GI tract hamartomatous polyposis
How to diagnose Hirschsprung disease
Rectal suction biopsy (gold standard)
Anorectal manometry, contrast enema (adjuncts)
Meconium ileus is associated with what disorder?
Cystic fibrosis
How to diagnose meconium ileus
Water-soluble contrast enema
What is the Meckel diverticulum rule of 2s?
Presentation often by age 2 (but any age)
Usually <2 inches long
Location within 2 feet of ileocecal valve
What is most common cause of small bowel bleeding in children?
Meckel diverticulum - from failed closure of vitelline duct
Why can Meckel cause bleeding?
Ectopic gastric mucosa –> intestinal ulceration and bleeding
Remant of the fetal vitelline duct
How do diagnose Meckel?
Technetium-99m pertechnetate scan
How to diagnose pyloric stenosis?
Ultrasound
Treatment for biliary atresia
Kasai procedure - hepatoportoenterostomy - diverts bile to SI
Performed before age 2 months
Liver transplantation is often ultimately required
What would liver ultrasound show in biliary atresia? What is definitive diagnosis?
Small/absent gallbladder
Triangular cord sign (fibrous remnants above the porta hepatis)
Definitive diagnosis: intraoperative cholangiography or liver biopsy
What is hemophagocytic lymphohistiocytosis?
Systemic inflammation with:
Cholestasis –> elevated direct bilirubin + GGT
Bone marrow failure –> cytopenia and low reticulocyte count
What is progressive familial intrahepatic cholestasis?
Rare genetic: elevated direct bilirubin with paradoxically normal GGT
Why is biliary cyst dangerous?
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
Treatment for GERD in infants
Famotidine
What fecal test is typically positive in IBD?
Fecal calprotectin - protein found within neutrophils
Salicylate toxicity has what early sign?
Tinnitus
Signs of iron toxicity
Abdominal pain, vomiting, diarrhea, bleeding (hematemesis, melena)
Hypovolemic shock within hours of ingestion due to volume loss
Diagnosis of midgut volvulus in a hemodynamically stable patient
Upper GI series with small bowel follow-through: gold standard
Biliary cyst is what?
Intra- or extrahepatic cystic dilation of biliary tree
Most common subtype (type 1) is cystic dilation of common bile duct
How might Eastern Asians have higher indirect bilirubin at 2-4 days old?
Decreased UGT enzyme than others (which normally doesn’t reach adult levels until 2 weeks) –> decreased conjugation of bilirubin –> decreased hepatic bilirubin clearance
What persona/family history is commonly seen in cyclic vomiting syndrome?
Personal or family history of migraines
Episodes often have identifiable trigger (eg infection, stress)
Diagnosis of exclusion
Cyclic vomiting syndrome - treatment
Abortive - triptans
Supportive - antiemetics, rehydration
PPI for infant GERD increases risk for what?
Pneumonia, diarrhea
Biliary cyst is associated with what abnormality?
Anomalous pancreatobiliary junction - abnormality long common channel predisposes to reflux, forming biliary cyst and/or pancreatitis
What is Reye syndrome?
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
Intestinal atresia vs malrotation with volvulus
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
Jejunal atresia caused by…
Cocaine or other vasoconstrictive substances during pregnancy
