GI Flashcards
treatment appendicitis
appendectomy
-give 3rd gen cephalosporin pre-op (remember ONE/TEN/ME for cephs) and if appendix is perf, continue it post-op
what is colic
severe and paroxysmal crying, usually in the evening
when does colic peak
2-3 months, ends around 4 months
rule of 3’s for colic
cry > 3 hrs/day, 3 d/wk, for 3 weeks
childhood constipation is almost always {what type of constipation}
functional
what diagnostic criteria is used to dx constipation
what imaging might you get
Rome III criteria
may have to get abdominal XR
Rome III criteria for constipation
At least two of the following in a child with a developmental age younger than four years
Two or fewer bowel movements per week
At least one episode of incontinence per week after the acquisition of toileting skills
History of excessive stool retention
History of painful or hard bowel movements
The presence of a large fecal mass in the rectum
History of large-diameter stools that may obstruct the toilet
At least two of the following in a child with a developmental age of four years or older with insufficient criteria for irritable bowel syndrome
Two or fewer bowel movements in the toilet per week
At least one episode of fecal incontinence per week
History of retentive posturing or excessive voluntary stool retention
History of painful or hard bowel movements
The presence of a large fecal mass in the rectum
History of large-diameter stools that may obstruct the toilet
MC triggers for constipation
transitioning to solid foods from breastmilk and formula, potty training, and starting school
tx constipation
increase fiber 11-24 g/day
decrease cow’s milk
mineral oil
polyethylene glycol
lactulose
bathroom training
what are the most accurate signs in dehydration
prolonged capillary refill, poor skin turgor, and abnormal breathing
what is duodenal atresia
complete absence or closure of a portion of the duodenum leading to a gastric outlet obstruction
what other issues is duodenal atresia associated with
down syndrome
polyhydramnios (be more suspicious of duodenal atresia if polyhydramnios is present)
sx duodenal atresia
bilious emesis within 24 hours after birth
abdominal distention
emesis worse with feeding
failure to pass meconium
dx duodenal atresia
abdominal XR - double bubble sign - distended air-filled stomach + smaller distended duodenum separated by the pyloric valve
tx duodenal atresia
non-emergent surgical correction
NG decompression
fecal incontinence is also called
encopresis
how old do you have to be to be dx with encopresis
4 or older
encopresis is almost always associated with
severe constipation
what diagnostic imaging should be obtained for encopresis
KUB, rectal exam
Traveler’s diarrhea
e coli
Diarrhea after a picnic and egg salad
staph aureus
Diarrhea from shellfish
vibrio cholera
Diarrhea from poultry or pork
salmonella
Diarrhea in a patient post-antibiotics
c diff
Diarrhea in poorly canned home foods
C. perfringens
Diarrhea breakout in a daycare center
Rotavirus
Diarrhea on a cruise ship
norovirus
Diarrhea after drinking (not so) fresh mountain stream water
Giardia lamblia – incubates for 1-3 weeks, causes foul-smelling bulky stool, and may wax and wane over weeks before resolving
what is frequently associated with GERD
hiatal hernia
what is a significant risk factor for GERD
obesity
pathophys of GERD
hypotensive LES or transient LES relaxations
sx GERD
heartburn (pyrosis) and regurgitation
heartburn - burning sensation in retrosternal area after eating, worse when supine; relieved with antacids (usually)
regurgitation - sour/acidic taste in mouth
criteria standard dx for GERD and what should you do if alarm features
pH monitoring - < 4 = diagnostic
upper endoscopy if alarm features
tx GERD
diet modifications
H2RAs (sx < once weekly) - famotidine for example
PPI (2 or more episodes per week) - omeprazole for example
what is the MC cause of cholestasis in newborn
neonatal hepatitis
Hirschsprung disease is also called
congenital aganglionic megacolon
what is the cause of Hirschsprung disease
absence of ganglion cells in the mucosal and muscular layers of the colon leading to a functional obstruction (failure of colonic muscles to relax)
what organs are MC affected in Hirschsprung disease
rectum and part of the sigmoid colon
who is more likely to get Hirschsprung disease, M or F?
M 4:1
sx Hirschsprung disease
neonatal large bowel obstruction –> meconium ileus within first 48 hours of life
bilious vomiting
progressive abdominal distention
poor feeding –> failure to thrive
PE for Hirschsprung disease
no stool in rectal value bc of the tight anal sphincter
abdominal distention
tx Hirschsprung disease
surgical resection
how to remember the location of indirect vs direct inguinal hernia
MDs LIe
Medial (to the inferior epigastric artery) = direct
Lateral (to the inferior epigastric artery) = indirect
what is hesselbach’s triangle composed of (inguinal hernia anatomy)
RIP - rectus abdominis (medial border), inferior epigastric vessels (lateral border), poupart’s (inguinal) ligament (inferior border)
what is the MC type of hernia in both sexes, young children, and adults
indirect hernia
indirect hernia is due to
persistent patent processes vaginalis
sx indirect hernia
asx
may develop scrotal swelling
incarcerated - painful, enlargement of irreducible hernia
strangulated - irreducible hernia with compromised blood supply + toxicity
sx direct hernia
asx, swelling at hernia site
incarcerated - painful, irreducible
strangulated - irreducible + compromised blood supply + toxicity
dx inguinal hernia
clinical
groin US initial
CT if unsure or possibility of strangulation
tx inguinal hernia
surgical repair with mesh
strangulated = medical emergency
what is intussusception and what place is MC involved?
telescoping (invagination of an intestinal segment into the adjoining distal intestinal lumen leading to bowel obstruction
Ileocolic junction MC (ileum + cecum)
what is the most common cause of bowel obstruction in infants and young kids
intussusception
MCC of intussusception
idiopathic (75%)
sx intussusception
triad - vomiting + abdominal pain + passage of blood per rectum – currant jelly stools (stool mixed with blood and mucus)
abdominal pain is usually severe, crampy, and progressive
vomiting may be bilious
PE for intussusception
sausage-shaped mass may be palpation in mid-right upper abdomen + emptiness in right lower quadrant (Dance’s sign)
may have positive guaiac if currant jelly stool
Dx for intussusception
Make sure to remember what type of contrast
US - best initial; donut, target, or bull’s eye sign - concentric alternative echogenic and hypo echoic bands
air or contrast enema - diagnostic and therapeutic; air enema MC»_space;
water-soluble contrast»_space; barium
Tx intussusception
initial - fluid and electrolyte replacement
pneumatic (air) decompression enema
surgery if air enema fails
when is hyperbilirubinemia considered pathologic in a newborn
within the first 24 hours of life
what type of hyperbilirubinemia in dubin-johnson syndrome
direct (conjungated) = dubin-johnson
sx dubin-johnson syndrome
usually asx
generalized constitutional sx
mild icterus
dx dubin-johnson syndrome
mild, isolated conjugated hyperbilirubinemia - can increase w illness, pregnancy, contraception
bx - grossly black liver and dark granular pigment in hepatocytes
tx dubin-johnson syndrome
no treatment
inheritance for crigler-najjar syndrome
autosomal recessive
what type of hyperbilirubinemia in crigler-najjar syndrome
unconjugated = crigler-najjar
what is the cause/pathophysiology of crigler-najjar syndrome
decreased glucuronosultransferase (UGT) enzyme which converts indirect bilirubin to direct
different types of crigler-najjar syndrome
type 1 - no UGT activity
type 2 - markedly reduced UGT activity
sx crigler-najjar syndrome
type 1 - neonatal jaundice w severe progression –> kernicterus
type 2 - asx
dx Crigler-najjar syndrome
isolated indirect (unconjugated) hyperbilirubinemia
molecular testing for mutations in the bilirubin-UGT1 A1 gene
normal hepatic bx
tx crigler-najjar syndrome
type 1 - chronic daily phototherapy
type 2 - no tx usually - can use phenobarbital
what type of hyperbilirubinemia of Gilbert’s syndrome
mild isolated unconjugated (indirect) = Gilbert’s
what is the cause/pathophysiology of Gilbert’s syndrome
reduced uridine diphosphoglucuronate-glucuronosyltransferase 1A1 (UGT1A1)
sx Gilbert’s syndrome
transient episodes of jaundice triggered by stress, fasting, alcohol, illness, dehydration, menstruation, overextension
dx Gilbert’s syndrome
slight increase in indirect (unconjugated) bilirubin
tx Gilbert’s
no tx
lactose intolerance is due to
low levels of lactase enzyme in SMALL INTESTINE
test of choice for lactose intolerance
mainly a clinical dx
hydrogen breath test -hydrogen produced when colonic bacteria ferment undigested lactose
B3 is also called
niacin
niacin is also called
B3
what is the MCC of B3 deficiency
alcohol use
what is the clinical name for B3/niacin deficiency
pellagra
sx of pellagra
dermatitis - photosensitive hyper pigmented dermatitis (pigmentation and scaling similar to sunburn, esp on sun-exposed areas
diarrhea - due to malabsorption and proctitis
dementia - irritability, anxiety, insomnia, disorientation, delusions, dementia, encephalopathy
what is another dermatologic manifestation of pellagra
casal’s necklace - ring dermatitis around the neck
tx pellagra
oral supplementation w 100-200 mg of nicotinamide or nicotinic acid 3x daily for 5 days
what is pyloric stenosis
hypertrophy and hyperplasia of the pyloric muscles causing a functional gastric outlet obstruction leading to non bilious vomiting, dehydration, and ALKALOSIS in infants < 12 weeks
when is pyloric stenosis MC
3-12 weeks of life
what sex is more likely to get pyloric stenosis
M : F
4 : 1
what abx are a huge risk factor for pyloric stenosis
macrolides - esp erythromycin and azithromycin when given < 2 weeks of age
sx pyloric stenosis
non bilious, forceful vomiting esp AFTER feeding
strong!!! appetite — “hungry vomiter”
what is the nickname for an infant who has pyloric stenosis
“hungry vomiter”
PE for pyloric stenosis
olive sign - palpable pylorus; olive-shaped NONTENDER, mobile hard 1-2 cm mass RUQ esp after emesis
have have dehydration
Dx for pyloric stenosis
US - elongated, thickened pylorus - also called a target sign on transverse view
upper GI series - string sign - narrowed elongated pyloric channel
lab studies for pyloric stenosis
hypochloremic hypokalemic metabolic alkalosis from vomiting
tx pyloric stenosis
surgical pylorotomy after fluid and electrolyte correction
when does umbilical hernia usually resolve
by 2 years
when should surgery be performed for umbilical hernia
5 years or older or incarcerated/strangulated
sx vitamin A deficiency
night blindness
xerophthalmia (dry eyes)
bitot’s spots - white spots on conjunctiva due to squamous metaplasia of the corneal epithelium
dx vitamin A deficiency
clinical; decreased serum retinol levels
what is the syndrome of vitamin C deficiency called
Scurvy
sx scurvy
hyperkeratosis - hyperkeratotic follicular papules (keratosis pilaris?) surrounded by hemorrhage
hemorrhage - vascular fragility w recurrent hemorrhages into the gums, skin, joints; impaired wound healing
hematologic - anemia, glossitis, malaise, weakness, increased bleeding time
dx scurvy
clinical
serum ascorbic acid levels
leukocyte ascorbic levels more accurate
vitamin C is also called
ascorbic acid
ascorbic acid is also called
vitamin C
vitamin D deficiency can cause what 2 clinical syndromes
osteomalacia (adults MC but also kids)
rickets (kids)
sx osteomalacia
diffuse bone pain + tenderness
proximal muscular weakness
bowing of long bones (waddling)
dx osteomalacia
decreased calcium
decreased phosphate
decreased 25-hydroxyvitamin D
increased PTH
radiographs - looser lines (femoral neck, shaft, and trochanter)
definition of osteomalacia
decreased bone mineralization
definition of rickets
decreased cartilage at the growth plates
sx rickets
delayed fontanel closure
craniotabes (soft skull bones)
growth dleays
genu varum (lateral bowing of the femur and tibia)
dx rickets
same levels as for osteomalacia
radiographs - widening of epiphyseal plate, costochondral junction enlargement (rachitic rosary), & long bones have a fuzzy appearance
