GI Flashcards
Triad of biliary colic
RUQ pain
Vomiting
Jaundice
2 ways to diagnose lactase deficiency
Hydrogen urea breath test
Dietary elimination
How long is the contagious period for Hep A?
2 weeks before
7 days after onset of symptoms
Who needs Hep A prophylaxis
Household contacts
Sexual partners
Needle sharing partners
Daycare and nursing home attendees and staff
Prophylaxis for Hep A
Hep A vaccine = > 1 year
Hep A Ig = < 1 year
Ideally within 2 weeks of exposure
Psittacosis
Bird fever
Symptoms range from asymptomatic to severe (fever, pneumonia, headaches)
Tx: doxycycline
Legionella
Fresh water
Symptoms: pneumonia, cough, chest pain, fever, can get abdo pain, headache, diarrhea
Tx: cephalosporin and macrolide
Q fever
Barnyard dust
Reservoirs are cattle, sheep, goats
Symptoms: high fever, headache, cough, GI sx, arthralgias, pericarditis, hepatitis, rhabdo, HSM
Tx: doxycycline
Most common blood borne infection transmitted post blood transfusion
Hep B
Most common
1. extrahepatic
2. intrahepatic
causes of portal hypertension
- Portal vein thrombosis
- Cirrhosis
Clinical manifestations of portal HTN
GI bleeding
Splenomegaly
Ascites
Growth delay
Hepatic encephalopathy
Pulmonary complications
Non pharm management for GERD
Thickened feeds
Modify feeding volumes and frequency
2-4 week trial of extensively hydrolyzed formula (same sx as CMPA)
Course of pharm treatment for GERD
4-8 weeks
Needs reassessment
How to manage coin in stomach
Conservative management
Repeat XR in 2 weeks
Endoscopic removal if not passed in 2-4 week
Which antigens/antibodies are positive if an infant is immunized against Hep B
Surface antigen negative (is not infected)
Core antibody negative (has never seen the actual virus)
Surface antibody positive (has been immunized)
E antigen negative (virus is not actively replicating)
How to manage newborn born to mom who is Hep B positive
Hep B vaccine within 12 hours of birth
Hep Ig can be delayed up to 7 days if serology is pending, otherwise give right away
Red flags on constipation history/exam
Constipation starting at <1 mo of life
Passage of meconium > 48 hours
Family history of Hirschsprung’s
Ribbon stools
Blood in the stools without anal fissures
FTT, fever, bilious vomiting
Abnormal thyroid gland
Severe abdo distension
Perianal fistula
Abnormal position of the anus, gluteal cleft deviation
Absent anal or cremasteric reflex
Decreased lower extremity strength/tone/reflex
Sacral dimple, tuft of hair on spine
Extreme fear during anal inspection, anal scars
5 day bilirubin photo cut offs for
1. High risk
2. Medium risk
3. Low risk
- 250
- 300
- 350
Autoantibodies to check for in AIH
ANA
Anti-smooth muscle Ab
Anti-liver-kidney microsomal Ab
Wilson disease manifestations
Kayser Fleisher rings
Hepatic (hepatomegaly, hepatitis, can progress to liver failure)
Neuro (school troubles, tremors, slurred speech, dystonia)
Psychiatric dysfunction
Fanconi syndrome
Hemolytic anemia
Diagnosis of Wilson disease
Treatment
Ceruloplasmin for screening, also 24 h urinary copper
Liver biopsy is gold standard
Tx: limit copper intake, D-penicillamine is chelating agent
Treatment for H pylori
14 days
Amox + clarithro + PPI
Amox + flagyl + PPI
Claritho + flagyl + PP1
Celiac dx presentation
Variable
Malabsorptive diarrhea, constipation
Poor weight gain, short stature, pubertal delay
Abdominal distension
Proximal muscle wasting
Can lead to vitamin D deficiency, hypocalcaemia, and iron deficiency
Rash (dermatitis herpetiformis)
Oral ulcers, dental enamel defects
Peripheral neuropathy
Osteoporosis
Celiac diagnosis
Screen with TTG but ALSO need total serum IgA
Confirm with biopsy of small intestine
Peutz Jegers syndrome
Autosomal dominant
Hamartomatous polyps and mucocutaneous hyperpigmentation of lips and gums
Remove all polyps
Surveillance colonoscopy from 8 yrs or when symptomatic
Infection associated with narrowing of the terminal ileum
Yersinia
Cut offs for overweight vs obese
Overweight: 85th to 95th %
Obese: > 95th %
Risk factors for rectal prolapse
CF
Chronic constipation
Parasites
Ehlers-Danlos
Meingocele
Diarrhea
UC
Malnutrition
Management options for CMPA
Breastfed: cut out dairy and soy, if no response for 2 weeks then can also eliminate egg and corn
Extensively hydrolyzed formula
Amino acid formula
Diagnostic path for EoE
If not on PPI, scope, treat with PPI for 8 weeks, then rescope
If already on PPI then scope
Want to know if PPI responsive or not
Diagnosis made if 15+ eosinophils/hpf
Treatment options for EoE
Consider allergy history +/- food allergy testing
Diet: elimination diet
Steroids: swallowed > oral
Infant dyschezia
10+ mins of straining or crying before stooling
Stool is soft
Due to difficulty coordinating increased intraabdominal pressure and relaxation of the pelvic floor
Provide reassurance, no treatment needed
Should resolve around 9 mo
Triad of choledochal cyst
Abdominal pain
Cholestatic jaundice
RUQ mass
Alagille syndrome
AD
Cholestatic jaundice!
Facial: broad forehead, deep-set and widely spaced eyes, long nose, pointed chin, bulbous nose
Ocular abnormalities: posterior embryotoxin, microcornea, optic disc drusen, shallow anterior champer
Cardiovascular anomalies: PPAS most commonly, TOF, etc
Vertebral defects: butterfly vertebrae
Dx: liver biopsy, genetics
Most will improve over first year of life
Lipid panel in obesity vs familial hyperlipidemia
Obesity: elevated TG
Familial: elevated LDL, tendon xanthomas
When to feed kids with pancreatitis
NPO while vomiting
Early enteral nutrition (48-72 hours)
Criteria for liver failure from acetaminophen overdose
Arterial pH <7.3 (regardless of hepatic encephalopathy)
OR all 3 of the following:
INR > 6.5
Creatinine >300
Hepatic encephalopathy grade 3-4
Treatment for cyclic vomiting if
1. < 5 years
2. > 5 years
- cyproheptadine
- amitriptyline
Indications for probiotics
FGIDs (e.g. IBS)
Prevention of antibiotic associated diarrhea
Reduce incidence of c difficile associated diarrhea, but not for treatment
Colic symptoms
H pylori eradication (along with standard treatment)
Prevention of atopic dermatitis (but not established)
SMA syndrome
Bifurcation of the superior mesenteric artery from the aorta compresses the third portion of the duodenum
Obstruction = bilious vomiting, gastric distension, abdo pain
From decrease in fat pad that cushions the space
Anorexia, post major surgery (esp spinal fusion)
Dx with UGI or CT abdo with contrast
Tx: NG or GJ past obstruction until weight is gained
What genetic phenotype for A1AT is the most severe
ZZ
M is norMal, S is so-so, Z is zero function
ZZ < SZ < MZ < SS < SM < MM
When to avoid soy formula
On thyroxine
Reduces absorption
Rumination syndrome
Vomiting immediately after eating, semi-purposeful and small in volume
Not preceded by retching
Many patients have comorbid anxiety or depression
Treatment is supportive, relying on psychotherapy and CBT
Gastroparesis
Delayed gastric emptying in the absence of mechanical obstruction
Most common cause is post-infectious (neuropathy of the autonomic ganglia via the inflammatory response)
elf-resolves in 1-3 months but can take up to 2 years
N/V, abdo pain, early satiety, distension, wt loss
vomiting undigested food in middle of night
Gastric emptying study is the gold standard for diagnosis
Can be treated with erythromycin ethylsuccinate or metoclopramide if delayed resolution
Which is the best test to check for vitamin D deficiency?
25-hydroxyvitamin D
