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Special Pops- Peds > GI > Flashcards

GI Flashcards

1
Q

What is GERD

A

post prandial regurgitation

• 85% resolves by 12 m, mostly benign and self limiting

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2
Q

What are 5 disorders of the esophagus?

A 
Gastroesophageal Reflux
Eosinophilic Esophagitis
Achalasia of the Esophagus
Caustic Burns of the Esophagus
Foreign Bodies of the Alimentary Tract
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3
Q

What are some complications of GERD?

A

apnea, aspiration, irritability, neck contortions
o sandifer syndrome→ severe form of reflux when they arch their back and turn their head to the side
o RED FLAG: bilious vomitus→ could be malrotation with volvulus, insussuception

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4
Q

4 Ways to diagnose GERD?

A
  • Antacid trial→ diagnostic & therapeutic
  • UGI: r/o anatomic probs, non specific
  • pH probe
  • Esophagoscopy: evaluate the esophagitis
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5
Q

Treatment for GERD?

A

• Smaller more frequent meals, thickened foods, H2 antagonists, hydroxylated formulas, fundoplication

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6
Q

Eosinophilic Esophagitis

A
  • MC in boys
  • Sx similar to gerd, with dysphagia→ don’t respond to antacids
  • Endoscopy→ white exudate w/eosinophils, hypertrophied mucosal ring
  • Skin testing may show allerfins to foods
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7
Q

3 treatments for Eosinophilic Esophagitis?

A

o Exclusion/elimination diet
o Inhailed steroids
o Esophageal dilation for strictures

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8
Q

Achalasia of the Esophagus

A
  • MC in kids over 5

* SX→ dysphagia, posprandial vomiting, retrosternal pain, early satiety, weight loss, solid food impaction,

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9
Q

Caustic Burns of the Esophagus symptoms?

A

pH12= larger volume of ingestion=liquefaction necrosis

• Sx→hoarseness, stridor, drooling, food refusal, dyspnea

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10
Q

Caustic Burns of the Esophagus is caused by?

A

• Caused by→ gels/powders (dishwashing detergent)

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11
Q

Caustic Burns of the Esophagus Dx and complications

A
  • Dx→ endoscopy72 hrs could be perfed

* Complications→ full thickness necrosis , can lead to stricture

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12
Q

Caustic Burns of the Esophagus

A

• Tx→ repeated esophageal dilation, colonic interposition/gastric tube for strictures resistant to dilation

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13
Q

Foreign Bodies in GI Tract:

A
  • 80-90% pass, MC are coins, things with heavier blunt ends pass w/out problem
  • Removal: button batteries, open safety pins, more than one magnet, objects > 5cm. wooden tooth picks
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14
Q

3 disorders of the stomach and duodenum

A

Pyloric stenosis
Gastric & duodenal ulcer
Congenital duodenal obstruction

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15
Q

Pyloric Stenosis

A

MC males, 13% fam hx,

• Sx→2-12 weeks of posprandial nonbilious projectile vomiting, ravenous appetitie after vomiting

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16
Q

What are 3 findings on PE for pyloric stenosis?

A

o Dehydration, hypochloremic lkalosis
o RUQ/epigastric “olive”
o Gastric wave=pathognmomonic

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17
Q

Work up for pyloric stenosis

A

o UGI→ long narrow pyloric channel (dbl track sign), tightened pyloris
o U/S→ hypoechoic mass, thickness, pyloric lenghth over 15mm

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18
Q

Treatment for pyloric stenosis?

A

o Pyloromyotomy

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19
Q

Gastric & Duodenal Ulcer

A

Local erosion of gastric/duodenal mucosa, any age, MC males, often “stressed”/ICU babies
• SX→ pain, bleeding, obstructions, anemia, perforation

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20
Q

MC causes of gastric & duodenal ulcer

A

o Underlying severe illness: CAN, burns, sepsis, cirrhosis, RA
o H.pylori
o NSAIDS, ASA, alcohol
o Toxins

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21
Q

Diagnosis of gastric & duodenal ulcer

A

preferably endoscopy
o UGI may show ulcer, but non specific
o Breath test after PO radioactive-labeled urea→ for H.pylori

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22
Q

Treatment for gastric & duodenal ulcer

A

o H2 receptor agonist & proton pump inhibitors
o 7-14 day course of sucralfate
o Limit caffeine, ASA, alcohol (what the fuck?), NSAIDS
o Amoxicillim, metronidazole, clarithromycin, bismuth subsalicylate for 10-14 days (for h.pylori)
o Amox for 14 days + omeprazole for 6 wka
o Clairthro for 7 days w/PPI for 6 wks

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23
Q

what is Congential Diaphragmatic Hernia

A

→ abd contents herniate through posterolateral defect, diaphragm doesn’t fuse=lung hypoplasia (80% are L.diaphragm)

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24
Q

How is Congenital diaphragmatic hernia usually diagnosed?

A
  • When newborn→ resuscitate, intubate, cant use bag+mask (bowel will inflate)
  • Can be found on CXR by accident
  • Kids w/it often have GERD
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25
Q

Intestinal Atresia & Stenosis:

A

• Usually dx’d prenatally with U/S
• Sx→ bilious vomiting & distension soon after birth
o Associated with: atresias, cardiac & renal anomalies, downs syndrome

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26
Q

how to diagnose and treat Intestinal Atresia & Stenosis:

A
  • X-ray→ double bubble w/gasless bowel

* Tx→ duodenoduodenostomy→ bypasses the stenosis/atresia

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27
Q

Intestinal Malrotation:

A

most present in 1-3 weeks with bilious vomiting leading to obstructions, malabsorption, diarrhea

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28
Q

How to diagnose Intestinal Malrotation:

A

o Plain film→ will see dbl bubble, distal gas
o UGI→ gold standard, 96% sensitivity
o Barium enema for confirmation

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29
Q

How to treat Intestinal Malrotation:

A

o Ladd procedure→ duodenum mobilized, mesenteric root extended, bowel fixed in more normal layout

30
Q

What is short bowel syndrome?

A

when 50% of bowel is removed
• Cant grow in length to compensate, with nutrition enterocytes proliferate and villi lengthen and intestine will elongate in height

31
Q

Causes/ complications/ treatments for Short Bowel Syndrome

A
  • Causes→ necrotized enterocolitis, intestinal atresia, gastroschisis, volvulus, congenital SBS
  • Treatment→ TPN
  • Complications→ liver failure
32
Q

Intussusception

A

MC cause of obstruction in 1st 2 yrs
Cause:
• Often unknown, could be led paint, lymphoma (MC if over 6)

33
Q

How would patient present with Intussusception

A
  • 3-12 mo of abd pain, vomiting, diarrhea, current-jelly stool (mucous w/blood)
  • May be able to palpate sausage shaped mass in upper mid abd
34
Q

How do you treat Intussusception

A
  • Barium + air enemas→ diagnostic & therapeutic

* Surgery if toxic

35
Q

Inguinal Hernia

A

o MC indirect (follow processus vaginalis)
o MC males 9:1
o Presentation→ painless mass
o Incarceration more likely to occur

36
Q

Umbilical Hernia

A

o MC in pre-term
o Often go away on their own if less than 1cm
o If they last for more than 4 yrs, repair it

37
Q

Meckel Diverticulum

A

MC omphalomesenteric duct remnant
• Most complications occur before 2 yo
• Presentation→ rectal bleeding, intestinal obstruction w/volvulus, diverticulitis

38
Q

Acquired Megacolon, Chronic Constipation and/or Encopresis

A

2% of children MC males 4:1 to females
• Chronic constipation (2 or more of the following)
o 1 episode of soiling/week (overflow diarrhea)
o Impaction of rectum w/stool
o Large stools that plug the toilet
o Retentive posturing and fecal withholding
o Tenesmus, meatochezia

39
Q

How to diagnose Acquired Megacolon, Chronic Constipation and/or Encopresis?

A

o Hx of soil pattern, on PE may seen dilated rectum w/impacted stool
o KUB to R/O abnormal bowel

40
Q

Acquired Megacolon, Chronic Constipation and/or Encopresis

A

o Dietary, stool softeners/lubricants, evacuate regularly

41
Q

Congenital Aganglionic Megacolon (Hirschsprung Dz)→

A

absence of ganglion cells in colon, neural crest cells don’t migrate to mesodermal layer in gut

42
Q

What causes Congenital Aganglionic Megacolon (Hirschsprung Dz)

A

genetic

o Familial, 10-15% have down syndrome

43
Q

How does Congenital Aganglionic Megacolon (Hirschsprung Dz) present?

A

o Colonic muscles fail to relax infront of advancing bolus

o Enterocolitis can occur= fever and explosive diarrhea (toxic megacolin)→ can become septic→ can be fatal

44
Q

How to diagnose Congenital Aganglionic Megacolon (Hirschsprung Dz)

A

o DRE→ minimal stool despite abd distension and retained stool on KUB
o Unprepped barium enema→ can see distinct transition pt between narrow distal & dilated proximal colon
o Rectal manometry of “ultra short”

45
Q

How to treat Congenital Aganglionic Megacolon (Hirschsprung Dz)

A

o Surgical resection

46
Q

Appendicitis

A
  • MC age= 15-30

* Not common in toddlers→ hard to dx and often end up with perforation

47
Q

Presentation and treatment of appendicitis

A

• Presentation
o Fever, periumbilical pain, vomiting, (+)CRP, leukocytosis, fecolith on KUB, may see it on U/S
• Treatment:
o Laparotomy/laparoscopy

48
Q

Anterior displacement of anus

A

o Females→ vaginal fourchette to anus
o Males→ base of scrotum to anus
• Presentation→ constipation w/straining
• Treatment→ stool softeners

49
Q

3 types of congenital anorectal anomalies

A

anterior displacement of anus
anal stenosis
imperforate anus

50
Q

Anal Stenosis

A

o Presentation→ ribbon like stools, blood, mucus at rectum, fecal impaction & abd distension, can have fissures
o Treatment→ dilation of anal ring daily for several weeks

51
Q

Imperforate Anus

A

o Presentation→ can’t pass thermometer through, no meconium coming out, often have no anal sphincter or musculature
o Treatment→ surgery

52
Q

Pseudomembranous enterocolitis→ C.diff

A

Starts 1-14 days after abx started to 30 days after abx are d/c
• May be normal flora in up to 50% of new borns who may lack the receptor for the toxin to cause sx
• Treatment: stop abx, then oral canco or metronidazole

53
Q

How does someone with Celiacs Disease present?

A

immune mediated enteropathy triggered by gluten
• Presentation→ abd pain/distension, diarrhea, vomiting, puritic rash, iron-deficiency anemia, decreased bone mineralization, arthritis, delayed puberty/short stature, iron deficiency anemia, elevated liver fxn enzymes, epilepsy w/cerebral calcifications

54
Q

How to diagnose Celiacs Disease?

A

o Bx w/gluten exposure→ Gold standard
o Iga anti-tissue transglutaminase Ab
o Genetic testing: HLA-DQ2 & DBQ
o Stool testing for partially digested fat

55
Q

How do you treat Celiacs Disease?

A

o Gluten free diet, corticosteroids for celiac crisis

56
Q

Disaccharidase Deficiency

A

RARE
• Congenital lactase deficiency→Can be genetic/familial
• Can be acquired→ usually d/t bowel injury/ viral enteritis

57
Q

Presentation/ Testing/ Treatment for Disaccharidase Deficiency

A 
•	Presentation
o	Liquid/frothy stools, ph<5.5
•	Testing
o	Lactase breath hydrogen (increase H2)
•	Treatment
o	Lactose restrictions or lactase supplement
58
Q

Cow’s Milk Protein Intolerance

A

Very rare
• MC in males w/fam hx of atopy
• Presentation:
o Flecks of blood in stool/loose bloodstreaked mucous stool
• Treatment:
o Bread-feeding, protein hydrolase formulas

59
Q

How does Inflammatory Bowel Disease Present

Crohns, Ulcerative Colitis

A

• Presentation:
o Abd pain, diarrhea, bloody stools, anorexia, weight loss
• Crohns may have strictures w/obstructions or fistulas
o Location:
• Crohns: any part, has areas that are unaffected (skip lesions)
• UC: proximal colon without skip areas
• Extra intestinal manifestation→ uvitis, arthritis, delayed growth, rash

60
Q

How to diagnose Inflammatory Bowel Disease

Crohns, Ulcerative Colitis

A

o Upper endoscopy and ileocolonoscopy most useful
o Labs:
• ESR/CRP, ab to saccharomyces (crohns), serum pANCA antibodies (UC)

61
Q

Complications of Inflammatory Bowel Disease

Crohns, Ulcerative Colitis

A

o Crohns→ malnutrition, fistulas, obstructions, abcess, arthritis
o UC→ arthritis, growth failure, liver dz

62
Q

Treatment for Inflammatory Bowel Disease

Crohns, Ulcerative Colitis

A

o ASA, corticosteroids, immunomodulators (Azathioprine, 6MP, MTX), infliximab, surgery (curative in UC), in crohns would be for abscess, strictures, fistulas

63
Q

Rotovirus

A

Acute Diarrhea
MC presents in 3-25 month olds in winter and spring
• Disease Progression
o 1-3 days incubation→ vomiting→ profuse watery diarrhea for 4-8 days

64
Q

Labs and Treatment for Rotovirus

A

• Labs→ normal CBC, + rotovirus antigen in stool, elyte imbalance
• Treatment→ supportice, IV fluids, oral rehydration
o Prevented with oral vaccine (2,4,6, mo)

65
Q

Chronic Diarrhea Causes

A
  • ABX→ eradicates normal gut flora and overgrowth of other organisms→ probiotics can help regrow normal flora
  • Extra-intestinal infections→ UTI’s, URI
  • Malnutrition→ decreased bile, decreased pancreatic enzymes, zinc & vit A deficiency
  • Diet→ overfeeding, fruit juice, high fibers, foods that contain/release histamine (citrus, tomatoes, cheese)
  • Other medications→ laxative abuse, too much magnesium intake
  • Allergic→ cows milk, celiac dz (but celiac dz is NOT gluten allergy)
  • Immunologic causes→ hypogammaglobulinemia, agammaglobulinemia (congenital), IgA deficiency
  • Post infectious
  • Parsites/bacteria→ giardia, salmonella, Yersinia
  • Pancreativ insufficiency→ common in CF
  • Zinc deficiency→ often developing nations
66
Q

Presentation for Toddlers Diarrhea

A

• Presentation
o 3-6 or more loose stools/day (no blood, parasites, bacteria or WBC in stool)
o Diarrhea gets worse on low residue, low fat, high carb diet

67
Q

Toddlers Diarrhea

A

chronic nonspecific diarrhea

often otherwise healthy 6mo old – 20 month old

68
Q

Toddler Diarrhea Treatment

A

• Treatment:
o Either increase or decrease fiber
o Slight increase in dietary fat
o Restrict fruit juice

69
Q

Cyclic Vomiting Syndrome Presentation

A 
Usually occurs over 1 yo
•	Presentation:
o	Recurrent vomiting lasting up to 72 hrs
o	Pallor, sweating, temp, lethargy
o	Hx of migraine headaches
70
Q

Triggers and Treatment of Cyclic Vomiting Syndrome

A

• Triggers→ infection, emotional stress, diet, menses, motion sickness
• Treatment→ acoid triggers, antihistamines/benzodiazapines, antiemetics, migraine meds (sumatriptan)
o Prophylactic→ occasionally used for disabling spells→ propranolol, amitriptyline, antihistamines

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