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GI Flashcards

1
Q

vit a

A

night blindness, xerophthalmia (dry conjunctiva, cornea)

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2
Q

vit D

A

rickets/osteomalacia, dental caries, hypocalcemia, hypophosphatemia

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3
Q

Vit E

A

anemia/ hemolysis, neuro deficit, altered prostaglandin syn

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4
Q

vit K

A

abn bone matrix sun

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5
Q

B1

A

thiamine, beriberi (cardiac failure, peripheral neuropathy, hoarseness, or aphonia, wrenches’ encephalopathy)

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6
Q

B6

A

pyridoxine. dermatitis, cheilosis, glossitis, microcytic anemia, peripheral neuritis

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7
Q

Vit C

A

scurvy (hematologic abn, edema, impair collagen syn= wound healing, swelling of gums)

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8
Q

B12

A

cobalamin

megaloblastic anemia, demyelination, methylmalonic acidemia

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9
Q

foli cacid

A

megaloblastic anemia, neutropenia, impaired growth, diarrhea

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10
Q

niacin

A

pellagra (diarrhea, dermatitis, dementia) glossitis, stomatitis

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11
Q

zinc

A

skin lesion, poor wound healing, immune dysfunc, diarrhea, growth failure

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12
Q

malnutrition

A

1) marasmus- most common energy depletion state- near starvation from protein and nonprotein def. thin from loss of M and fat
2) kwashiokor- protein def, edema, abd distension, pigmentaiton change, thin sparse hair
if both= protein -energy malnutrition

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13
Q

malabsorption

A

diarrhea, abd distension, impaired growth

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14
Q

Carb malabsorption

A

undigested carb are osmotically active –> incr stool V, draw water, incr peristaltic activity, decr transit time –> fermented by bacteria = watery, acidic stool w/ unabsorbed sugar detected as reducing substances by positive Flintiest run. pH

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15
Q

protein malabsorption

A

etio: congenital enterokinase def (hypoproteinemia + edema and growth impairment),protein losing enteropathies, inflammatory D
look at fecal alpha antitrypsin lvl. see low serum albumin

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16
Q

lipid malabsorption

A

decr lipase = steatorrhea. exocrine pacreatic insuf (CF, pancreatitis), intestinal mucosal atrophy, BA def

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17
Q

macrocytic blood smear

A

folic acid or B12 def

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18
Q

acanthocytosis of erythrocyte

A

abetalipoproteinemia

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19
Q

neutropenia

A

schwachman -diamond syndrome. FTT, short stature, AR

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20
Q

celiac disease

A

P: D, V, bloating, anorexia, FTT
SB bx- deep crypt, flat villi, vacuolated epi. serum IgA endomysial and serum tissue transglutaminase ab testing abetalipoproteinemia.
tx: corticosteroid for D. noncompliance growth failure and delayed sexual maturity

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21
Q

protein intolerance

A 
Cow's milk protein cause this. 
P: enteropathy- progressive onset of D, V, irritability, colicky abd pain, chronic blood loss in stool lead to anemia stool protein loss cause edema, FTT
enterocolitis: acute onset of same sx
dx: stop ag= stop sx
tx: avoid ag. resolve by 1-2yo
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22
Q

short bowel syndrome

A

malabsorption - malnutrition, compromised bowel function
2/2 bowel resection (nec, crohn, ca) carb and fat mal with steatorrhea
dehydratoim, hyponatremia, hypokalemia. distal SB= B12, bile absorption
tx: TPN. SB transplant in pt with liver disease.
complication: TPN cholestasis - gallstone and cholestatic liver disease, intestinal bacterial overgrowth, nutritional def, poor bone mineralization, renal stone, secretory diarrhea

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23
Q

GERD

A

etio: predom is inappropriate transient lower esophageal sphincter relaxation (TLESR). result in inflm.
happy spitters
emesis is begin but dramatic and resolve by 6-12mo
1) infant: emesis -most common. FTT. sandier syndrome - torticollis arching of the back caused by painful esophagitis. feeding refusal. constant hunger.
older kids- midepigastric pain. N upon awakening, hoarseness, halitosis, wheezing
sequelae: upper and lower airway disease exacerbated. acid reflex induce bronchopulmonary constriction - chronic laryngitis, hoarseness, wheezing,
gastrointestinal sequelae- FTT, barrett’s esophagus

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24
Q

GERD dx

A

barium upper GI (UGI) study is bad.
scintigraphy- radioactive marker.
pH probe measure- gold standard. endoscopy with bx if uncertain dx. bronchoscopy with alveolar lavage if suspect aspiration

25
GERD tx
position upright. freq small meals. thickener. acid inhibition.. motility agent incr LES tone or incr gastric emptying- metoclopramid. surgery- nissen fundoplication+ gastrotomy tube- last reserve
26
hypertropic pyloric stenosis
2-3wk- haundice in 5%, labs: hypochloremic, hypoK, metabolic alkalosis. US- gold standard. UGI- string sign. tx: correct electrolyte abn and dehydration. partial pyloromyotomy
27
malrotation
midgut twist around SMA - obstruct and infarct bowel. M>F 1) no sb fixation cause peritoneal bands (Ladd's bands) - cause duodenum compression= obstruction 2) pedicle that suspects SB can twist - ischemic + midgut volvulus P: healthy looking+ bilious V+ acute abd pain. PE: normal -> peritonitis --> shock and CV collapse as bowel ischemia conti dx: abd radiograph - proximal distention and obstruction, no distal gas. gold- upper intestinal contrast imaging tx: emergency surgery.
28
duodenal atresia
most common cause of obstruction in neonatal period. M>F. 1/4 in down. dx: suspect in prenatal polyhydramnios. birth- scaphoid abd with epigastric distention. feeding intolerance +V AXR- double bubble sign tx: NG decompression, duodenodeuodenostomy
29
jejunoileal atresia
cause by mesenteric vascular accident in fetus. air fluid lvl. NG suction and fluid resuscitation bc surgical resistction and anatomosis of atretic seg.
30
intrussuception
peak 5-9mo. most common cause of obstruction after neonal period + bf 2yo. lead pt like merciless, polyp, peyer's patch leads proximal bowel inward. ID in 5% cause bowel wall edema, hemorrhage and maybe ischemia and infarction P: sudden onset of cramp or colicky ad pain in travels. cry and draw legs toward chest. V and lethargy. stool- currant jelly. sausage shaped mass palpated. eval: fluids, abd US, gold-air or contrast enema- coil spring sign tx: contrast enema, operative reduction, 5% recurrence
31
peritonitis
P: decr bowel sounds, abd wall rigidity, involuntary guarding, rebound tenderness
32
acute pancreatitis
uncommon in kids. et- most common is trauma, then idiopathic, infection P: periumbilical, epigastric pain that radiate to back. fever anorexia N/V PE: gray turner sing- blue discoloration of flanks. cullen- bluish discoloration of periumbilical area. both = blood tracking along fascial planes labs: incr serum amylase, lipase (more specific). leukocytosis, hyperglycemia, hypocalcemia, abd US to monitor. abd CT for pseudocyts, abscess, necrosis Tx: supportive,TPN, antibiotics- severe necrotizing pancreatitis, surgery to move necrotic tissue- controversial for early acute Complication: pseudocyts, ARDS, renal failure, shock, GI bleeding
33
cholecystitis
uncommon in kids. in predisposed- sick cell, CF or prolong TPN
34
chronic abd pain
occurs each mo for 3+ mo. organic- cause by disease process or D (1/3). nonorganic (functional)- 2/3.
35
functional pain
varied quality. tent to be periumbilical. doesn't interfere with pleasurable activity. 2nd gain. predispose- stressors, preg prob, neonatal prob, minor Gi disturbances, adhd healthier kid appear,s more likely functional r/o lactose into with lactose breath hydrogen test bc it also present as pain in otherwise healthy
36
epigastric pain
associate with belching, bloating, N.V, early satiety.
37
infraumbilical pain
abd cramping, bloating, alteration in stool. ~ adult's IBS.
38
functional fecal retention (FFR)
most common form of constipation in kids. inappropriate constriction of external anal sphincter path: due to trauma events (hard stool, painful diarrhea, diaper rash) --> self fulfilling cycle of incr fecal mass, hardness, painful defecation. ID sentinel event (diarrhea, enviro change) after toilet training, + normal growth/dev no dx studies needed tx: stool evaulation, mineral oil as maintenance therapy
39
organic fecal retention
5%. hirshspringu's disease most common. suggested by delay meconium pass >48hr after birth, hx of pelvic surgery, encopresis bc 3yo. can't toilet train
40
IBD
bimodal onset: 15-20, 50yo. Labs: anemia, leukocytosis, incr ESR, serum albumin decr, serum ab, stool test to r/o infection, colonoscopy with bx confirms tx: sulfasalazine- mild especially US corticosteorids, immunosupressive agents, metronidazole- CD, TPN in flaure ups
41
UC
limted to mucosa in colon. beign in rectum, extend proximally in contiguous fashion. ulcerative proctitis- isolated to rectum. pancolitis- entire colon mild: 60%. bleeding, D, abd pain mod: 30%: noctural stooling, cramping, tenesmus. systemic sx of wt loss, anorexia, fever, anemia severe: 10%: >6stool/d/ fever anemia, leukocytosis, hpoalbuminemia C: toxic megacolon- decr motility, bacteria enter, colonic dilatation, fever,abd distension, septic shock. incr risk of ca. see antineutrophil cytoplasmic ab in 80%
42
crohns
any set from mouth to anus. skip lesion, transmural inflm- causing sinus tracts, fistula, crypt abscess. abd pain, postprandial cramping, diarrhea, anorexia. malabsorption- vit def. perianal disease like skin tag, fissure, fistula often occur bf intestinal disease see anti-saccharomyces cerevisiae ab in 70%. C: stricture, fistula abscess less incr in ca risk
43
upper GI bleeding
guiac false neg- large dose vit C upper intestinal endoscopy used for dx and tx of active bleeding with hemodynamic changes tx: initial stabilization of hypovolemia and anemia. 2 large bore peripheral lines and rapid fluid bolus. octreotide to vascoconstrict varies
44
lower GI bleeding
consider NEC in any newborn with rectal bleeding, feeding intol, abd distention juvenile polyps, hirschsprung's disease. allergic colitis (cow's milk), infectious enterocolitis (salmonella, shigella,) merkle's diverticulum, hemolytic uremic syndrome, hence schonlein purr (IgA vasculitis), IBD
45
juvenile polyps
most common cause of sig lower GI bleeding after infancy. painless, intermittent streaky. tx: polypectomy + colonscopy
46
merckle's diverticulum
has extopic gastric mucasa that make acid damaging adj intestinal mucosa - P: painless, acute rectal bleeding in healthy kid. dx: nuc med scan to ID ectopic gastric mucosa. tx: surgical resection
47
liver markers
AST-sensitive, nonspecific ALT- specific LDH: nonspecific but for hepatocellular necrosis
48
biliary enzyme
Alk Phos in biliary disease but also incr in kids due to rapid growth GGTP is more specific for biliary tract disease
49
cholestatic jaundice
retention of bile in liver. direct bili >2 and >15% of total. 50% cause by neonatal hepatitis or biliary atresia
50
UDP glucuronyl transferase def
Gilbert syndrome: lose 50% activity. mild unconjugated bili associated with stress crigler Najjar type I: AR- lose 100% activity. kernicterus crigler Najjar type II: AD. lose 90%. less kernicterus
51
neonatal hepatitis
idiopathic inflm. most common cause of cholestasis in newborn. P: transient jaundice, acholic stool, can cause liver failure, cirrhosis, portal HTN. start in 1st wk. hepatomegalyFTT usually self limited with full recovery in 70% dx-clinical, liver bx and exclusion tx: supportive, ursodeoxycholic acid to enhance bile flow/ decr viscosity. liver transplant
52
biliary atresia
progressive fibrosclerotic disease affecting extra hepatic biliary tree. cause 50% of pediatric liver transplant bc cause liver failure unknown et P: 2/3 present btw 4-6wk with jaundice, dark urine, pale or echoic stool. 1/2 present in 2wks - confuse with physiologic jaundice. rapid progression with bile duct obliteration and cirrhosis by 4mo. PE: hepatosplenomegaly, ascites, steatorrhea, peripheral aedema, polysphenia syndrome (bilobed lung, abd heterotaxia, situs ambiguous) labs: elevated bili Dx: abd US, liver bx to ro other causes. intraoperative cholangiogram with lap confirm dx tx: supportive, reestablish bile duct in Kasai portoenterostomy. liver transplant
53
alagille syndrome
AD. paucity of intrahepatic bile duct and multiorgan involvement. P: cholestatic liver disease. pruritus can be debilitating. unusually facial characteristics (broad forehead, deep wide spaced eyes, saddle nose with bulbous tip, large ears), cardiac disease (pul outflow obstruction or to), renal disease in 50%, eye anomalies (posterior embryotoxon), MSK (butterfly vertebrae), growth failure, short, pancreatic issue, hypercholesterolemia dx: clinical, liver bx, exclusion tx: supportive
54
viral hepatitis
most is hep A and B. most asx as kids. supportive etc
55
hep A
picornavirus. fecal oral. most common hepatitis virus. 70% asx. jaundice rare. not chronic infection. Dx: IgM anti HAV in ealry and persist 6mo elevated IgG anti HAV early and lifelong immunity tx: supportive
56
hep B
DNA virus. perinatal verticle infected blood, body secretions. onset 90d post incubation. acute sx of hepatitis incr as get older. chronic HBV more common in younger- chronic liver disease with cirrhosis, hepatic fibrosis, portal HTN, incr risk for HCC Lab: HBsAg-pathognomonic for active infection. HBsAb-protective from vaccine or natural infection, HBcAb from natural infection and persist lifelong, HBeAg, early in active so dx acute, HBeAb late in infection Dx: PCR tx: supportive for acute, interviraon and antiviral for chronic
57
hep C
RNA virus. perinatal. 90% of transfusion associated hepatitis. acute is rarely sx. chronic- cirrhosis, fibrosis in 80%. dx HCV ab and PCR
58
AI hepatitis
elevated serum transaminases, hypergamaglobulinemia, circulating autoab. destructive and progressive. type I: ANA or anti Smo M ab. type 2: anti liver kidney microsome ab or anti liver cytosol ab predom in female with presentation bf puberty nonhepatic Ai in 20-40% dx: suspect if Fx of Ai, lliver bx to eval for cirrhosis and grade disease tx: corticosteroid, immnosuppresive like azathioprine

Peds (21 decks)

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