GI Flashcards
vit a
night blindness, xerophthalmia (dry conjunctiva, cornea)
vit D
rickets/osteomalacia, dental caries, hypocalcemia, hypophosphatemia
Vit E
anemia/ hemolysis, neuro deficit, altered prostaglandin syn
vit K
abn bone matrix sun
B1
thiamine, beriberi (cardiac failure, peripheral neuropathy, hoarseness, or aphonia, wrenches’ encephalopathy)
B6
pyridoxine. dermatitis, cheilosis, glossitis, microcytic anemia, peripheral neuritis
Vit C
scurvy (hematologic abn, edema, impair collagen syn= wound healing, swelling of gums)
B12
cobalamin
megaloblastic anemia, demyelination, methylmalonic acidemia
foli cacid
megaloblastic anemia, neutropenia, impaired growth, diarrhea
niacin
pellagra (diarrhea, dermatitis, dementia) glossitis, stomatitis
zinc
skin lesion, poor wound healing, immune dysfunc, diarrhea, growth failure
malnutrition
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
malabsorption
diarrhea, abd distension, impaired growth
Carb malabsorption
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
protein malabsorption
etio: congenital enterokinase def (hypoproteinemia + edema and growth impairment),protein losing enteropathies, inflammatory D
look at fecal alpha antitrypsin lvl. see low serum albumin
lipid malabsorption
decr lipase = steatorrhea. exocrine pacreatic insuf (CF, pancreatitis), intestinal mucosal atrophy, BA def
macrocytic blood smear
folic acid or B12 def
acanthocytosis of erythrocyte
abetalipoproteinemia
neutropenia
schwachman -diamond syndrome. FTT, short stature, AR
celiac disease
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
protein intolerance
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
short bowel syndrome
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
GERD
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
GERD dx
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
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
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
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.
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
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.
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
peritonitis
P: decr bowel sounds, abd wall rigidity, involuntary guarding, rebound tenderness
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
cholecystitis
uncommon in kids. in predisposed- sick cell, CF or prolong TPN
chronic abd pain
occurs each mo for 3+ mo. organic- cause by disease process or D (1/3). nonorganic (functional)- 2/3.
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
epigastric pain
associate with belching, bloating, N.V, early satiety.
infraumbilical pain
abd cramping, bloating, alteration in stool. ~ adult’s IBS.
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
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
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
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%
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
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
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
juvenile polyps
most common cause of sig lower GI bleeding after infancy.
painless, intermittent streaky.
tx: polypectomy + colonscopy
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
liver markers
AST-sensitive, nonspecific
ALT- specific
LDH: nonspecific but for hepatocellular necrosis
biliary enzyme
Alk Phos in biliary disease but also incr in kids due to rapid growth
GGTP is more specific for biliary tract disease
cholestatic jaundice
retention of bile in liver. direct bili >2 and >15% of total. 50% cause by neonatal hepatitis or biliary atresia
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
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
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
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
viral hepatitis
most is hep A and B. most asx as kids. supportive etc
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
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
hep C
RNA virus. perinatal. 90% of transfusion associated hepatitis. acute is rarely sx. chronic- cirrhosis, fibrosis in 80%. dx HCV ab and PCR
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
