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Peds Shelf > GI > Flashcards

GI Flashcards

1
Q

VACTERL

A

Vertebral

Anorectal

Cardiac

Tracheal

Esophageal

Renal

Limb Anomalies

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2
Q

Esophageal atresia commonly occurs with what other anomaly?

A

Tracheoesophageal fistula

-distal esophagus connects with posterior trachea-

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3
Q

What is this? When does it present?

A

Esophageal atresia - maternal poly hydramnios

Vomiting up first feed

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4
Q

Reflux, back arching, stiffness, and torticollis

A

Sandifer’s Syndrome = GERD

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5
Q

What percentage of kids with GERD resolve without treatment by age 2?

A

60%

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6
Q

What is the most common cause of esophagitis?

A

Candida

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7
Q

How do you treat GERD?

A

Positioning after feeds

Thicken formula w/ rice cereal

Antacids, H2 blockers, PPIs

Motility agents = metoclopramide, erythromycin

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8
Q

How do primary gastric ulcers present in the first month of life, neonatal period, preschool, and > 6 yrs?

A

1st month: GI bleed/perforation

Neonatal: recurrent vomiting, slow growth

Preschool: Periumbilical, postprandial pain + vomiting

> 6 yo: epigastric abdominal pain, + blood loss/anemia

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9
Q

Gastric ulcers following surgery or head trauma?

A

Cushing

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10
Q

Stress gastric ulcers or those related with burns?

A

Curling ulcers

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11
Q

Colic

A

Frequent, complex abdominal pain and crying in infants < 3 months

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12
Q

Sudden onset loud crying

Circumoral pallor

Distended tense abdomen

Feet cold

*Relief with passage of feces/flatus*

A

Colic

R/o other causes

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13
Q

When and how does pyloric stenosis present?

A

Nonbilious vomiting

After 3 weeks, up to 5 months

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14
Q

What is the “olive” felt on exam of a pt. with pyloric stenosis?

A

Duodenal bulb

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15
Q

How do you diagnose pyloric stenosis?

A

U/S - 90% Senstive

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16
Q

What is this?

A

Pyloric stenosis

Also look for

string sign, double tract sign, shoulder sign

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17
Q

How does duodenal atresia present?

A

Bilious vomiting without abdominal distention

**First day of life**

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18
Q

What is this? How do you treat it?

A

Duodenal atresia - double bubble sign

NG tube, IVF, surgery

**Associated with malrotation, esophageal atresia, and heart disease**

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19
Q

Moms with polyhydramnios might have an infant with what?

A

GI atresia

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20
Q

How does volvulus present?

A

Gastric: Severe abrupt epigastric pain, intractible emisis - failure to pass NG tube

Intestinal: Vomiting, abdominal pain

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21
Q

What is the most common cause of acute intestinal obstruction under 2 yo?

A

Intussusception - Ileocolic (90%)

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22
Q

What things can cause “lead point” for intussusception to develop? (6)

A

Viral illness

Meckel’s diverticulum

Polyp

Lymphoma

Henoch-Schonlein purpura

CF

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23
Q

Intermittent colicky abdominal pain, bilious vomiting, and currant jelly stool.

A

Classic triad of Intussusception

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24
Q

Who do you diagnose intussusception?

A

US: Target/donut sign, Pseudokidney

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25
Q

Impression: Paucity of bowel gas in film, air enema partially reduces it in film B.

A

Intussusception

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26
Q

What is the rule of 2’s for Meckel’s diverticulum?

A

2% of the population

2 inches long

2 feet from iliocecal valve

< 2 yo

2% symptomatic

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27
Q

What are the signs of symptomatic meckel’s diverticulum?

A

Intermittent painless rectal bleeding

Obstruction

Diverticulitis

**Can mimic appendicitis**

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28
Q

What is the perforation rate in kids with appendicitis after 48 hours?

A

>65%

**Can’t localize pain**

Pain first, then V/D or anorexia

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29
Q

Which kids with possible appendicitis get CTs?

A

Indicated if diagnosis is equivocal

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30
Q

How do you treat appendicitis?

A

Surgery

Broad spec antibiotics if perfed for 7 days

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31
Q

What are causes of constipation in the neonatal period? (5)

A

Hirschprungs

Intestinal pseudo-obstruction

Hypothyroidism

Cows milk protein intolerance

Low K, High Ca

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32
Q

What is the cause of Hirschprungs Megacolon? What is associated with?

A

Absence of ganglion cells in bowel

M > F, Down Syndrome

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33
Q

How do you diagnose and treat Hirschprung’s Disease?

A

Rectal suction biopsy - need submucosa

Rectal manometry

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34
Q

How do you treat an anal fissure?

A

Sitz baths, fiber supplements, increased fluid

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35
Q

What is appropriate initial management of the following: 14 yo girl with 2-month hx of crampy diffuse abdominal pain with anorexia nad 4.5 kg weight loss. Pain unrelated to meals no diarrhea or constipation.

A

Rectal exam, stool exam

CBC, ESR

Review of family/emotional stress

**Do not refer to eating disorder clinic**

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36
Q

True or false: Extraintestinal manifestations of IBD are more commonly seen in Crohn’s.

A

True

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37
Q

Perianal fistula, sclerosing cholangitis, pyoderma gangrenosusm and ankylosing spondylitis are seen with what?

A

Crohns

38
Q

IBD + bloody diarrhea, anorexia, weight loss, pyoderma gangrenosum, sclerosing cholangitis is most likely what?

A

Ulcerative colitis

39
Q

How do you treat Crohns?

A

Steroids

Aminosalicylates

MTX

AZA

Cyclosporine

Metronidazole

Sitz baths

TNF-α inhibitors

40
Q

How do you treat UC?

A

Aminosalicylates

Steroids

Colectomy

41
Q

Abdominal pain with intermittent diarrhea and constipation without organic basis

A

Irritable Bowel Syndrome

Must exclude other pathology

CBC, ESR and FOBT

42
Q

What is the most common cause of diarrhea in children?

A

Viral - rotavirus

43
Q

Diarrhea and emesis =

Diarrhea and fever =

Diarrhea and tenesmus -

A

Non-inflammatory

Inflammatory

Large Colon Involvement

44
Q

What does fecal leukocytes infer?

A

Invasive cytotoxin organism

Shigella, Salmonella

45
Q

Patients with enterohemorrhagic E. coli and Entamoeba histolytica have ___________ fecal leukocytes.

A

Minimal to none

46
Q

What is the BRAT diet for diarrhea?

A

Bread

Rice

Applesauce

Toast

47
Q

If a kid has E. coli 0157:H7 do you treat with antibiotics?

A

No - higher incidence of HUS

48
Q

Pseudomembranous colitis

A

Post-antibiotic c diff infection

Treat with PO metronidazole or PO Vanc

49
Q

When is surgery indicated for abdominal umbilical hernias?

A

Symptomatic

Strangulated

Grows larger after age 1 or 2

50
Q

Perianal itching at night

A

Enterobius vernicularis - pinworm

Albendazole or mebendazole

51
Q

Mild anemia, abdominal pain, diarrhea tenesmus

Perianal itching

A

Trichuris trichuia - whipworm

Albendazole or mebendazole

52
Q

Pneumonia

Intestinal obstruction

Liver failure

A

Ascaris lumbricoides

Albendazole or mebendazole

53
Q

Intense dermatitis

Loeffler’s pneumonitis

Anemia/GI symptoms

A

Necator americanus & Ancylostoma duodenale

Hookworm (skin penetration)

Albendazole or mebendazole

54
Q

Dermatitis, pneumonitis

Anemia, GI symptoms

Diarrhea 3-6 weeks

Superimposed bacterial sepsis

A

Strongyloides stercoralis (skin)

Ivermectin

55
Q

Myalgias

Facial periorbital edema

Conjunctivitis

Pneumonia, myocarditis, encephalitis, nephritis, meningitis

A

Albendazole

56
Q

What is a weird cause of irreversible developmental delay in kids?

A

Intestinal worms

Necator or a. duodenale - hookworms

Strongyloides

57
Q

What is the most common type of inguinal hernia?

A

Indirect > direct > femoral

58
Q

How can you distinguish an inguinal hernia from a hydrocele?

A

Hernia increases with straining

59
Q

15 yo girl with spots on her lips has crampy abdominal pain + bleeding

A

Peutz-Jeghers

60
Q

Multiple intestinal polyps, tumors of soft tissue/bone (mandible)

A

Gardner’s syndrome

Aggressive surgical removal of polyps - high malignant potential

61
Q

Carcinoid Tumors

A

Tumors of Enterochromaffin cells in intestine

Appendicitis

Carcinoid Syndrome

62
Q

Carcinoid Syndrome

A

Inc. serotonin

Vasomotor disturbances

Bronchoconstriction

63
Q

Familial Polyposis Coli

A

AD - APC mutation

Hematochezia, cramps, diarrhea

Resection of affected colonic mucosa

64
Q

Juvenile polyposis coli

A

2-10 years

Bright red painless bleeding with bowel movement

Iron deficiency

65
Q

What is the most common childhood bowel tumor?

A

Juvenille polyposis coli

66
Q

When does short bowel syndrome occur

A

With loss of at least 50% small bowel

Dec. Na and K

Acidosis - loss of bicarb

67
Q

How do you treat short bowel syndrome?

A

TPN

Small feeds PO

Metronidazole to treat bacterial overgrowth

68
Q

5 yo girl presents with protuberant abdomen and wasted extremities

A

Gluten induced enteropathy

69
Q

Celiac disease is asociated with which genetic types?

A

HLA-B8

DR7, DR3, DQW2

70
Q

Bx: Vilous shortening inc. crypt depth, increased inflammatory cells in lamina propria of small bowel

A

Tropical Sprue

Abx 3-4wks

Folate and B12

71
Q

Explosive watery diarrhea with abdominal distention in response to lactose

A

Lactose deficiency (AR)

Eliminate from diet

72
Q

Gilbert Syndrome

A

Benign - unconjugated hyperbilirubinemia

73
Q

Crigler Najjar I (AR)

A

Glucuronyl Transferase mutation

Unconj. bili in first 3 days of life

**Absence of hemolysis**

Need liver transplant

74
Q

Crigler Najjar 2 (AD)

A

Glucuronyl transferase mutation

Kernicterus unusual

Unconj. bili in first 3 days - resolves

Phenobarbital for 7-10 days

75
Q

Alagille Syndrome

A

Absence or dec. # of bile ducts

Occular, vertebral, and CV abnormalities

Unusual facies

76
Q

Zellweger Syndrome AR

A

Progressive degeneration of liver and kidneys

Fatal in 6-12 months

**Absence of peroxisomes on hepatic cells**

77
Q

Extrahepatic Biliary Atresia

A

Acholic stool, polysplenia, malrotation

Drain or liver transplant

78
Q

Which is the only hepatitis virus that is a DNA virus?

A

Hep B

79
Q

What causes most of the cases of hepatitis in children?

A

Hep A

80
Q

10 yo boy is diagnosed with Hep A, how would you treat the parents and siblings not sick?

A

IVIg

81
Q

What causes neonatal hepatitis?

A

Most from systemic disease i.e. sepsis

CMV, HSV, HIV

Congenital syphilis & toxo

82
Q

How do you treat neonatal hepatitis?

A

Abx for bacterial associated

Acyclovir for HSV

Ganciclovir and foscarnet for CMV

83
Q

How do you treat chronic (autoimmune) hepatits?

A

Steroids

Azathioprine

84
Q

What causes Reye’s Syndrome?

A

URI/chicken pox or ASA

Improvement

Abrupt protracted vomiting 5-7 days after illness onset

85
Q

How do you treat Reye’s Syndrome?

A

Control ICP 2/2 cerebral edema

Supportive management

86
Q

What is the most likely manifestation of α1-antitrypsin deficiency in the newborn?

A

Jaundice (neonatal cholestasis)

87
Q

Jaundice

Portal HTN, liver failure

Tremors

Delayed puberty

A

Wilsons Disease - Excessive copper deposition in brain and liver

Low ceruloplasmin

High serum copper

Kayser-Fleischer rings

88
Q

How do you treat Wilson’s Disease

A

Zinc - block Cu absorption

Penicillamine

Restrict copper

89
Q

Hepatoblastoma

A

Associated with Beckwith-Wiedemann syndrome

Large abdominal mass, R lobe

αFP, CT, MRI

Resect, cisplatin and doxorubicin

90
Q

Inc. abdominal girth, hmegaly, vomiting, pain

or

Chest pain, coughing, hemoptysis

A

Echinococcus - domestic and wild canines

Liver and/or lungs

Anaphylaxis 2/2 rupture and spillage

Surgery or albendazole

91
Q

Abd. pain, distention, hmegaly

Anemia, inc. ESR, nonspecific ALT

slightl leukocytosis

A

Amebic abscess - from disseminated infection

Metronidazole

Chloroquine

Aspiration

Peds Shelf (11 decks)

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