GI Flashcards
How does functional dyspepsia present
Recurrent pain in the upper abdomen or periumbilical area that cannot be relieved with change in stool patterns and there is no organic cause
Symptoms must be present once a week for at least 2 months
Tx for functional dyspepsia
Eliminate nsaid, spicy foods and soda
Meds - h2 blockers or PPI also low dose antidepressants
How does IBS present
Abdominal discomfort improved with defecation, changes in stool frequency or changes in stool consistency
Could also have bowel urgency with feeling of incomplete evacuation. Passage of mucus, bloating, and abdominal distention.
Tx for IBS
Dietary changes (reduce sorbitol, fructose and gas forming foods) and address psychological issues
What should you consider in a pt that presents with recurrent abdominal pain and urinary retention, tachycardia, blurred vision, dry mouth
Anticholinergic meds that were inappropriately prescribed
What should be the diet for a child who has moderate to severe dehydration due to diarrhea
Avoid fatty foods and foods high in simple sugars
Oral rehydration solution should be 2% glucose and 90meq of sodium chloride
What are the different ecoli that cause diarrhea and which ones cause bloody stools
Enteropathogenic - non bloody (neonates and kids < 2)
Enterotoxigenic - non- bloody (travelers diarrhea)
Shiga toxin producing/enterohemorrhagic - bloody after 3-4 days (can cause HUS antibiotics contraindicated)
Enteroaggregative - non bloody
Enteroinvasive - bloody with tenesmus
XRAY findings for volvulus
Gastric and duodenal dilatation
Decreased intestinal air and cork screw appearance of the duodenum
Lab findings in pyloric stenosis
Hypochloremic metabolic alkalosis with severe hypokalemia
Elevated indirect bill
Diagnostic criteria on ultrasound for pyloric stenosis
Pyloric length > 14mm
Pyloric muscle thickness > 4mm
How does ectodermal hypoplasia present and how is it diagnosed
Absent teeth. X linked
Diagnosed by skin biopsy which shows lack of sweat pores
How does hallermann Strieff syndrome present
Underdeveloped small teeth
What are risk factors for h. Pylori
Low socioeconomic status and immigration from a developing country
Next step if h. Pylori serologic testing is positive
Another study to confirm such as fecal antigen or urea breath test
Limit testing to those at risk
Tx for h. Pylori
PPI + 2 antibiotics
Clarithromycin and amox or clarithromycin and metronidazole
7-14 day course
How do you diagnose celiac disease
Biopsy
Antibodies are only for screening
Tx for irritable bowel syndrome
High fiber diet, attention to emotional factors. Amitryptyline.
How does gardners syndrome present
Extra teeth, polyps (premalignant), ostromas
Autosomal dominant
How does peutz-jeghers syndrome present
Pigmentation of lips and gums along with a lot of colonic polyps (premalignant)
Tx for UC when disease is a medical emergency
Fluids, blood transfusion and steroids
Tx for UC when infection
Metronidazole
First line medical tx for UC
5 ASA (aminosalycylate)
Second line medical tx for UC
Corticosteroids, 6 mercaptopurine or azarhioprine or methotrexate, cyclosporine or tacrolimus
Descriptions for chron’s
Skip lesions on XRAY, cobblestone appearance on endoscopy. Transmural lesions and noncaseating granulomas
What should you rule out in a child older than 6 that presents with intussusception
Lymphosarcoma
Tx for intussusception
Air contrast enema as it’s diagnostic and therapeutic
Dx and tx for hirschsprung disease
Rectal biopsy / surgical excision
Proximal aganglionic segment is distended with stool
Tx of peptic ulcer disease
H2 blocker, sucralfate, prostaglandin analogues (misoprostol), PPI
What are the rules of 2 for meckel diverticulum
Presents around the age of 2 or bf
2 types of tissue (gastric and intestinal)
2 feet from ileocecal valve
2 inch in length
2% of newborns affected
(Painless rectal bleeding)
How does cholestatic jaundice present
Stasis!
Elevated direct bili and elevated alkaline phosphatase and elevated GGT
Liver dz vs anatomic/obstructive hepatobiliary scintigraphy first step for dx
Most common cause is TPN
How does biliary atresia present
Elevated direct bili in newborn usually at 3 wks of age and less than 2 months old
Clay colored stools
How does choledochal cyst present
Neonatal jaundice, fever, acholic stool, RUQ pain, palpable mass
Dx with ultrasound
What is the deficiency in GILBERT syndrome
Glucuronyl transferase deficiency
Presentation of GILBERT syndrome
Teenager who is jaundiced after a URI or fasting!
Intermittently elevated unconjugated bili w illness or other stressors. Recognized after puberty.
Familial condition
Lab findings in GILBERT syndrome
Elevated indirect bili and normal LFTs
Lab findings in Wilson disease
Low serum Cooper and ceruloplasmin level
Elevated tissue Cooper (liver) and urine
Tx of Wilson disease
D-Penicillamine
Lab finding in liver failure
Elevated serum ammonia level and mental status change
Think of reye when you give aspirin to someone with varicella or flu
Most specific test in diagnosing pancreatitis
Abdominal ultrasound
What can pancreatitis be associated with
Pulmonary edema and pleural effusion
Causes of recurrent or chronic pancreatitis
Familial dyslipidemia
Hypercalcemia (hx of hyperparathyroidism or kidney stones)
Infection, autoimmune, inherited conditions, medications
Presentation of cholecystitis
fever, pain radiating to the right scapula, palpable mass in the right upper quadrant
Jaundice not common
Conditions that predispose kids to cholecystitis
Hemolytic disease, TPN, small intestinal disease, obesity, pregnancy
Risk factors for gallstones
CF, ileal resection, treatment with ceftriaxone, TPN
Presentation of cholelithiasis
Jaundice, hepatosplenomegaly
How do you dx biliary atresia
Biopsy!
First test is ultrasound followed by HIDA ultimately a biopsy
Tx for biliary atresia
Kasai procedure to act as a bile duct. Where you join liver to intestines
What markers will you see during acute Hep b infection
HBsAg
HBeAg
HBV-DNA
What markers are present during recovery of Hep b
Anti-HBs
Anti- HBc
Anti- HBe
What is Hep C associated with
Hepatocellular carcinoma and cirrhosis
Most common cause of chronic viral hepatitis
Hep C
