GI

Question 1

How does functional dyspepsia present

Answer 1

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

Question 2

Tx for functional dyspepsia

Answer 2

Eliminate nsaid, spicy foods and soda

Meds - h2 blockers or PPI also low dose antidepressants

Question 3

How does IBS present

Answer 3

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.

Question 4

Tx for IBS

Answer 4

Dietary changes (reduce sorbitol, fructose and gas forming foods) and address psychological issues

Question 5

What should you consider in a pt that presents with recurrent abdominal pain and urinary retention, tachycardia, blurred vision, dry mouth

Answer 5

Anticholinergic meds that were inappropriately prescribed

Question 6

What should be the diet for a child who has moderate to severe dehydration due to diarrhea

Answer 6

Avoid fatty foods and foods high in simple sugars

Oral rehydration solution should be 2% glucose and 90meq of sodium chloride

Question 7

What are the different ecoli that cause diarrhea and which ones cause bloody stools

Answer 7

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

Question 8

XRAY findings for volvulus

Answer 8

Gastric and duodenal dilatation

Decreased intestinal air and cork screw appearance of the duodenum

Question 9

Lab findings in pyloric stenosis

Answer 9

Hypochloremic metabolic alkalosis with severe hypokalemia

Elevated indirect bill

Question 10

Diagnostic criteria on ultrasound for pyloric stenosis

Answer 10

Pyloric length > 14mm

Pyloric muscle thickness > 4mm

Question 11

How does ectodermal hypoplasia present and how is it diagnosed

Answer 11

Absent teeth. X linked

Diagnosed by skin biopsy which shows lack of sweat pores

Question 12

How does hallermann Strieff syndrome present

Answer 12

Underdeveloped small teeth

Question 13

What are risk factors for h. Pylori

Answer 13

Low socioeconomic status and immigration from a developing country

Question 14

Next step if h. Pylori serologic testing is positive

Answer 14

Another study to confirm such as fecal antigen or urea breath test

Limit testing to those at risk

Question 15

Tx for h. Pylori

Answer 15

PPI + 2 antibiotics

Clarithromycin and amox or clarithromycin and metronidazole

7-14 day course

Question 16

How do you diagnose celiac disease

Answer 16

Biopsy

Antibodies are only for screening

Question 17

Tx for irritable bowel syndrome

Answer 17

High fiber diet, attention to emotional factors. Amitryptyline.

Question 18

How does gardners syndrome present

Answer 18

Extra teeth, polyps (premalignant), ostromas

Autosomal dominant

Question 19

How does peutz-jeghers syndrome present

Answer 19

Pigmentation of lips and gums along with a lot of colonic polyps (premalignant)

Question 20

Tx for UC when disease is a medical emergency

Answer 20

Fluids, blood transfusion and steroids

Question 21

Tx for UC when infection

Answer 21

Metronidazole

Question 22

First line medical tx for UC

Answer 22

5 ASA (aminosalycylate)

Question 23

Second line medical tx for UC

Answer 23

Corticosteroids, 6 mercaptopurine or azarhioprine or methotrexate, cyclosporine or tacrolimus

Question 24

Descriptions for chron’s

Answer 24

Skip lesions on XRAY, cobblestone appearance on endoscopy. Transmural lesions and noncaseating granulomas

Question 25

What should you rule out in a child older than 6 that presents with intussusception

Answer 25

Lymphosarcoma

Question 26

Tx for intussusception

Answer 26

Air contrast enema as it's diagnostic and therapeutic

Question 27

Dx and tx for hirschsprung disease

Answer 27

Rectal biopsy / surgical excision Proximal aganglionic segment is distended with stool

Question 28

Tx of peptic ulcer disease

Answer 28

H2 blocker, sucralfate, prostaglandin analogues (misoprostol), PPI

Question 29

What are the rules of 2 for meckel diverticulum

Answer 29

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)

Question 30

How does cholestatic jaundice present Stasis!

Answer 30

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

Question 31

How does biliary atresia present

Answer 31

Elevated direct bili in newborn usually at 3 wks of age and less than 2 months old Clay colored stools

Question 32

How does choledochal cyst present

Answer 32

Neonatal jaundice, fever, acholic stool, RUQ pain, palpable mass Dx with ultrasound

Question 33

What is the deficiency in GILBERT syndrome

Answer 33

Glucuronyl transferase deficiency

Question 34

Presentation of GILBERT syndrome

Answer 34

Teenager who is jaundiced after a URI or fasting! Intermittently elevated unconjugated bili w illness or other stressors. Recognized after puberty. Familial condition

Question 35

Lab findings in GILBERT syndrome

Answer 35

Elevated indirect bili and normal LFTs

Question 36

Lab findings in Wilson disease

Answer 36

Low serum Cooper and ceruloplasmin level Elevated tissue Cooper (liver) and urine

Question 37

Tx of Wilson disease

Answer 37

D-Penicillamine

Question 38

Lab finding in liver failure

Answer 38

Elevated serum ammonia level and mental status change Think of reye when you give aspirin to someone with varicella or flu

Question 39

Most specific test in diagnosing pancreatitis

Answer 39

Abdominal ultrasound

Question 40

What can pancreatitis be associated with

Answer 40

Pulmonary edema and pleural effusion

Question 41

Causes of recurrent or chronic pancreatitis

Answer 41

Familial dyslipidemia Hypercalcemia (hx of hyperparathyroidism or kidney stones) Infection, autoimmune, inherited conditions, medications

Question 42

Presentation of cholecystitis

Answer 42

fever, pain radiating to the right scapula, palpable mass in the right upper quadrant Jaundice not common

Question 43

Conditions that predispose kids to cholecystitis

Answer 43

Hemolytic disease, TPN, small intestinal disease, obesity, pregnancy

Question 44

Risk factors for gallstones

Answer 44

CF, ileal resection, treatment with ceftriaxone, TPN

Question 45

Presentation of cholelithiasis

Answer 45

Jaundice, hepatosplenomegaly

Question 46

How do you dx biliary atresia

Answer 46

Biopsy! First test is ultrasound followed by HIDA ultimately a biopsy

Question 47

Tx for biliary atresia

Answer 47

Kasai procedure to act as a bile duct. Where you join liver to intestines

Question 48

What markers will you see during acute Hep b infection

Answer 48

HBsAg HBeAg HBV-DNA

Question 49

What markers are present during recovery of Hep b

Answer 49

Anti-HBs Anti- HBc Anti- HBe

Question 50

What is Hep C associated with

Answer 50

Hepatocellular carcinoma and cirrhosis

Question 51

Most common cause of chronic viral hepatitis

Answer 51

Hep C