GI Flashcards
Features of Crohn’s Disease
ThE PUSHPIN T: transmural ulcers E: erythema nodosum P: perianal fistulas U: uveitis S: skip lesions - top to bottom H: hepatic disease P: pyoderma gangrenosum I: inflammatory markers (ESR, CRP) N: noncaseating granulomas
Tests for Celiac disease
Stool:
- split fats
- reducing substances
Blood:
- antiendomysial antibodies
- anti-TTG (more sensitive)
- anti-DPG (highest specificity)
Gold standard: upper endoscopy with duodenal biopsy showing villous atrophy
Irritable bowel syndrome
- Noninvasive testing (CBC, ESR, anti-TTG, stool guiac –>
- Fiber trial –>
- EGD and/or colonoscopy –>
If these fail, you can diagnose IBS
Hirschprung Disease
Aganglionic segment of bowel (lack of parasympathetic innervation) that is narrow or contracted that can result in magacolon proximal to that segment.
The affected segment is the narrow segment.
Pyloric stenosis
- Non-bilious projectile vomiting
- Labs: hypochloremic hypokalemic metabolic alkalosis
- Pylorus: > 14 mm long or > 4 mm thick
Volvulus
- Bilious emesis
- Malrotation -> poorly fixed bowel -> bowel wraps around SMA (may cause ischemic bowel) -> bloody stools
- Double bubble sign on imaging
- Gold standard study: upper GI series
- May see “corkscrew” appearance of duodenum
Duodenal Atresia
- Bilious emesis on DOL 1
- possible jaundice due to increased enterohepatic circulation
- KUB: double bubble (only if incomplete atresia)
Intussusception
- Often in ileocecal area
- Currant jelly stools
- Abdominal pain, bilious emesis, palpable mass
- Ages: 3 months - 6 years
Meckel’s Diverticulum
- Contains all 3 layers of bowel wall
- Large volumes of painless rectal bleeding
- Most present before 2 years of age
- Found in 2% of population
- Located 2 ft from ileocecal valve
- Most are 2 inches in length
What is the inheritance pattern for familial adenomatous polyploid?
Autosomal dominant
Presentation for familial adenomatous polyposis
Painless rectal bleeding -> polyp found on evaluation in a child less than 10 years of age
When is the colon resected in a child with FAP?
- Yearly screening for polyps after 10 years of age
- Once large adenomas (>1 cm) are found
- After age 25 years
What is esophageal perforation associated with?
- Marfan syndrome
- Ehlers-Danlos
- Epidermolysis bullosa
- Ingestion of bases
What is a single umbilical artery associated with?
VACTER-L syndrome
What are the five things that can cause rectal prolapse?
- Constipation
- Diarrhea
- Polyps
- Trichuris/Whipworm
- Shigella
What is congenital hepatic fibrosis associated with?
Polycystic kidney disease
Can lead to varices and portal hypertension
What is gallbladder hydrops and what is it associated with?
- Right upper quadrant pain from acute swelling or distention without gallstones
- Associated with fasting, HSP, Kawasaki syndrome, strep pharyngitis, TPN
What is primary sclerosing cholangitis and what is it associated with?
- Chronic cholestatic liver disease from autoimmune inflammation -> fibrosis of the intrahepatic and extrahepatic biliary tree
- ERCP: beading and stenosis of the biliary ducts
- Associated with ulcerative colitis
How do you differentiate hepatocellular jaundice from cholestatic jaundice?
- Hepatocellular jaundice: associated transaminitis
- Cholestatic jaundice: marked elevation in alkaline phosphatase
What will be the clinical findings of neonatal cholestasis?
- Jaundice, pale stools, hepatomegaly
- ⬆️ conjugated bilirubin
- HIDA scan: uptake without excretion due to obstructive process
What causes kernicterus: conjugated or unconjugated bilirubin?
Unconjugated bilirubin
What are the clinical features of biliary atresia?
- ⬆️ conjugated bilirubin
- Can result in liver failure
What are the clinical findings of a choledochal cyst?
- Congenital cystic dilation of biliary tree
- Sxs: RUQ abdominal pain, abdominal mass, nausea, vomiting, pancreatitis
- Increased risk of cancer
What are the clinical features of alagile syndrome?
- Neonatal jaundice
- Liver:
• Paucity of bile ducts - Heart:
• Pulmonary stenosis
• TOF - Features:
• Small chin -> triangular jaw
• ⬆️ cholesterol, xanthomas
• Eye abnormalities
• Acholic stools
What are the features of Gilbert’s Syndrome?
"GUC DRC" Gilbert's Unconjugated Crigler-Najjar Dublin Johnson Rotor Conjugated
- Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
- Autosomal recessive
- Benign
- Noted at times of illness or stress
What are the features of Crigler-Najjar Syndrome?
"GUC DRC" Gilbert's Unconjugated Crigler-Najjar Dublin Johnson Rotor Conjugated
- Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
- Type I: NO DIRECT BILIRUBIN; jaundice in first few days of life; lifelong phototherapy
- Type II: some glucuronyl transferase activity
How is Wilson’s disease treated?
Penicillamine, a copper chelator
How do you screen family members for Wilson’s disease?
Obtain a ceruloplasmin level
- Primary copper carrying protein made in the liver
- If low, suggests Wilson’s disease
What is cholangitis?
- A medical emergency
- Infection in the biliary tract
- Charcot’s triad: fever, RUQ pain, leukocytosis
What is the most common etiology of nodular gastritis?
H. Pylori
Gold standard for Dx: EGD with bx
Can be seen in Crohn’s disease
What is Zollinger Ellison syndrome?
- Gastrin tumor of the pancreas -> multiple GI ulcerations
- Diagnose with high fasting gastric level
- Associated with MEN I (PPP tumors: Pituitary, Parathyroid, Pancreas
What are the clinical features of ulcerative colitis?
ULCERS IN ABDomen
Ulcers (mucosal and submucosal) Large intestine (rectum always involved) Clubbing of fingers Extra-intestinal manifestations (e.g. Erythema nodosum) Remnants of old ulcers (pseudopolyps) Stools bloody Inflamed, red granular mucosa/submucosa Neutrophil invasion Abscesses in crypts Biochemical markers of inflammation (⬆️ESR) Diarrhea (esp. in pancolitis)
What are the clinical features of congenital hypothyroidism?
- Constipation
- Delayed anterior fontanelle closure
- Hoarse cry
- Poor growth
- Umbilical hernia
What are some prophylactic medications that may be used in patients with cyclic vomiting?
(May be a FHx of migraines or IBS.)
Amitriptyline
Cyproheptadine
Propranolol
(A diagnosis of exclusion, so make sure some sort of work up is done first.)
