GI Flashcards
A patient with JIA presents with epigastric pain, what is the most likely underlying cause?
Inhibition of prostaglandin synthesis (use of NSAIDs)
What is the best treatment in a patient with post op intestinal obstruction?
Decompression of the abdomen
What is the definition of functional dyspepsia?
Pain in the upper abdomen or periumbilical region that occurs at least once a week for >2 months
What is the treatment of functional dyspepsia?
Elimination of exacerbating factors such as NSAIDs or soda
Can also use h2blockers or PPIs
When should you test for h pylori in a patient who presents with symptoms of functional dyspepsia ?
Routine testing for h pylori is NOT indicated for functional dyspepsia
What is the treatment of abdominal migraine?
Removal of triggers such as caffeine or nitrate containing foods and reducing psychological stress
Can also use propranolol, ciproheptadine and sumatriptan
What should you consider in a patient with abdominal pain who presents with urinary retention, tachycardia and dry mouth?
Inappropriate use of anticholinergic for abdominal pain
What might be the diagnosis in a patient with several weeks of watery diarrhea, abdominal distention and no fever in a child who attends daycare?
Giardia
What is the best test for diagnosis of giardia?
Antigen stool studies
What is the treatment for giardia?
Metronidazole or nitazoxanide or tinidazole
What two tests might be indicated when a patient presents with a large amount of watery diarrhea?
Cholera or clostridium difficile
What is the optimum mixture of oral rehydration fluid?
2% glucose and 90 mEq NaCl
What is the appropriate prophylaxis against travelers diarrhea?
Bismuth subsalicylate or
Bactrim
When is the only time antibiotics should be considered for E. coli diarrhea ?
If no improvement after several days and only if shiga toxin negative
What are the main signs of HUS?
Renal failure
Thrombocytopenia
Hemolytic anemia
What type of bacteria is likely the cause of green foul smelling diarrhea that occurs 2 days after a picnic?
Salmonella
What is the appropriate treatment of salmonella / typhoid fever?
Rocephin or cefotaxime
What disease has the classic finding of rose spots as well as fever and muscle aches?
Typhoid fever
What is the diagnosis in a patient with bloody diarrhea and seizure ?
Shigella
What is the treatment of choice for shigella diarrhea?
Bactrim
What lab abnormality is common with shigella infection?
High bands
What is the appropriate treatment for campylobacter?
Erythromycin or azithromycin
What diagnosis should you consider in a patient with fever and crampy periumbilical or RLQ pain that is relieved with defecation?
Campylobacter
What do you do to treat an asymptomatic child who is c diff positive but under 6 months old?
No treatment
What is the treatment of yersinia colitis?
No treatment
What is the treatment for c diff?
Oral flagyl
What is the definition of chronic diarrhea ?
Diarrhea >2 weeks that cannot be attributed to acute gastroenteritis
What is the mechanism by which neuroblastoma can cause diarrhea ?
Vasoactive intestinal peptides
What is proper way to screen for fat malabsorption?
A 3 day fecal fat measurement
What is the most common cause of diarrhea in children under age 3?
Toddlers diarrhea
What 3 symptoms can NOT be present in the diagnosis of toddlers diarrhea ?
Poor growth
Fever
Melena
What is the treatment of toddlers diarrhea?
Decrease carbohydrates
Increase fat and high fiber
Removal of cold foods from diet
What is the difference between milk protein allergy and food sensitivities?
Milk protein allergy is IgE mediated but food sensitivity is non igE mediated
What are the symptoms of food protein enterocolitis syndrome (FPIES)?
Vomiting and bloody diarrhea …commonly due to cow and soy milk
What are “starvation stools”?
Frequent passage of loose green stools due to malnutrition
What disease presents with steatorrhea and RBCs with spiney projections ?
Abetalipoproteinemia
What are the long term sequelae of abetalipoproteinemia?
Retinal damage and neurological sequelae
What are the findings in a patient with intestinal lymphangiectasia?
Protein losing enteropathy with low protein, hypogammaglobulinemia, lymphedema and lymphopenia
What diagnosis should you consider in a patient with non bilious vomiting within the first 6 months of life who had low birthweight and polyhydrambios in utero?
Antral web
What is seen on imaging in a patient with antral web?
radiolucent filling defect in PRE pyloric region
What is the electrolyte abnormality found in pyloric stenosis?
Hypochloremic metabolic alkalosis with severe hypokalemia
What is the diagnostic criteria for pyloric stenosis?
Pyloric length >14 mm or muscle thickness >4 mm
What is the likely diagnosis in a patient with progressive non bilious vomiting and high indirect bilirubin?
Pyloric stenosis
What diagnosis should you consider in a patient with vomiting and elevated anion gap with hypoglycemia?
Inborn error of metabolism
What is the classic imaging finding in a patient with duodenal atresia?
Double bubble on X-ray
What disease presents with bilious vomiting on the first day of life?
Duodenal atresia
What do you do if a newborn presents with bilious vomiting?
If only one episode …observe. If multiple episodes…Abdominal X-ray
How would malrotation present ?
Bilious vomiting and abdominal tenderness/distention with crampy abdominal pain and bloody stool
What do Ladd bands cause?
Volvulus- construction of large and small bowel
What are the X-ray findings seen with volvulus?
Decreased intestinal air and corkscrew appearance of duodenum
What is an annular pancreas?
The pancreas forms a ring around the intestine causing obstruction
What is the anatomical cause of malrotation?
Cecum fails to descend and compresses the duodenum
What is the most valuable test for diagnosing gerd in an older child?
Upper endoscopy and biopsy
When should gerd be worked up or treated?
Posturing
FTT
Apnea
What is an upper Gi series used to evaluate ?
Assess malrotation and hiatal hernia
What is the mechanism of action of ondansetron?
Serotonin receptor antagonist
Which risk factors cause higher risk of complications in infants with gerd?
Prematurity
Neurological impairment
Family hx GERD
What is the treatment for cyclic vomiting ?
Fluids, zofran and lorazepam
What are 3 causes of severe episodic vomiting?
Cyclic vomiting
Pancreatitis
Metabolic defects
What diagnosis is associated with forceful vomiting, weight loss and dysphagia?
Achalasia
What is the disease that presents with parotitis, dry mouth and poor tear production?
Mikulicz’s disease
What is the most common etiology of parotitis?
Idiopathic
What should you consider in a patient with parotitis with high fever and tenderness?
Staph aureus
What is the diagnosis and treatment of a mucocele on the floor of the mouth?
Ranula- excision
What is the diagnosis and treatment of a midline mass on the floor of the mouth?
Ectopic thyroid - do not remove
What is the main presentation of ectodermal hypoplasia ?
Underdeveloped or absent teeth
How do you diagnose ectodermal hypoplasia?
Skin biopsy shows lack of sweat pores
What is the inheritance pattern of ectodermal hypoplasia?
X linked
What is the presenting finding in a patient with hallermann streiff syndrome ?
Underdeveloped small teeth
What is the diagnosis in a patient with liver disease, tarry stools and hematemesis ?
Esophageal varices
What should you suspect in a patient with coughing who can only drink liquids ?
Foreign body
What should you suspect in a patient with coughing while feeding, copious oral secretions and inability to pass a feeding tube?
TE fistula
What is the treatment for TE fistula?
Npo and drainage of the esophagus before surgery
How to NSAIDs cause GI symptoms ?
Interfering with prostaglandin synthesis
What is the best first study when evaluating a child with abdominal pain?
Plain KUB
What is the best diagnostic study when PUD is suspected ?
Upper GI endoscopy and biopsy for H pylori
What are the treatment options for PUD?
H2 blocker
Sucralfate
Prostaglandin analogues
PPI
Which prostaglandin can not be used in pregnant teens ?
Misoprostol
What is the mechanism of action of prostaglandin analogues ?
Enhanced bicarb production and decreased gastric acid production
What should you do if a patient with abdominal pain is positive for H pylori serology?
Confirm with fecal antigen or breath test (remember that positive h pylori does not prove that this is the cause of abdominal pain)
What is the proper treatment for h pylori?
PPI + clarithromycin + amoxicillin/metronidazole (14 days)
How do you diagnose Zollinger Ellison syndrome ?
fasting gastrin levels
How can you diagnose celiac disease?
Screen for high IgA against tissue transglutaminase or endomysial antibodies
Confirm with biopsy!
What diagnosis should you consider in a patient with anemia who has had a small bowel resection ?
B12 deficiency / pernicious anemia
What two things could block B12 absorption in the terminal ileum?
Parasites or IBD
What is the treatment for irritable bowel syndrome ?
High fiber diet and decreased emotional factors
What diagnosis should you consider in a patient with bulky, pale foul smelling stools and proximal muscle wasting?
Celiac disease
What are 4 causes of rectal prolapse?
Cystic fibrosis
Constipation/increased intraabdominal pressure
Meningomyelocele
Parasites
How can you distinguish cystic fibrosis from shwachman diamond syndrome?
Both cause malabsorption but shwachman diamond is associated with bone abnormalities
What electrolyte abnormality is common with cystic fibrosis ?
Hyponatremia
What disease must be ruled out in a patient with meconium plug syndrome?
Cystic fibrosis
What is the inheritance pattern for Gardner syndrome ?
Autosomal dominant
What diagnosis presents with supernumerary teeth and pre-malignant polyp in the large and small intestine?
Gardner syndrome
What diagnosis should you consider in a teenager with chronic crampy abdominal pain, fever,anemia and low albumin?
Ulcerative colitis
What antigen is associated with both Crohn’s an UC?
HLA B27
What is first line treatment for ulcerative colitis? What are other drug options ?
5 amino salicylates…can also use corticosteroids, 6MP, methotrexate, azathioprine, cyclosporine or tacrolimus
When should you get a barium enema in a patient suspected of having UC?
Never - risk of perforation!
What is the risk of cancer with UC?
20% risk per decade after the first 10 years of disease
What are 3 main extracolonic manifestations of UC?
Arthritis
Mucocutaneous lesions
Liver disease
What one lab finding may be important in a child with short stature?
ESR (r/o Crohn’s)
What disease presents with skip lesions on X-ray with are transmural with non caseating granulomas?
Crohns
What diagnosis should you consider in a patient with pyoderma gangrenosum of the foot and arthritis?
Crohns
What disease should you consider in a patient with erythema nodosum and renal stones ?
Crohns
What disease should you consider in a patient with uveitis and liver disease?
Crohns
In which inflammatory bowel disease is surgery curative ?
Ulcerative colitis
What is the purpose of medication use in patients with Crohns ?
To decrease morbidity - meds do not change long term course
What is the rate of remission and relapse with steroid treatment for Crohns ?
Steroid induce remission in 70% with small bowel involvement but relapse rate is high once steroids are weaned
What might be the cause of crampy SEVERE periumbilical pain in a febrile child?
Yersinia
What diagnosis should you consider in an 8 month old child with bilious vomiting and sausage like mass in abdomen ?
Intussusception
What is the treatment for intussusception?
Air enema
What diagnosis must be ruled out in a child older than 6 years old who gets intussusception?
Lymphosarcoma (lead point)
What is the most common cause of a palpable abdominal mass in infants?
Multicystic dysplastic kidney
What should you consider in a 2 y/o child who is afebrile but appears septic?
Intussusception
What is the first thing to do to distinguish upper from lower GI bleeding?
Nasogastric lavage
What diagnosis presents with constipation, poor growth, umbilical hernia and delayed closure of fontanelle?
Congenital hypothyroidism
What diagnosis presents with infants who strain to pass small liquid stools but resolves by age 1?
Anal stenosis
What test helps determine whether blood is the mothers or the infants ?
Apt test
What syndrome presents with increased risk for Hirschsprung’s?
Down syndrome
What are 3 possible causes of a lower GI bleed in the newborn ?
Hirschsprung’s
Malrotation
NEC
What are 2 main causes of painless rectal bleeding?
Meckels
Juvenile polyp
How do you test for entamoeba histolytica?
Serology
What is the treatment for entamoeba histolytica?
Flagyl for colitis or liver abscess
Iodoquinol for asymptomatic disease
What is a cause of bloody diarrhea in a patient in preschool who is from Native American reservation in southwestern United States?
Entamoeba histolytica
How do you diagnose meckels?
Technetium 99m pertechnetate scintigraphy
Where is a meckels diverticulitis typically located and how long is it?
Rule of twos - presents at age 2 with 2 types of tissue (gastric and intestinal), found 2 feet from ileocecal valve and is 2 inches in length. Presents in 2% of the population
What is the cause of alagille syndrome?
Intrahepatic biliary atresia
What is the treatment for biliary atresia?
Kasai (anastomoses between liver and intestine) - only done if child is younger than 2 months
What is the first test to rule out biliary atresia? What is the method of confirmation of disease?
Ultrasound then HIDA. Confirm with biopsy
What is the most common cause of cholestatic jaundice in a newborn?
TPN
How can you distinguish jaundice due to cholestasis vs hepatocellular disease?
Cholestasis causes high alkaline phosphatase
Hepatocellular disease causes high ALT
What enzyme deficiency is the cause of Gilbert syndrome ?
Glucuronyl transferase
What diagnosis should you consider in a patient with elevated bilirubin after recent illness? His brother had the same phenomenon…
Gilbert syndrome
A child presents with elevated LFTs and high ammonia. He is lethargic. History positive for recent URI with medication given for fever. What is the diagnosis? What if this is the second episode?
Reye syndrome
If second episode, think inborn error of metabolism!!!
What is the treatment for Wilson’s disease? What side effect can occur from the treatment?
D penicillamine
Can cause aplastic anemia
What is the most specific test for diagnosis of pancreatitis?
Abdominal ultrasound
A patient presents with epigastric pain that radiates to the back and vomiting. He is most comfortable laying on his side in the fetal position. Amylase is normal. What is the diagnosis?
Pancreatitis - remember lipase is more specific for pancreatic disease
What abnormal lung findings are associated with pancreatitis?
Pulmonary edema
Pleural effusion
What 5 lab abnormalities are associated with acute pancreatitis (other than elevated amylase and lipase)?
Hyperglycemia Hypocalcemia Elevated BUN Anemia Coagulopathy
What test may reveal the underlying cause of a patient with epigastric pain and vomiting?…his father died from atherosclerosis disease
Serum lipids – Chronic pancreatitis is caused by hyperlipidemia
What diagnosis should you consider in a patient with recurrent epigastric pain and hx of hyperparathyroidism?
Hypercalcemia causing pancreatitis
Abdominal pain that radiates to the shoulder is likely from what organ?
Gallbladder
What are 4 main risk factors for gallstones ?
Cystic fibrosis
Ileal resection
Ceftriaxone
TPN
What diagnosis should you consider in a patient with fever, jaundice, abdominal and shoulder pain and intolerance to fatty foods?
Cholecystitis
A 15 year old boy presents with right shoulder pain, vomiting and lethargy, what is the best diagnostic tool and treatment?
Abdominal US - surgery for cholecystitis
What is the difference in presentation between cholecystitis and cholelithiasis?
Cholecystitis presents with should pain and lethargy
Cholelithiasis presents with jaundice and hepatomegaly
What is the best study to diagnose hepatitis A?
IgM (IgG levels persist for life)
Ok what populations is hepatitis A more common?
Native Americans and Alaskans
Not commonly seen in Asians
What are the typical symptoms of hepatitis A?
Flu like symptoms (but 90% are asymptomatic)
When is hep B surface antigen present?
Present during active infection but does not differentiate acute vs chronic
When is hep B surface antigen antibody (HBsAb) present ?
Previous infection or past immunization
What does high HBeAg indicate ?
High infectivity
When is anti-HBcAg positive ?
Indicates recent infection (remain elevated up to 6 months)
What is the most common cause of chronic viral hepatitis?
Hep C
What does hepatitis D virus require to replicate ?
HBsAg
How is hepatitis E transmitted? Where is it common?
Fecal oral
Asia, Africa and Mexico
Which types of hepatitis can cause chronic infection ?
B and C and D
What are the classic X-ray findings of acute appendicitis?
Sentinel loop and absence of air in the RLQ
