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