GI Flashcards
1
Q
A patient with JIA presents with epigastric pain, what is the most likely underlying cause?
A
Inhibition of prostaglandin synthesis (use of NSAIDs)
2
Q
What is the best treatment in a patient with post op intestinal obstruction?
A
Decompression of the abdomen
3
Q
What is the definition of functional dyspepsia?
A
Pain in the upper abdomen or periumbilical region that occurs at least once a week for >2 months
4
Q
What is the treatment of functional dyspepsia?
A
Elimination of exacerbating factors such as NSAIDs or soda
Can also use h2blockers or PPIs
5
Q
When should you test for h pylori in a patient who presents with symptoms of functional dyspepsia ?
A
Routine testing for h pylori is NOT indicated for functional dyspepsia
6
Q
What is the treatment of abdominal migraine?
A
Removal of triggers such as caffeine or nitrate containing foods and reducing psychological stress
Can also use propranolol, ciproheptadine and sumatriptan
7
Q
What should you consider in a patient with abdominal pain who presents with urinary retention, tachycardia and dry mouth?
A
Inappropriate use of anticholinergic for abdominal pain
8
Q
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?
A
Giardia
9
Q
What is the best test for diagnosis of giardia?
A
Antigen stool studies
10
Q
What is the treatment for giardia?
A
Metronidazole or nitazoxanide or tinidazole
11
Q
What two tests might be indicated when a patient presents with a large amount of watery diarrhea?
A
Cholera or clostridium difficile
12
Q
What is the optimum mixture of oral rehydration fluid?
A
2% glucose and 90 mEq NaCl
13
Q
What is the appropriate prophylaxis against travelers diarrhea?
A
Bismuth subsalicylate or
Bactrim
14
Q
When is the only time antibiotics should be considered for E. coli diarrhea ?
A
If no improvement after several days and only if shiga toxin negative
15
Q
What are the main signs of HUS?
A
Renal failure
Thrombocytopenia
Hemolytic anemia
16
Q
What type of bacteria is likely the cause of green foul smelling diarrhea that occurs 2 days after a picnic?
A
Salmonella
17
Q
What is the appropriate treatment of salmonella / typhoid fever?
A
Rocephin or cefotaxime
18
Q
What disease has the classic finding of rose spots as well as fever and muscle aches?
A
Typhoid fever
19
Q
What is the diagnosis in a patient with bloody diarrhea and seizure ?
A
Shigella
20
Q
What is the treatment of choice for shigella diarrhea?
A
Bactrim
21
Q
What lab abnormality is common with shigella infection?
A
High bands
22
Q
What is the appropriate treatment for campylobacter?
A
Erythromycin or azithromycin
23
Q
What diagnosis should you consider in a patient with fever and crampy periumbilical or RLQ pain that is relieved with defecation?
A
Campylobacter
24
Q
What do you do to treat an asymptomatic child who is c diff positive but under 6 months old?
A
No treatment
25
What is the treatment of yersinia colitis?
No treatment
26
What is the treatment for c diff?
Oral flagyl
27
What is the definition of chronic diarrhea ?
Diarrhea >2 weeks that cannot be attributed to acute gastroenteritis
28
What is the mechanism by which neuroblastoma can cause diarrhea ?
Vasoactive intestinal peptides
29
What is proper way to screen for fat malabsorption?
A 3 day fecal fat measurement
30
What is the most common cause of diarrhea in children under age 3?
Toddlers diarrhea
31
What 3 symptoms can NOT be present in the diagnosis of toddlers diarrhea ?
Poor growth
Fever
Melena
32
What is the treatment of toddlers diarrhea?
Decrease carbohydrates
Increase fat and high fiber
Removal of cold foods from diet
33
What is the difference between milk protein allergy and food sensitivities?
Milk protein allergy is IgE mediated but food sensitivity is non igE mediated
34
What are the symptoms of food protein enterocolitis syndrome (FPIES)?
Vomiting and bloody diarrhea ...commonly due to cow and soy milk
35
What are "starvation stools"?
Frequent passage of loose green stools due to malnutrition
36
What disease presents with steatorrhea and RBCs with spiney projections ?
Abetalipoproteinemia
37
What are the long term sequelae of abetalipoproteinemia?
Retinal damage and neurological sequelae
38
What are the findings in a patient with intestinal lymphangiectasia?
Protein losing enteropathy with low protein, hypogammaglobulinemia, lymphedema and lymphopenia
39
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
40
What is seen on imaging in a patient with antral web?
radiolucent filling defect in PRE pyloric region
41
What is the electrolyte abnormality found in pyloric stenosis?
Hypochloremic metabolic alkalosis with severe hypokalemia
42
What is the diagnostic criteria for pyloric stenosis?
Pyloric length >14 mm or muscle thickness >4 mm
43
What is the likely diagnosis in a patient with progressive non bilious vomiting and high indirect bilirubin?
Pyloric stenosis
44
What diagnosis should you consider in a patient with vomiting and elevated anion gap with hypoglycemia?
Inborn error of metabolism
45
What is the classic imaging finding in a patient with duodenal atresia?
Double bubble on X-ray
46
What disease presents with bilious vomiting on the first day of life?
Duodenal atresia
47
What do you do if a newborn presents with bilious vomiting?
If only one episode ...observe. If multiple episodes...Abdominal X-ray
48
How would malrotation present ?
Bilious vomiting and abdominal tenderness/distention with crampy abdominal pain and bloody stool
49
What do Ladd bands cause?
Volvulus- construction of large and small bowel
50
What are the X-ray findings seen with volvulus?
Decreased intestinal air and corkscrew appearance of duodenum
51
What is an annular pancreas?
The pancreas forms a ring around the intestine causing obstruction
52
What is the anatomical cause of malrotation?
Cecum fails to descend and compresses the duodenum
53
What is the most valuable test for diagnosing gerd in an older child?
Upper endoscopy and biopsy
54
When should gerd be worked up or treated?
Posturing
FTT
Apnea
55
What is an upper Gi series used to evaluate ?
Assess malrotation and hiatal hernia
56
What is the mechanism of action of ondansetron?
Serotonin receptor antagonist
57
Which risk factors cause higher risk of complications in infants with gerd?
Prematurity
Neurological impairment
Family hx GERD
58
What is the treatment for cyclic vomiting ?
Fluids, zofran and lorazepam
59
What are 3 causes of severe episodic vomiting?
Cyclic vomiting
Pancreatitis
Metabolic defects
60
What diagnosis is associated with forceful vomiting, weight loss and dysphagia?
Achalasia
61
What is the disease that presents with parotitis, dry mouth and poor tear production?
Mikulicz's disease
62
What is the most common etiology of parotitis?
Idiopathic
63
What should you consider in a patient with parotitis with high fever and tenderness?
Staph aureus
64
What is the diagnosis and treatment of a mucocele on the floor of the mouth?
Ranula- excision
65
What is the diagnosis and treatment of a midline mass on the floor of the mouth?
Ectopic thyroid - do not remove
66
What is the main presentation of ectodermal hypoplasia ?
Underdeveloped or absent teeth
67
How do you diagnose ectodermal hypoplasia?
Skin biopsy shows lack of sweat pores
68
What is the inheritance pattern of ectodermal hypoplasia?
X linked
69
What is the presenting finding in a patient with hallermann streiff syndrome ?
Underdeveloped small teeth
70
What is the diagnosis in a patient with liver disease, tarry stools and hematemesis ?
Esophageal varices
71
What should you suspect in a patient with coughing who can only drink liquids ?
Foreign body
72
What should you suspect in a patient with coughing while feeding, copious oral secretions and inability to pass a feeding tube?
TE fistula
73
What is the treatment for TE fistula?
Npo and drainage of the esophagus before surgery
74
How to NSAIDs cause GI symptoms ?
Interfering with prostaglandin synthesis
75
What is the best first study when evaluating a child with abdominal pain?
Plain KUB
76
What is the best diagnostic study when PUD is suspected ?
Upper GI endoscopy and biopsy for H pylori
77
What are the treatment options for PUD?
H2 blocker
Sucralfate
Prostaglandin analogues
PPI
78
Which prostaglandin can not be used in pregnant teens ?
Misoprostol
79
What is the mechanism of action of prostaglandin analogues ?
Enhanced bicarb production and decreased gastric acid production
80
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)
81
What is the proper treatment for h pylori?
PPI + clarithromycin + amoxicillin/metronidazole (14 days)
82
How do you diagnose Zollinger Ellison syndrome ?
fasting gastrin levels
83
How can you diagnose celiac disease?
Screen for high IgA against tissue transglutaminase or endomysial antibodies
Confirm with biopsy!
84
What diagnosis should you consider in a patient with anemia who has had a small bowel resection ?
B12 deficiency / pernicious anemia
85
What two things could block B12 absorption in the terminal ileum?
Parasites or IBD
86
What is the treatment for irritable bowel syndrome ?
High fiber diet and decreased emotional factors
87
What diagnosis should you consider in a patient with bulky, pale foul smelling stools and proximal muscle wasting?
Celiac disease
88
What are 4 causes of rectal prolapse?
Cystic fibrosis
Constipation/increased intraabdominal pressure
Meningomyelocele
Parasites
89
How can you distinguish cystic fibrosis from shwachman diamond syndrome?
Both cause malabsorption but shwachman diamond is associated with bone abnormalities
90
What electrolyte abnormality is common with cystic fibrosis ?
Hyponatremia
91
What disease must be ruled out in a patient with meconium plug syndrome?
Cystic fibrosis
92
What is the inheritance pattern for Gardner syndrome ?
Autosomal dominant
93
What diagnosis presents with supernumerary teeth and pre-malignant polyp in the large and small intestine?
Gardner syndrome
94
What diagnosis should you consider in a teenager with chronic crampy abdominal pain, fever,anemia and low albumin?
Ulcerative colitis
95
What antigen is associated with both Crohn's an UC?
HLA B27
96
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
97
When should you get a barium enema in a patient suspected of having UC?
Never - risk of perforation!
98
What is the risk of cancer with UC?
20% risk per decade after the first 10 years of disease
99
What are 3 main extracolonic manifestations of UC?
Arthritis
Mucocutaneous lesions
Liver disease
100
What one lab finding may be important in a child with short stature?
ESR (r/o Crohn's)
101
What disease presents with skip lesions on X-ray with are transmural with non caseating granulomas?
Crohns
102
What diagnosis should you consider in a patient with pyoderma gangrenosum of the foot and arthritis?
Crohns
103
What disease should you consider in a patient with erythema nodosum and renal stones ?
Crohns
104
What disease should you consider in a patient with uveitis and liver disease?
Crohns
105
In which inflammatory bowel disease is surgery curative ?
Ulcerative colitis
106
What is the purpose of medication use in patients with Crohns ?
To decrease morbidity - meds do not change long term course
107
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
108
What might be the cause of crampy SEVERE periumbilical pain in a febrile child?
Yersinia
109
What diagnosis should you consider in an 8 month old child with bilious vomiting and sausage like mass in abdomen ?
Intussusception
110
What is the treatment for intussusception?
Air enema
111
What diagnosis must be ruled out in a child older than 6 years old who gets intussusception?
Lymphosarcoma (lead point)
112
What is the most common cause of a palpable abdominal mass in infants?
Multicystic dysplastic kidney
113
What should you consider in a 2 y/o child who is afebrile but appears septic?
Intussusception
114
What is the first thing to do to distinguish upper from lower GI bleeding?
Nasogastric lavage
115
What diagnosis presents with constipation, poor growth, umbilical hernia and delayed closure of fontanelle?
Congenital hypothyroidism
116
What diagnosis presents with infants who strain to pass small liquid stools but resolves by age 1?
Anal stenosis
117
What test helps determine whether blood is the mothers or the infants ?
Apt test
118
What syndrome presents with increased risk for Hirschsprung's?
Down syndrome
119
What are 3 possible causes of a lower GI bleed in the newborn ?
Hirschsprung's
Malrotation
NEC
120
What are 2 main causes of painless rectal bleeding?
Meckels
| Juvenile polyp
121
How do you test for entamoeba histolytica?
Serology
122
What is the treatment for entamoeba histolytica?
Flagyl for colitis or liver abscess
| Iodoquinol for asymptomatic disease
123
What is a cause of bloody diarrhea in a patient in preschool who is from Native American reservation in southwestern United States?
Entamoeba histolytica
124
How do you diagnose meckels?
Technetium 99m pertechnetate scintigraphy
125
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
126
What is the cause of alagille syndrome?
Intrahepatic biliary atresia
127
What is the treatment for biliary atresia?
Kasai (anastomoses between liver and intestine) - only done if child is younger than 2 months
128
What is the first test to rule out biliary atresia? What is the method of confirmation of disease?
Ultrasound then HIDA. Confirm with biopsy
129
What is the most common cause of cholestatic jaundice in a newborn?
TPN
130
How can you distinguish jaundice due to cholestasis vs hepatocellular disease?
Cholestasis causes high alkaline phosphatase
| Hepatocellular disease causes high ALT
131
What enzyme deficiency is the cause of Gilbert syndrome ?
Glucuronyl transferase
132
What diagnosis should you consider in a patient with elevated bilirubin after recent illness? His brother had the same phenomenon...
Gilbert syndrome
133
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!!!
134
What is the treatment for Wilson's disease? What side effect can occur from the treatment?
D penicillamine
| Can cause aplastic anemia
135
What is the most specific test for diagnosis of pancreatitis?
Abdominal ultrasound
136
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
137
What abnormal lung findings are associated with pancreatitis?
Pulmonary edema
| Pleural effusion
138
What 5 lab abnormalities are associated with acute pancreatitis (other than elevated amylase and lipase)?
```
Hyperglycemia
Hypocalcemia
Elevated BUN
Anemia
Coagulopathy
```
139
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
140
What diagnosis should you consider in a patient with recurrent epigastric pain and hx of hyperparathyroidism?
Hypercalcemia causing pancreatitis
141
Abdominal pain that radiates to the shoulder is likely from what organ?
Gallbladder
142
What are 4 main risk factors for gallstones ?
Cystic fibrosis
Ileal resection
Ceftriaxone
TPN
143
What diagnosis should you consider in a patient with fever, jaundice, abdominal and shoulder pain and intolerance to fatty foods?
Cholecystitis
144
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
145
What is the difference in presentation between cholecystitis and cholelithiasis?
Cholecystitis presents with should pain and lethargy
| Cholelithiasis presents with jaundice and hepatomegaly
146
What is the best study to diagnose hepatitis A?
IgM (IgG levels persist for life)
147
Ok what populations is hepatitis A more common?
Native Americans and Alaskans
| Not commonly seen in Asians
148
What are the typical symptoms of hepatitis A?
Flu like symptoms (but 90% are asymptomatic)
149
When is hep B surface antigen present?
Present during active infection but does not differentiate acute vs chronic
150
When is hep B surface antigen antibody (HBsAb) present ?
Previous infection or past immunization
151
What does high HBeAg indicate ?
High infectivity
152
When is anti-HBcAg positive ?
Indicates recent infection (remain elevated up to 6 months)
153
What is the most common cause of chronic viral hepatitis?
Hep C
154
What does hepatitis D virus require to replicate ?
HBsAg
155
How is hepatitis E transmitted? Where is it common?
Fecal oral
| Asia, Africa and Mexico
156
Which types of hepatitis can cause chronic infection ?
B and C and D
157
What are the classic X-ray findings of acute appendicitis?
Sentinel loop and absence of air in the RLQ
