GI Flashcards
Inheritance of Cleft Lip
Most are multifactorial inheritance; also autosomal dominant in families (most with isolated cleft palate)
Tx of CLAP
Treatment—surgical correction
− Lip at 3 months of age
− Palate at <1 year
Causes of chronic diarrhea (infant)
• Postinfectious lactase deficiency • Milk/soy intolerance • Chronic diarrhea of infancy • Celiac disease • Cystic fibrosis
Causes of chronic diarrhea (child)
Postinfectious lactase deficiency • Irritable bowel syndrome • Celiac disease • Lactose intolerance • Giardiasis • Inflammatory bowel disease
Causes of chronic diarrhea (adolescent)
Irritable bowel syndrome • Inflammatory bowel disease • Lactose intolerance • Giardiasis • Laxative abuse
Diarrhea associated with:
Nurseries, daycare
Enteropathogenic E. coli
Enteropathogenic E. coli TX
Supportive care in severe cases, neomycin or colistin
Enterotoxigenic /Traveler’s diarrhea
_______
E. coli
Enterotoxigenic /Traveler’s diarrhea Tx
Supportive care trimetho prim-sulfamethoxazole in severe
cases
Enterhemorrhagic E. coli Association
Hemorrhagic colitis, HUS
Enterhemorrhagic E. coli Tx
No antimicrobial therapy in suspected cases due to ↑ risk
of HUS; supportive care only
Salmonella Tx
Treatment indicated only for patients who are ≤3 months
of age, toxic, has disseminated disease, or S. typhi
Shigela Tx
Trimethoprim/sulfamethoxazole
Diarrhea caused by person to person sprad
Shigella, Campylobacter
Tx of Campylobacter
Self-limiting; erythromycin speeds recovery and reduces
carrier state; recommended for severe disease
Yersinia enterocolitica Tx
No antibiotic therapy; aminoglycosides plus a third-generation cephalosporin for infants ≤3 months of age or with culture-proven septicemia
Bacteria asstd with food poisoning
Staphylococcus aureus
Tx for Cryptosporidium
Raising CD4 count to normal is best treatment. No proven
therapy (antimicrobial); strong supportive care; may try
rifabutin
What syndrome?
– Pancreatic insufficiency
– Neutropenia
– Malabsorption
Schwachman-Diamond Syndrome
Dx
– Lymph fluid leaks into bowel lumen
– Steatorrhea
– Protein-losing enteropathy
Intestinal lymphangiectasia
Dx
– Osmotic diarrhea
– Acidic stools
Disaccaridase Deficiency
Dx
– Severe fat malabsorption form birth – Acanthocytes – Very low to absent plasma cholesterol, triglycerides, etc.
Abetalipoproteinemia
° Weight, height, and nutritional status is normal, and no fat in stool
° Excessive intake of fruit juice, carbonated fluids, low fat intake usually present in history
Chronic nonspecific diarrhea of infancy
Diarrhea with carbohydrates—__________
CHO malabsorption
Weight loss and stool with high fat—______
think malabsorption
Dxtics for fat malabsorption
° Most useful screening test is stool for fat ______
° Confirm with ______
(Sudan red stain)
72-hour stool for fecal fat (gold standard for steatorrhea)
Steatorrhea is most prominent with _______ all require a
sweat chloride
pancreatic insufficiency;
Serum _______ is also a good screen (reflects residual pancreatic function)
trypsinogen
CHO malabsorption—screen with ______
reducing substances in stool (Clinitest
Test for CHO malabsorption
___________—after a known CHO load, the collected breath hydrogen is analyzed and malabsorption of the specific CHO is identified
Breath hydrogen test
Screening for CHON malabsorption
Screen—spot stool α1-antitrypsin level
_________—only common primary infection causing chronic malabsorption
Giardiasis
Small-bowel disease causing malabsorption—
1
2
3
gluten enteropathy, abetalipoproteinemia, lymphangiectasia
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) types
– Isolated EA
– Isolated (H-type) TEF
– EA and distal TEF
What type of EA
presents chronically and diagnosed later in life with chronic respiratory problems
H-type—
Tx of EA with TEF
Treatment—surgical ligation of TEF and resection with end-to-end anastomosis of esophageal atresia
What is the dx?
− Postprandial regurgitation
− Signs of esophagitis—arching, irritability, feeding aversion, failure to thrive
− Obstructive apnea, stridor, lower airway disease (cough, wheezing
Gastroesophageal Reflux Disease (GERD)
GERD Dx
______—quantitative and sensitive documentation
of acid reflux (normal pH in lower esophagus is <4 only 5−8% of time)
Esophageal pH monitoring (best test)
Endoscopy findings of GERD
Endoscopy—erosive esophagitis and complications
GERD
_______—to document aspiration
Radionucleotide scintigraphy (Tc)
GERD Tx
_______—first-line with overall best safety profile
H2-receptor antagonist (ranitidine, cimetidine, famotidine)
GERD Tx
________—most potent for severe reflux and esophagitis
Proton pump inhibitor (omeprazole, lansoprazole, pantoprazole)
GERD Type of Sx
fundoplication for refractory esophagitis, strictures, chronic pulmonary disease, continued obstructive apnea
What is the dx
− Nonbilious, projectile vomiting
− Still hungry and desire to feed more
− Usually age ≥3 weeks (1 week to 5 months)
Pyloric Stenosis
Dx of Pyloric Stenosis
best test is ultrasound (a target-like appearance in cross-section)
Tx of Pyloric Stenosis
− Rehydrate, correct electrolytes (NaCl, KCl)
− Pyloromyotomy
MC association with Duodenal Atresia
Down syndrome
Other associations with Duodenal atresia
malrotation, esophageal atresia, congenital heart defects, anorectal malformation, renal anomalies
Clinical presentation of duodenal atresia
− Bilious vomiting without abdominal distention on first day of life (obstruction
just distal to ampulla)
− Polyhydramnios prenatally
− Many with jaundice (increased enterohepatic circulation)
Xray of duodenal atresia
X-ray shows classic double bubble with no distal bowel gas.
Xray of duodenal atresia
Surgery—duodenoduodenostomy
− Incomplete rotation of intestine during fetal development
− Superior mesenteric artery acts as axis for rotation
Malrotation and Volvulus
Malrotation and Volvulus
______ may extend from cecum to right upper quadrant (RUQ) to produce
duodenal obstruction
Ladd bands
SSx of Malrotation and Volvulus
− Most present in first year of life with acute or chronic incomplete obstruction
− Bilious emesis, recurrent abdominal pain with vomiting
An acute small-bowel obstruction in a patient without previous bowel surgery is
suspicious for_________
volvulus (acute surgical abdomen)
Barium enema of volvulus
Barium enema shows malposition of cecum (mobile cecum is not situated in the
right lower quadrant); upper gastrointestinal will show malposition of ligament of
Treitz
UTZ findings of volvulus
Ultrasound will show inversion of superior mesenteric artery and vein (superior
mesenteric vein to the left of the artery is suggestive) and duodenal obstruction
with thickened bowel loops to the right of the spine
Etiology of Meckel Diverticulum
− Remnant of embryonic yolk sac (omphalomesenteric or vitelline duct), lining similar to stomach
− Most frequent congenital gastrointestinal anomaly
CX of Meckel
May have partial or complete bowel obstruction (lead point for an intussusception)
or develop diverticulitis and look like acute appendicitis (much less common
presentation
Dx of Meckel
Meckel radionuclide scan (Tc-99m pertechnetate
MC type of intussusception
most ileal-colic
intussusception usually follows what infection?
Commonly following adenovirus or rotavirus infection, upper respiratory infection,
otitis media
Other associations of intussusception
Associated with HSP (Henoch-Schönlein purpura)
intussusception may also occur with a leading point such as?
Meckel diverticulum, polyp, neurofibroma,
hemangioma, malignancy
Pathophysio of “black currant jelly” stool
bowel drags mesentery with it and produces arterial and venous obstruction and mucosal necrosis
SSx of intussusception
− Sudden onset of severe paroxysmal colicky abdominal pain; straining, legs flexed
− Progressive weakness
− Lethargy, shock with fever
PE of intussusception
slightly tender, sausage-shaped mass on right in cephalocaudal axis
DX and Tx of Intu
______ is the next study of choice as it is far safer than the previously-used barium enema (0.1 vs. 2.5% risk of perforation); it may be therapeutic and prevent the need for immediate surgery
Air enema
Tx of Intu
________—most will reduce if done within
48 hours of presentation (goes down to half after that time)
Radiographic reduction under fluoroscopy
If surgical—if manual operative reduction is not possible or bowel is not viable,
then __________
resection and end-to-end anastomosis
PE of Functional Constipation
large volume of stool palpated in suprapubic area; rectal
exam shows vault filled with stool
Etiology of Hirschprung
absence of a ganglion cells in bowel wall beginning at internal anal sphincter
and extending variably proximally
SSx of Hirschprung
− Suspect in any full-term infant with a delay in passage of meconium (>24 hours)
TX of Hirschprung
Treatment—surgery (most with temporary colostomy) and wait 6−12 months for definitive correction (most achieve continence)
