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Peds Boards > GI > Flashcards

GI Flashcards

1
Q

Polyposis syndromes: Peutz Jeghers

A
  • when children have 5 or more juvenile polyps
  • adenomatous polyps
  • or family hx of polyposis or early colorectal cancer

Juvenile polyposis: Just polyps in GI tract

  • 5 or more polyps = JPS
  • referred for genetic testing
  • surveillance yrly if polyps present

Peutz Jeghers:
+ freckling of mucocutaneous and hands/feet
polyps that frequently present as intussusception

Gardner: + desmoid tumors, osteoma, dental

Familial adenomatous polyposis: + desmoid tumors, osteoma, dental, hypertrophy of retinal pigment epithelium (eye shit)

ALL are AUTOSOMAL DOM
ALL are associated with certain cancers - need to be followed by Onc

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2
Q

Irritable Bowel syndrome Tx

A

Tx: peppermint oil

DX: at least 3 days/month in the past 3 months without other etiology. pain may change with stooling pattern and may be relieved by defecation.

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3
Q

Rectal Prolapse - screen for what disease?

A

CF

Causes of rectal prolapse:

  • functional constipation and excessive straining
  • chronic diarrhea
  • CF (prevalence of rectal prolapse 19%!)
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4
Q

juvenile Colonic Polyps

A

Juvenile colonic polyps are relative common
Present in 1st decade of life.
Can be associated with bleeding.

If LESS THAN 5 = okay.

If SOLITARY and NO ADENOMATOUS component - then there is no risk for cancer.

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5
Q

Campylobacter

A

Most are self-limited and do not require tx.
Gram-Neg helical bacteria

Associated with ingestion of contaminated poultry or fecal material from pets, untreated water, unpasturized milk.

BUT treat if immunocompromised, chronically ill, pregnant, severe or prolonged (> 1 wk) sx.
AKA like in CF patients**

Tx:
Azithromycin**

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6
Q

What condition is associated with achalasia?

A

Adrenal insufficiency!

Triple-A or Allgrove syndrome

  • Achalasia
  • Adrenal insufficiency
  • Alacrima (reduced ability to secrete tears)
  • Autonomic dysfxn (abnl sweating, orthostatic hypotension, altered heart rate)
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7
Q

Autoimmune Hepatitis

A

Type I:

  • 10-20 years, females
  • ANA and Anti-SM

Type II:

  • younger children
  • more severe
  • anti-liver kidney microsomal Ab is positive
  • HYPERgammaglobulinemia
  • fever, RUQ pain, jaundice, transaminases, bilirubins, GGT and Alk phos elevated
  • Tx: immunosuppression
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8
Q

Hirshsprung on barium enema

A

Aganglionic segment = Distal narrowed segment

Ganglionic segment = Proximal dilated segment

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9
Q

Pyloric Stenosis

A

Pyloric Thickness > 4 mm
Overall Pyloric Length of > 18 mm

HypoK HypoCl Met Alkalosis

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10
Q

Test to confirm biliary atresia

A

Intraoperative Cholangiogram
- if positive, proceed to Kasai procedure

Initial tests:

  • Abd US
  • HIDA
  • Liver Biopsy
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11
Q

DDX of neonatal unconjugated vs conjugated bilirubinemia

A

Unconjugated - messed up UGT1A1

  • Crigler-Najjar
  • Gilbert

Conjugated

  • Dubin Johnson and Rotor - genetic defects that prevent exportation of bile from hepatocytes to bile
  • Biliary atresia
  • cystic fibrosis
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12
Q

Hereditary Hemachromatosis

A

Iron overload disease

  • high ferritin and transferrin**
  • mutation in the HFE gene - hepcidin expression. Hepcidin is inversely proportional to iron

Sx: fatigue, malaise, abdominal pain, arthralgias, impotence, cardiomyopathy, and development of diabetes secondary to pancreatic overload.
Physical findings include hepatosplenomegaly, bronze discoloration of skin, and arthropathy.

Tx: phlebotomy, chelation with desferrioxamine

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13
Q

Hepatitis A

A

flu-like symptoms + elevated liver enzymes
from endemic countries usually

EXCLUDED from work/school for 1 wk after symptom onset (shedding of hep A in stool diminishes significantly after 1 wk).

No post exposure prophylaxis

Hepatitis A does not induce a chronic carrier state, nor does it lead to chronic infection.

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14
Q

What is a complication of UC that causes fatigue, pruritis, HSM, and elevated GGT?

A

Primary Sclerosing Cholangitis

  • chronic inflam and fibrosis of intra and/or extra hepatic bile ducts
  • MRCP to diagnose
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15
Q

What is preferred diagnostic imaging modality for cholelithiasis, cholecystitis, or choledocholithiasis?

A

Ultrasound!!!

Cholelithiasis: colicky RUQ pain, shoulder pain, n/v
Cholecystitis: fever, RUQ pain, murphy’s
Choledocholithiasis: jaundice, acholic stools
Cholangitis: jaundice, AMS, shock

The risk for cholelithiasis is highest in children with chronic hemolytic anemia, obesity, or long-term exposure to parenteral nutrition.

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16
Q

Cyclic Vomiting Syndrome

A

Functional disorder

  • episodes of nausea and vomiting that last hours to days with return to baseline health btwn episodes
  • 3-7 year olds

Tx: Cyproheptadine in those 5 or younger.
TCAs in those > 5

17
Q

Hepatitis B Serologies

A

file:///Users/vicky/Downloads/C245A.pdf

18
Q

Celiac Disease

A

Present after introduction of cereal and solids (btwn 6 to 24 months)

IgA antibodies against tissue transglutaminase

Abd pain, diarrhea, or FTT and vomiting

Dental enamel hypoplasia, short stature, dermatitis herpetiformis, recurrent aphthous stomatitis

Iron def anemia (due to malabsorption from villous atrophy), hypoproteinemia

Assoc. with T1DM, Thyroiditis and in Turner, Williams, and Downs

19
Q

Choledochal cyst - why should they be removed?

A

Risk of developing cholangiocarcinoma!

20
Q

Types of Esophagitis

A

Herpes - ulcerations that can coalesce with normal intervening mucosa (like reactivation when you’re on HD corticosteroids)

Candida - typically demonstrates white mucosal plaque-like lesions.

Eosinophilic esophagitis- multiple ring-like structures and/or small whitish papules representing eosinophilic abscesses.

Medication (pill-induced) esophageal injury - deep, singular ulceration(s) at points of stasis (especially near the carina) with sparing of the distal esophagus.

Barrett esophagus - long segments of columnar epithelium that extend above the esophagogastric junction. Columnar epithelium has a reddish color and velvet-like texture, whereas squamous epithelium has a more pale, glossy appearance. The squamocolumnar junction forms a visible line (the Z-line).

21
Q

Perinatal HCV - how to detect

A

NAA for HCV RNA (NOT DNA VIRUS!!!)

IgG is unreliable bc maternal IgG ab for anti-HCV is identified in infants up to 18 mo of age.

Should perform testing at 1-2 mo of age

22
Q

Hep B vs. Hep A

A

Hep B - more extrahepatic manifestations like arthralgia, rashes, thrombocytopenia

Both have - fever, general malaise, nausea, anorexia, jaundice, abdominal pain, tender hepatomegaly, and, in up to 10% of cases, splenomegaly.

23
Q

Gallbladder Hydrops

A

Gallbladder distension by sterile bile

- can be caused kawasaki!

24
Q

How to reduce cholestasis risk?

A

CYCLE THE TPN. Reduces insulin exposure allowing for mobilization of fat and decreased cholestasis

  • increasing lipid content, GIR and trace minerals increases the risk of cholestasis.
25
Q

Hepatitis D needs what coinfection

A

it can not replicate without a coexisting infections with hepatitis B virus (HBV). Coinfection with HDV is more severe than having HBV alone. This coinfection can progress more rapidly to liver failure and cirrhosis. The diagnosis is confirmed with the presence of anti-HDV antibody.

26
Q

Celiac is associated with what conditiosn

A 
*trisomy 21*
diabetes mellitus Type 1
Williams syndrome
Turner syndrome
autoimmune thyroiditis
selective IgA deficiency

1st and 2nd degree relatives of individuals with celiac disease. Up to 16% of individuals with trisomy 21 have celiac disease.

27
Q

Celiac intestine biopsy shows

A

Flattened villi
intraepithelial lymphocytes
Crypts

CF - normal intestine bx, has decreased fecal elastase

28
Q

Functional Abdominal Pain Syndrome

A

Pain is usually periumbilical

The Rome III Criteria for the diagnosis of childhood functional abdominal pain syndrome are: 1) Episodic or continuous abdominal pain, 2) Insufficient criteria for other functional gastrointestinal disorders, 3) No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms, 4) Criteria fulfilled at least once per week for at least 2 months prior to diagnosis.

29
Q

SMA syndrome

A

Loss of fat (such as in anorexia**) that causes the duodenum to be compressed by the SMA and abdominal aorta.

Relief of symptoms when lying prone/left lateral decub/knee chest positions.

Tx: NG or GJ tube past obstruction to allow for formula feeding and wt gain

30
Q

What is the most common cause of acute fulminant liver failure in US?

A

Drug hepatotoxicity

31
Q

What medication should you avoid giving to your child after varicella vaccine?

A

Salicyclates for at least 6 weeks due to risk of Reye syndrome

32
Q

PPIs increase the risk of ?

A

C diff diarrhea

Also:

  • increased risk of PNA (reduction in gastric acid allows for pathogens to more easily colonize upper GI with potential to spread to lower resp tract)
  • malabsorption of vit B 12, iron, hypomag, ca
33
Q

Wilsons

A

Defective mobilization of Cu from lysosomes for excretion into bile.

Elevated URINE Cu** and Cu accumulation in liver, brain, kidney, cornea

Decreased serum ceruloplasmin
Decreased serum cu (due to decreased ceruloplasmin)
Elevated transaminases

TX: D-penicillamine to chelate Cu. + pyroxidine supplmentation.

34
Q

Genetic Defects

A

PRSS1 - hereditary pancreatitis (leads to conversion of trypsinogen to trypsin while still in the pancreas rather than intestinal lumen)

NOD2 - crohn’s

A1AT - hereditary liver disease

JAG1 - Alagille syndrome

35
Q

C diff testing

A

Stool for C diff toxin (NOT CULTURE as this is unreliable and frequently falsely neg).

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