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*Review TD 2020 > GI > Flashcards

GI Flashcards

1
Q

Conditions associated with Celiac Disease

A
  • Type 1 Diabetes
  • IgA Deficiency
  • Down Syndrome
  • Turner Syndrome
  • Williams Syndrome
  • Other Autoimmune Disorders (thyroid, arthritis, liver)
  • First Degree Relative with Celiac
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2
Q

Extraintestinal manifestations of celiac disease

A 
Dermatitis Herpetiformis
Dental Enamel Hypoplasia of permanent teeth
Osteopenia/ Osteoporosis
Short Stature
Delayed puberty
Iron Deficiency Anemia
Hepatitis
Arthritis
Epilepsy w occipital lobe calcifications
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3
Q

rash in celiac disease

A

Dermatitis Herpetiformis

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4
Q

what has gluten in it

A

wheat
rye
barley
(technically not oats but often manufactured same place as wheat)

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5
Q

how long do you need to eat gluten before you can get real results of ttg/bx

A

8 weeks

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6
Q

Presentation of Crohns vs Colitis

A

Crohns: skinny kid
UC: bloody poop

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7
Q

Terminal ileum - in UC or crohns?

A

UC: TI not involved

Crohn’s: thick/stenosed TI

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8
Q

Key macroscopic features of UC vs Crohns

A

UC:

  • rectum always involved
  • No TI
  • Hemorrhagic mucosa
  • Bowel wall normal
  • rare stricture or fistula
  • common PSC

Crohns:

  • Segmental, diffuse involvement
  • skip lesions
  • thick, stenosed TI
  • Thickened bowel wall
  • cobblestoning/deep ulcers (serpiginous)
  • common to have strictures, fistulas, EN
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9
Q

Granuloma’ - UC or Crohns’

A

only in crohns

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10
Q

Key microscopic features of UC vs Crohns

A

UC

  • mucosal/superficial
  • extensive crypt absess
  • mucus depletion

Crohn’s

  • transmural
  • common lymphoid hypertrophy
  • focal crypt abscess
  • +granulomas
  • common submucosal fibrosis
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11
Q

Crohn’s Mgmt

A

Induction:

  • Tube feeds/EEN
  • Steroids
  • 5ASA
  • Biologics

Maintenance

  • Tube feeds/EEN
  • Azathioprine
  • MTX
  • Biologics
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12
Q

UC Mgmt

A

Induction:

  • Steroids
  • 5ASA
  • Biologics

Maintenance

  • 5ASA
  • Azathioprine
  • MTX
  • Biologics
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13
Q

Differential Diagnosis of Terminal Ileitis

A
  • Crohn’s
  • Lymphoma
  • Yersinia Infection
  • Tuberculosis
  • Chronic Granulomatous Disease
  • Severe Eosinophilic Gastroenteropathy
  • Lymphonodular hyperplasia (normal finding)
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14
Q

Organic Causes of constipation

A 
• Hypothyroidism 
• Celiac Disease 
• Lead Poisoning 
• Cystic Fibrosis
• HYPERcalcemia 
• HYPOkalemia
• CNS disorders
o Hirschprung’s
o Cerebral palsy
o Neural tube defects
• Idiopathic
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15
Q

Dysphagia ddx

A
  • Eosinophilic esophagitis
  • Esophageal motility disorder (scleroderma)
  • Achalasia
  • Anatomic obstruction
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16
Q

Painful Swallowing: Odynophagia

A
  • Candidal infection

* Reflux esophagitis

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17
Q

Bugs of bloody diarrhea

A
  • Yersinia (usually)
  • Salmonella (usually)
  • Shigella
  • E. coli
  • Campylobacter

YOUR SHIT SMELLS EXTREMELY CRAPPY

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18
Q

Hirshsprung - investigations and what will you see

A

Barium enema
dilation of the large bowel with narrowing immediately proximal to the rectum

Then do rectal biopsy

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19
Q

Functional constipation

A

<3 bowel movements/week
• Excessive stool retention
• Painful or hard bowel movements
• Large fecal mass in rectum
• posturing position to avoid stooling
• 3x/wk episode of incontinence after toilet training
• Large-diameter stools that block toilet

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20
Q

Colic definition

A
  • Infant <5 months old when symptoms start and stop
  • Recurrent and prolonged periods of infant crying, fussing, or irritability without obvious cause, cannot prevent or resolve
  • No evidence of FTT, fever, or illness
  • Episodes lasting >3 hours/day for 3 days per week for >1 week
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21
Q

Rumination d/o - how to tx

A

relaxation therapies, avoidance of behavioral reinforcement

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22
Q

Cyclic vomiting syndrome

A

• At least 2 periods of intense nausea and hyperemesis or retching lasting hours to days (in past 6mo)
(at least 4x/hr for 1hr–10d)
• Episodes are stereotypical
• Return to usual state of health lasting weeks to months
• Symptoms not attributable to other conditions

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23
Q

Gilberts Syndrome

A

Non hemolytic unconjugated hyperbilirubinemia

Persistant unconjugated hyperbili in infant

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24
Q

Hepatic causes of hyperbilirubinemia

A 
Infectious
Medications/Ingestions/Toxins
Metabolic (A1AT, hemochromatosis, Wilsons)
Inflammatory (AIH, NAFLD/NASH)
Neoplastic (primary, mets, hematologic)
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25
Q

Post hepatic causes of hyperbilirubinemia

A

conjugated hyperbilirubinemia

  • Biliary atresia
  • Choledochal cyst
  • CF
  • Gallstones
  • Primary Sclerosing Cholangitis
  • Neoplastic
  • Inspissated bile syndrome
  • Genetic (PFIC)
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26
Q

Clinical features of acute liver failure

A 
Cerebral edema
High Output Cardiac failure
Acute respiratory distress syndrome
Upper GI bleeding
Hypoglycemia, lactic acidosis, coagulopathy
Hypoadrenalism
AKI
Pancreatitis
Infectious diseases (impaired leukocyte fn)
27
Q

Infant at risk of Hep B - what to do

A

Hepatitis B vaccine within 12 hours

Hepatitis B Immunoglobulin within 12 hours; max 7 days

28
Q

marker for protein malabsorption

A

Stool alpha-1-antitrypsin

29
Q

Derm features of IBD

A 
Erythema nodosum
Pyoderma gangrenosum
Perianal fistula
Aphthous ulcers
Sweet Syndrome - fever, leukocytosis, tender nodules/papules on upper body and face.
Necrotizing vasculitis
Metastatic Crohn’s disease
30
Q

Ingestion of button battery - when to do urgent endoscopy

when to do serial Xray

A

Esophageal: always
Gastric: if >20mm AND <5yo
or if symptomatic

otherwise serial xray
if >20mm repeat in 48h
if <20mm repeat in 10-14d

31
Q

ingestion of coin management
esophageal
gastric
SB

A

esophageal:
- symptomatic: scope immmediately
- asymptomatic: scope within 24 h

gastric:
observe
consider scope if not passed in 2-4 weeks

SB:
scope if symptomatic

32
Q

What is the GI issues in Schwachman-Diamond

A

Pancreatic insufficiency

33
Q

Lytes in pyloric stenosis

A

Met alkalosis
Low K
Low Cl
Low Na

34
Q

Associations with opmhalocele

A

35% have other gastrointestinal defects (malrotation, intestinal atresia, and necrotizing enterocolitis)
20% have congenital heart defects
T13, T18
Urinary tract anomalies

35
Q

what is more common gastroschisis or ompahleocele

A

gastroschisis

36
Q

most common lead point for intussecption

A

meckels

37
Q

Kasabach–Merritt syndrome

A

Hemangioma with thrombocytopenia

38
Q

Biliary atresia

  • first investigation
  • diagnostic
A

U/S with doppler

cholangiogram with liver biopsy

39
Q

what is more sensitive and specific for acute pancreatitis?

A

lipase

40
Q

What is best to feed short gut

A

elemental formula with MCT

41
Q

All sugars are reducing except what one?

A

sucrose

42
Q

After what age should you investigate prolonged jaundice?

A

2 weeks

43
Q

Peutz Jeghers syndrome

- 2 characteristics

A 
mucocutaneous hyperpigmentation (Macular pigmented lesions (dark brown or blue) found around lips and oral mucosa, also hands feet and perineum)
small bowel polyposis
44
Q

What is best indicator of liver function?

A

INR

45
Q

Indications for soy formula

A
  • Galactosemia

- Religious/cultural reasons (i.e. veganism).

46
Q

How to manage liver failure?

A
  • fluid restrict
  • PPI for gastric bleeding
  • monitor for hypoglycemia
  • follow INR, manage bleeding
  • PICU/transplant centre
47
Q

Barium swallow bird beak

A

achalasia

48
Q

Ddx dysphagia

A 
Achalasia
Scleroderma
Esophageal web
Zenker diverticulum
Stricture
Vascular ring
Pulmonary sling
EoE
GERD
Pill esophagitis
49
Q

Wilson Disease

  • what is the problem
  • presentation
  • lab
A

Copper overload
* AR

Presentation:
Conjugated hyperbilirubinemia
PALF
Neuropsych Sx
Kayser-Fleischer (K-F) rings

Ceruoplasmin

50
Q

Infant dyschezia

A

<9mo:

1) at least 10 min of straining/crying before successful/unsuccessful passage of SOFT stool
2) no other health problems

51
Q

Functional dyspepsia

A

at least one of at least 4 days/month:

1) post prandial fullness
2) early satiety
3) epigastric pain/burning not associated with defecation
4) after appropriate evaluation, sx cannot be explained by another medical condition

52
Q

Irritable Bowel Syndrome

A

All of in at least 2 months old:

1) abdo pain at least 4 days per month associated with 1 of:
- related to defecation
- change in frequency of stool
- change in form of stool

2) pain does not resolve with resolution of constipation
3) after appropriate evaluation, sx cannot be explained by another medical condition

53
Q

Abdo migraine

A

at least 2 episodes of all of:

1) paroxysmal episodes of intense, acute periumbilical, midline or diffuse abdominal pain lasting >/= 1 hr (should be the most severe/distressing sx)
2) episodes separated by weeks-months
3) pain is incapacitating and interferes w normal activities
4) stereotypical pattern and sx

5) pain is Assoc w at least 2 of:
- anorexia
- nausea
- vomiting
- headache
- photophobia
- pallor

6) after appropriate evaluation, sx cannot be explained by another medical condition

54
Q

Functional abdo pain

- criteria

A

at least 4 month of all of:

1) episodic/continuous abdo pain that does not occur solely during physiologic events (ex: eating/menses)
2) insufficient criteria for IBS/functional dyspepsia/abdo migraine
3) after appropriate evaluation, sx cannot be explained by another medical condition

55
Q

Neonatal cholestasis

ddx (6)

A
  • Biliary atresia
  • Choledochal cysts]
  • hypothyroidism
  • spesis
  • galactosemia
  • tyrosinemia
56
Q

Alagille Syndrome

A 
conjugated hyperbilirubinemia
paucity of bile ducts
posterior embryotoxon
butterfly vertebrae
pulmonary stenosis
renal issues
57
Q

Kwashiorkor

A

Protein malnutrition
Hypoalbuminemia
Edema

Inadequate protein intake, fair energy intake

58
Q

Marasmus

A

Severe protein - energy malnutrition
Emaciation

Body weight <70%
No edema

59
Q

Presentation of Meckels

A

painless PR bleeding

60
Q

Zinc deficiency

  • what does it cause
  • when does it happen
  • presentation (2)
A

Acrodermatitis enteropathica

When weaning from breast milk

Rash
Reddish tint hair

61
Q

CMPA

- presentation

A

diarrhea, vomiting, blood stool

no FTT

62
Q

CMPA

-mgmt

A

Breastfed: mom stop drinking milk

Formula: extensively hydrolyzed formula

63
Q

H Pylori

A

Peptic ulcer disaese

Epigastric pain

No empiric treatment until dx
No longer do urea breath test for dx

Dx: scope
- bx and susceptibility

can do urea breath test to follow to clear

Tx:
Triple therapy
- PPI
- Amox
- another abx based on susceptibility

*Review TD 2020 (16 decks)

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