GI Flashcards
Conditions associated with Celiac Disease
- Type 1 Diabetes
- IgA Deficiency
- Down Syndrome
- Turner Syndrome
- Williams Syndrome
- Other Autoimmune Disorders (thyroid, arthritis, liver)
- First Degree Relative with Celiac
Extraintestinal manifestations of celiac disease
Dermatitis Herpetiformis Dental Enamel Hypoplasia of permanent teeth Osteopenia/ Osteoporosis Short Stature Delayed puberty Iron Deficiency Anemia Hepatitis Arthritis Epilepsy w occipital lobe calcifications
rash in celiac disease
Dermatitis Herpetiformis
what has gluten in it
wheat
rye
barley
(technically not oats but often manufactured same place as wheat)
how long do you need to eat gluten before you can get real results of ttg/bx
8 weeks
Presentation of Crohns vs Colitis
Crohns: skinny kid
UC: bloody poop
Terminal ileum - in UC or crohns?
UC: TI not involved
Crohn’s: thick/stenosed TI
Key macroscopic features of UC vs Crohns
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
Granuloma’ - UC or Crohns’
only in crohns
Key microscopic features of UC vs Crohns
UC
- mucosal/superficial
- extensive crypt absess
- mucus depletion
Crohn’s
- transmural
- common lymphoid hypertrophy
- focal crypt abscess
- +granulomas
- common submucosal fibrosis
Crohn’s Mgmt
Induction:
- Tube feeds/EEN
- Steroids
- 5ASA
- Biologics
Maintenance
- Tube feeds/EEN
- Azathioprine
- MTX
- Biologics
UC Mgmt
Induction:
- Steroids
- 5ASA
- Biologics
Maintenance
- 5ASA
- Azathioprine
- MTX
- Biologics
Differential Diagnosis of Terminal Ileitis
- Crohn’s
- Lymphoma
- Yersinia Infection
- Tuberculosis
- Chronic Granulomatous Disease
- Severe Eosinophilic Gastroenteropathy
- Lymphonodular hyperplasia (normal finding)
Organic Causes of constipation
• Hypothyroidism • Celiac Disease • Lead Poisoning • Cystic Fibrosis • HYPERcalcemia • HYPOkalemia • CNS disorders o Hirschprung’s o Cerebral palsy o Neural tube defects • Idiopathic
Dysphagia ddx
- Eosinophilic esophagitis
- Esophageal motility disorder (scleroderma)
- Achalasia
- Anatomic obstruction
Painful Swallowing: Odynophagia
- Candidal infection
* Reflux esophagitis
Bugs of bloody diarrhea
- Yersinia (usually)
- Salmonella (usually)
- Shigella
- E. coli
- Campylobacter
YOUR SHIT SMELLS EXTREMELY CRAPPY
Hirshsprung - investigations and what will you see
Barium enema
dilation of the large bowel with narrowing immediately proximal to the rectum
Then do rectal biopsy
Functional constipation
<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
Colic definition
- 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
Rumination d/o - how to tx
relaxation therapies, avoidance of behavioral reinforcement
Cyclic vomiting syndrome
• 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
Gilberts Syndrome
Non hemolytic unconjugated hyperbilirubinemia
Persistant unconjugated hyperbili in infant
Hepatic causes of hyperbilirubinemia
Infectious Medications/Ingestions/Toxins Metabolic (A1AT, hemochromatosis, Wilsons) Inflammatory (AIH, NAFLD/NASH) Neoplastic (primary, mets, hematologic)
Post hepatic causes of hyperbilirubinemia
conjugated hyperbilirubinemia
- Biliary atresia
- Choledochal cyst
- CF
- Gallstones
- Primary Sclerosing Cholangitis
- Neoplastic
- Inspissated bile syndrome
- Genetic (PFIC)
Clinical features of acute liver failure
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)
Infant at risk of Hep B - what to do
Hepatitis B vaccine within 12 hours
Hepatitis B Immunoglobulin within 12 hours; max 7 days
marker for protein malabsorption
Stool alpha-1-antitrypsin
Derm features of IBD
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
Ingestion of button battery - when to do urgent endoscopy
when to do serial Xray
Esophageal: always
Gastric: if >20mm AND <5yo
or if symptomatic
otherwise serial xray
if >20mm repeat in 48h
if <20mm repeat in 10-14d
ingestion of coin management
esophageal
gastric
SB
esophageal:
- symptomatic: scope immmediately
- asymptomatic: scope within 24 h
gastric:
observe
consider scope if not passed in 2-4 weeks
SB:
scope if symptomatic
What is the GI issues in Schwachman-Diamond
Pancreatic insufficiency
Lytes in pyloric stenosis
Met alkalosis
Low K
Low Cl
Low Na
Associations with opmhalocele
35% have other gastrointestinal defects (malrotation, intestinal atresia, and necrotizing enterocolitis)
20% have congenital heart defects
T13, T18
Urinary tract anomalies
what is more common gastroschisis or ompahleocele
gastroschisis
most common lead point for intussecption
meckels
Kasabach–Merritt syndrome
Hemangioma with thrombocytopenia
Biliary atresia
- first investigation
- diagnostic
U/S with doppler
cholangiogram with liver biopsy
what is more sensitive and specific for acute pancreatitis?
lipase
What is best to feed short gut
elemental formula with MCT
All sugars are reducing except what one?
sucrose
After what age should you investigate prolonged jaundice?
2 weeks
Peutz Jeghers syndrome
- 2 characteristics
mucocutaneous hyperpigmentation (Macular pigmented lesions (dark brown or blue) found around lips and oral mucosa, also hands feet and perineum) small bowel polyposis
What is best indicator of liver function?
INR
Indications for soy formula
- Galactosemia
- Religious/cultural reasons (i.e. veganism).
How to manage liver failure?
- fluid restrict
- PPI for gastric bleeding
- monitor for hypoglycemia
- follow INR, manage bleeding
- PICU/transplant centre
Barium swallow bird beak
achalasia
Ddx dysphagia
Achalasia Scleroderma Esophageal web Zenker diverticulum Stricture Vascular ring Pulmonary sling EoE GERD Pill esophagitis
Wilson Disease
- what is the problem
- presentation
- lab
Copper overload
* AR
Presentation: Conjugated hyperbilirubinemia PALF Neuropsych Sx Kayser-Fleischer (K-F) rings
Ceruoplasmin
Infant dyschezia
<9mo:
1) at least 10 min of straining/crying before successful/unsuccessful passage of SOFT stool
2) no other health problems
Functional dyspepsia
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
Irritable Bowel Syndrome
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
Abdo migraine
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
Functional abdo pain
- criteria
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
Neonatal cholestasis
ddx (6)
- Biliary atresia
- Choledochal cysts]
- hypothyroidism
- spesis
- galactosemia
- tyrosinemia
Alagille Syndrome
conjugated hyperbilirubinemia paucity of bile ducts posterior embryotoxon butterfly vertebrae pulmonary stenosis renal issues
Kwashiorkor
Protein malnutrition
Hypoalbuminemia
Edema
Inadequate protein intake, fair energy intake
Marasmus
Severe protein - energy malnutrition
Emaciation
Body weight <70%
No edema
Presentation of Meckels
painless PR bleeding
Zinc deficiency
- what does it cause
- when does it happen
- presentation (2)
Acrodermatitis enteropathica
When weaning from breast milk
Rash
Reddish tint hair
CMPA
- presentation
diarrhea, vomiting, blood stool
no FTT
CMPA
-mgmt
Breastfed: mom stop drinking milk
Formula: extensively hydrolyzed formula
H Pylori
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
