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GI HEME ONC ID > GI > Flashcards

GI Flashcards

1
Q

What are the 4 common medications in IBD ?

A
  1. 5-asa 2. Azithropurine 3. MTX 4. Corticosteroids
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2
Q

What are the common side effects of the following: 1. 5-asa 2. Azithropurine 3. MTX 4. Biologics: infliximab, adalimumuab “mab” are anti-tnf

A

1) head/ache, n/v, yellow orange coloring, abdo pain, some what of a colitis FLARE 2) Azathiorpine: n/v/ abdo pain, mask pain 3)mtx- rash, n/v/d/, rash, mouth sores, hair loss, photosensitivity 4) similar to the above, fatigue, back pain

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3
Q

What are the immunosuppression counselling that one should counsel to those starting immunosuppressive medications ?

A

food safety: avoid undercooked meets, deli meats, raw eggs, dental hygiene exposure to heave concentrations of garden soil. Avoid: construction to sites, barns,

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4
Q

What are life threatening complications to IBD ?

A

-fulminant colitis -perforation -obstruction -GI hemorrhage -pouchitis

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5
Q

What is the adult chronic disease that ibd ( more uc > crohnes ) ?

A

colon cancer Managed with yearly scoping, once having the disease for 8-10 yrs

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6
Q

What are 3 syndromes that are risk factor for celiac disease ?

A
  1. Down syndrome 2. Turners syndrome 3. William syndrome
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7
Q

What is the diagnostic criteria ?

A

A normal appearing esophagus endsocopically does not exclude diagnosis. Diagnostic criteria -Esophageal eosinophilia: ≥15 eos/hpf in at least 1 esophageal mucosal biopsy -Other microscopic features of eosinophilic inflammation -Eosinophil degranulation/extracellular eosinophil granules -Surface/superficial layering layering of eosinophils -Eosinophilic microabscess (at surface)

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8
Q

What is the role of pH monitoring as per NASPHGAN recommendations ?When should you being using it ? (1)

A

To correlate symptoms of non-GERD and GERD symptoms.

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9
Q

HBsAG is often (+) first even before alt/ ast elevation? T OR false

A

True

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10
Q

What does the following mean: Seroconversion of ANTI-HBe indicates (mostly) …

A

active HBV replication phase is over, generally correlated with decreased HBV DNA Decline in HBV DNA reflects reduction in viral replication. If HBV DNA declines to low/undetectable levels, with loss of HBeAg and anti-HBe+  generally suggests favourable course, inactive disease

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11
Q

Name and describe the 4 phases of chronic hep B

A

Phase 1: Phase 2: Phase 3 : Phase 4:

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12
Q

____ is. risk factor for autoimmune hepatitis. Which is both a HISTOLOGICAL and a LAB/CHEMICAL DX.

A

IBD

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13
Q

what is the dx criteria for AUTOIMMUNE HEPATITIS ?

A

1) positive antibodies ie. antismoothe (>1:20) ANA -ANTI-LKMI -ANTI-lci anti-SLA 2)Liver biopsy: interface hepatitis, and interlobular colapse 3) Ruled out strutural causes ie. cholangiogram or mrcp

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14
Q

How do you make the dx of Allagile syndrome ? Cholestasis (with intrahepatic bile duct paucity) Cardiac murmur/heart disease Skeletal anomalies: butterfly vertebrae Ocular findings: posterior embriotoxin Renal anomalies** Structural vascular anomaly Characteristic facies: triangular facies,

A

3 or more if no genetic mutation/family history 2 or more if FHx 1 or more if mutation without FHx 0 or more if mutation and FHx

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15
Q

What measurements are considered best for evaluating nutrition of neurological abnormal or CP kids ?

A

Mid-upper arm circumference* Triceps skin fat-fold thickness* Subscapular skin fat-fold thickness Less affected in malnourished NI children Weight-for-length^ Weight-for-age Length-for-age^

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16
Q

What are some conservative suggestions for the CP population with help in feeding ?

A

recommendations for feeding positions, appropriate chairs, textures, temperatures, consistencies (e.g. thickening agents), adapted utensils, etc. May improve efficiency

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17
Q

Why not adult formulas?

A

Calorie/nutrient ratio inadequate for children Designed to meet micronutrient reqs if intake of 1500 kcal Iron, Ca, PO4, Vitamin deficiency

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18
Q

What are some goals for NI(CP) patients for weight ?

A

Wt/Ht often used, goals vary vt age/function: < 3 y/o: Wt/Length ~25-50%ile Older child, ~N activity: Wt/Ht ~50%ile Older child, independent transfers, wheelchair bound: Wt/Ht ~ 25%ile Older child, bedridden: Wt/Ht ~10%ile

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19
Q

CPS STATEMENT ON NUTRITION: WHAT WOULD OVO-VEGETARATION CHILD/ADOLSCENT BE MISSING ? WHAT SHOULD YOU BE COUNSELLING ?

A

-Never assume soy milk is adequate substitute in stem unless says its fortified (Fortified has Ca, Vit D, Vit B12) -Soy products also contain linolenic acid (precursor for EPA/DHA), more usable protein and more concentrated energy -Fermented soy products contain zinc Eggs: Vit B12, LCFA w-3FA (EPA/DHA) Green leafy: Vit A, Calcium COUNSEL Lacto-ovo-vegetarians can obtain B12 from dairy products and eggs if consumed regularly [7]. Breast milk of strict vegan mothers can be low in B12 ; therefore, their infants should be supplemented [43]. Strictly vegan pregnant women should ensure adequate intake or supplementation of vitamin B12 , vitamin D, iron, folic acid, linolenic acid and calcium (BII).

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20
Q

What are the a) hematological findings of B12 deficiency ? b)clinical findings of B12 deficiency ?

A

1)macrocytosis (before anemia), hypersegmented neutrophils 2)Clinical - Pallor,skin hyperpigmentation fatigue, ftt, n/v/ neurological: deve delay, seizures,

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21
Q

What are the main dietary sources of Vitamin B12? Which peds patients are at particular risk? How long does it take to become B12 deficient on basis of deficient diet (presuming adequate stores to begin with)

A

1) Animal products 2) infant of vegan mothers breast feeding 3) several years

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22
Q

B12 is absorbed in convereted to the r complex due to the ___ in the stomach. Then requires ____ ____ in the si to absorb

A

acid intrinsic factor

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23
Q

B12 Can be deficient and have normal levels, however but: Homocysteine and MMA Elevated levels more specific for B12 deficiency (esp. MMA) True or false

A

TRUE

24
Q

in an infant: Chronic diarrhea Erythematous and vesiculobullous dermatitis Alopecia Ophthalmic disorders Delayed growth/sexual maturity Frequent infections this is referred to ? aND treated with ?

A

Acrodermatitis Enteropathica tx with ZINC 3mg/kg/dau

25
Q

Petchiae, purpura, gum disease, poor wound healing is due to which deficient micrnutrient ?

A

Vitamin c

26
Q

Dermatitis of pellagra refers to photosensativity due to a depletion in Niacin (b3)- WITH significant malnutrition name the steps to refeed.

A

1) Slow volume, replete - wataching lytes closely ie. refeeding lytes, and extended lytes 2) Start cals high protein, low volumes, dense, and work up calories.

27
Q

WHAT IS THE CRITERIA OR LIVER TRANSPLANT ?

A

Acetaminophen-induced disease Arterial pH <7.3 (irrespective of the grade of encephalopathy) OR Grade III or IV encephalopathy AND Prothrombin time >100 seconds AND Serum creatinine >3.4mg/dL (301 µmol/L) All other causes of acute liver failure Prothrombin time >100 seconds (irrespective of the grade of encephalopathy) OR Any three of the following variables (irrespective of the grade of encephalopathy) 1. Age <10 years or >40 years 2. Etiology: non-A, non-B hepatitis, halothane hepatitis, idiosyncratic drug reactions 3. Duration of jaundice before onset of encephalopathy >7 days 4. Prothrombin time >50 seconds 5. Serum bilirubin >18 mg/dL (308 µmol/L)

28
Q

There is a decrease frequency of IBD in which types of disorders ? a) hematological disorders b) genetic disorders c) skin disorders d) endocrine disorders

A

1) hematological disorders: ie. VWD, and hemophilia

29
Q

What bacteria should you think of, if there is isolated terminal ileitis ? The bacterial infection that is the greatest mimicer of CD is ?

A

1) TB 2)YERSINIA

30
Q

The following are symptoms of the which type of drug: mood swings weight gain/obsesity bone health issues (osteo) acne Growth failure

A

steroids

31
Q

Which of the following increases the chances of adenocarcinoma in adults: 1) extent of UC 2) duration of uc 3) PSC - ASSOCIATED WITH IT 4) NONE 5) ALL

A

ALL

32
Q

COMMPLICATIONS FOR IBD: Skeletal Cutaneous Ocular Hepatic Endocrine Hematologic Renal Cardiac

A

CNS: peripheral neuropathy, myelopathy, myasthenia gravices oculur: uveritis, corneal ulceration disease, episcleritis Cutaneous: erythema nodosum, PG, vericulopustular, eruption, nec, crohn disease hepatic: psc, bile duct, fatty liver disease Endo: growth failure, puberty delay Hematologic: autoimmne hymolytic anemia, thrombocytosis, Renal: nephrolithiasis Pericarditis Myocarditis

33
Q

What is the criteria for toxic megacolon ?

A

-radiographic guidance of acute colitis AND 3 of the following: -fever >38.6 -hr > 120 wbc> 10.5 Anemia At least one of the following: -volume depletion -mental status charnges -electrolytes abnormalities -hypotension

34
Q

6 mo baby with loose stools is very irritable. Was breastfed initially and solids were introduced at 4 months of age. Mucus is also apparent in the stool. What is the most likely diagnosis?

A

TAKE HOME: Need to have a strong gluten exposure before you would be able to pick up the diagnosis but does not mean that symptoms can’t manifest themselves before. thus cows milk protein allergy

35
Q

Treatment strategies for IBD

A

1) induction: a) 5-asa b) steroids d) enteral therapy E) BIOLOGICs (infliximab, rituximab) maintenance a) 5-asa (if mild) b) enteral nutrition ( only CD) c)azathioprine

36
Q

Which drugs CAN cause full blown LIVER FAILURE ?

A

1) Acetaminophen 2)AED: phenytoin, PA, 3) anti-TB 4) AMANITA phalloides (MUSHROOMs)

37
Q

WHAT is the only factor made outside of the liver ?

A

factor 8

38
Q

how do yout treat a neonate who is just born who is AT RISK FOR HEP B?

A
  • vaccine within 12 hours and immunoglobin w/i 24 h
39
Q

what is the chronic managemnt for hep b?

A

Immunize against Hepatitis A Liver biopsy and consider treatment if >2 years old Persistent ALT >1.5 times ULN Persistence of HBsAg positive >6 mos Viral replication noted >10^4 Family history of HCC

40
Q

What is the vit d recommendations ? when should we be giving 800 units ?

A

Vitamin D 400 IU/day from 0-6 months min. increase to 800 IU/day if: living north of latitude 55 degrees, October-April living in community with high prevalence of vitamin D deficiency children with dark skin

41
Q

Beri beri results from what vitamin deficiency ? And how does it clinically present

A

B1 ( thiamine) Can occur in alcoholism or refeeding syndrome and lactic acidosis Wet- dilated cardiomyopathy Wenicke encephalopathy Dry beri beri - korsakoff encephalopathy

42
Q

GOAL weight for 0- 3 months 3 to 6 months 6 to 12 months and 2 years to prepubertal ( Male and FEMALE all per day

A

-15-20g//da 20-30g/day 10g / day Male:5.7-7.8g/day Female -6.0-9.9 g/ day

43
Q

The following is due to which deficiency: angular stomatitis, cheilosis glossitis, seborrhoeic dermatitis

A

Riboflavin (b2)

44
Q

What are the complications of tpn ie. why is Ng or g tube preferrred over tpn ? (4)

A
  1. Iv infection 2. Risk of electrolyte abnormalities 3.vascular injury 4. Cloth if centralize 5. Cholestasis risk and intestinal bacterial translocation
45
Q

What are are the contraindication to entral feeding ?

A
  1. Mechanical vowel obstructing 2. Insteatinal ischemiq 3. Risk of aspiration Or developmental or delay of skills Tube related complications
46
Q

Indications of tpn ?

A

5 to 7 days or > on npo Contraindications to enteral feeding for long duration Ie. not able to absorb or tolerate enteral feeds

47
Q

What are the protein requirements for the following Preterm neonate Term neonate Infant Toddler Child Adol

A

Preterm - 3 to 4 g/lg/d Term 2 to 3 Child 2 to 3 Toddler 2 to 3 Adol 1 to 2

48
Q

What are the essential fatty acids needed per day for: 1 preterm Term toddler/child Adol

A

1- 2.5 to 3 2- 2 to 3 2 to 3 1.5 to 2

49
Q

What is the indication for the addition of long chain fatty acids ?

A

Better for continuous feeds for absorption in comparison to mct

50
Q

What is the indication for Mct ?

A

Good for malabsorption or short gut because does not require micellular solubilization for intestinal absorption and thus is absorbed directly into the portal venous tract Thus good for Cholestasis Lymphangiectasia pancreatic insufficiency

51
Q

What are the Special nutritional considerations for the following A) cardiac B) renal disease C) cf D) critical disease E) Neuro

A

A) may require fluid restriction, increase tfi/calories , high protein if at risk for protein losing enteripafhy ie. all Fontans, mct - if in chylo, post op healing B) fluid restriction, consider low salt low k diet, mineral deficiencies ie. iron, vitamin deficiencies ie. but d , neeeds whey to case ratio 60:40 C) higher calories ie. about 120 % then typical, needs pancreatic enzymes, Na to avoid hypo na Vitamin ( fat soluble supplementation? D) higher Calories given higher demand E) keto diet

52
Q

NAME at least 5 presentations of celiac

A

Gi: malabsorption, iron def Derm: apthous ulcers, dermatitis malnutrition microdeficience Endo: primary amenorrhea growth issues weight issues Neuro: concentration, learning disabilities

53
Q

Differential for conjugated bilirubinemia in the infant time

A

1)Structural BA Choladocal cyst biliary stricture 2) Congenital -allagile syndrome -GALT -AAT 3) Hepatic Infection: sepsis, TORCH, hep b, hep c, cmv, Autoimmune Metabolics: glycogen storage disorders, ie - fructosemia, tyrosemia

54
Q

4 dermatological findings of ibd

A

-pydoderma gangrinosum -erythema nodosum Peri-anal Skin tags, fistula Oral : Pyostomatitis vegetans -apthous ulcers, cobble stoning swollen tongue

55
Q

4 NON-GI complications of IBD

A

Dermatological: (as above) Overall: poor growth due to multifactoral purposes, vitamin deficiency, and mineral deficiency Thus osteopenia Mental health issues Fatigue

GI HEME ONC ID (6 decks)

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