GI Flashcards
1
Q
diagnostic spot for pain in appendicitis
A
mcburney’s point
2
Q
pain w/ straightening leg in appendicitis
A
psoas sign
3
Q
xray findings in appendicitis
A
sentinel loop and absence of air in the RLQ OR nothing
4
Q
functional dyspepsia diagnosis
A
recurrent pain in upper abdomen or periumbilical pain that does not change with stooling and no organic cause (must be present at least once per week for at least 2 months to make diagnosis)
5
Q
functional dyspepsia treatment
A
smaller more frequent meals, H2 blocker or PPI, and avoid things that exacerbate symptoms (NSAIDs, spicy food, soda, caffeine) - sometimes antidepressant
6
Q
IBS diagnosis
A
abdominal pain that improves with stooling or change in stool frequency/consistency
(symptoms once per week for at least 2 months)
7
Q
IBS treatment
A
decrease sorbitol, fructose and gassy foods, TCA’s
8
Q
childhood functional abdominal pain definition
A
episodic or continuous pain w/ loss of daily activities and headache, limb pain or sleep disruption (symptoms must be at least once a week for at least 2 months)
9
Q
acute, incapacitating periumbilical abdominal pain that lasts >1 hour with pallor, anorexia, nausea, vomiting, headache or photophobia with weeks of no symptoms between
A
abdominal migraine
10
Q
abdominal migraine treatment
A
remove triggers (caffeine, nitrate foods) and decreasing stress
11
Q
watery diarrhea comes from
A
small intestine
12
Q
suspicions with watery diarrhea
A
cholera or C. diff
13
Q
diarrhea with blood, mucous and WBCs
A
inflammatory diarrhea
14
Q
oral rehydration solution for moderate to severe dehydration with diarrhea
A
2% glucose with 90 men NaCl
15
Q
what test do you use to find WBCs in diarrhea
A
methylene blue
16
Q
diarrhea with neutrophils
A
infectious
17
Q
leading cause of diarrhea in infants worldwide
A
rotavirus (2nd is adenovirus)
18
Q
viral diarrhea diagnostic
A
PCR antigen testing of stool
19
Q
watery, non-bloody diarrhea with fever and vomiting in children under 2 w/ poor sanitation
A
enteropathogenic E. coli (EPEC)
20
Q
severe watery non bloody diarrhea and cramping while travelin
A
enterotoxigenic E. coli (ETEC)
21
Q
watery diarrhea that becomes bloody after a few days with severe pain/cramping but no fever
A
shiva toxin producing E. coli (STEC) - O157:H7
22
Q
antibiotics in STEC
A
can cause increased release of shiga toxin and increased risk of HUS
23
Q
blood and mucous tinged diarrhea with tenesmus but no fever
A
enteroinvasive e. coli (EIEC)
24
Q
most common cause of parasitic diarrhea worldwide
A
giardia intestinalis
25
acute watery non bloody foul smelling diarrhea with abdominal pain and flatulence
giardia intestinalis
26
giardiasis diagnosis
enzyme immunoassay (EIA) and direct fluorescence antibody (DFA) assays in stool
27
treatment for giardiasis
self- limited but if needs treatment - tinidazole, metronidazole or nitazoxanide
28
clinitest
tests for reducing substances (all dietary sugars except sucrose) - presence = sugar malabsorption
29
hydrogen breath test
positive = sugar malabsorption (gut ferments sugar causing hydrogen production which is absorbed in the blood and excerpted in lungs)
30
length of test for fecal fat measurement
must be 3 days
31
vasoactive intestinal peptides
produced w/ neuroblastoma, cause diarrhea
32
most common cause of chronic diarrhea in children up to age 3
toddler's diarrhea (excessive fruit juice intake)
33
formed stool in the AM with looser stools later, normal growth and development
toddler's diarrhea
34
bilious vomiting during the first day of life
duodenal atresia
35
double bubble sign on xray
duodenal atresia
36
cecum fails to descend and is stuck to the posterior R abdominal wall
malrotation (compresses duodenum)
37
ladd bands
constrict the large and small bowel in volvulus
38
corkscrew appearance of duodenum with decreased intestinal air and gastric/duodenal dilation on xray
volvulus
39
test to assess malrotation or hiatal hernia
upper GI series
40
test to measure extent of reflux over 24 hours
pH probe aka esophageal impedance
41
test for gastroparesis
gastric emptying study
42
test to measure peristalsis and esophageal sphincter pressure
esophageal motility evaluation
43
zofran MOA
serotonin receptor antagonist
44
pyloric stenosis is more common in
white males
45
progressive non bilious vomiting in 2 to 5 month old
pyloric stenosis
46
pyloric stenosis labs
hypochloremic hypokalemic metabolic alkalosis and sometimes elevated indirect bilirubin
47
US findings for pyloric stenosis
length > 14 mm OR muscle thickness > 4 mm
48
pyloric stenosis treatment
correct electrolytes and IV rehydration, then pylotomyotomy
49
intense periods of vomiting lasting up to 48 hours with periods of feeling well between
cyclical vomiting
50
cyclical vomiting treatment during and episode
IV hydration
51
cyclical vomiting long term treatment
cyproheptadine, propranolol or TCA's
52
forceful vomiting, weight loss, dysphagia and FTT
achalasia
53
cyst on the floor of the mouth
ranula
54
midline mass in the floor of the mouth
ectopic thyroid
55
ectodermal hypoplasia presentation
underdeveloped or no teeth
56
ectodermal hypoplasia diagnosis
skin biopsy showing no sweat pores
57
Ballermann streiff syndrome
underdeveloped small teeth
58
most common TE fistula
blind upper esophageal pouch
59
chronic autoimmune condition that presents at GERD that doesn't respond to PPIs
eosinophilic esophagitis
60
eosinophilic esophagitis diagnosis
endoscopy with biopsy showing eosinophil predominant inflammation in the esophageal wall
61
medication to block gastric acid secretion
H2 blocker
62
medication to cast gastric mucosa
sulcralfate
63
medication to enhance bicarb production to decrease gastric acid production
prostaglandin analogues
64
medication that inhibits gastric acid pump
PPI
65
vomiting after eating with epigastric pain that wakes them from sleep and guaiac positive stool
peptic ulcer disease
66
peptic ulcer disease diagnostic study
endoscopy - histology (ulcers) and culture for H. pylori
67
NSAID induced gastric ulcer treatment
H2 blocker
68
h. pylori treatment
1 to 2 weeks of PPI and 2 antibiotics (clarithromycin and amoxicillin OR clarithromycin and metronidazole)
69
abdominal distention, anorexia, diarrhea, FTT, proximal muscle wasting, non resolving iron deficiency anemia
celiac disease
70
celiac disease screening
elevated IgA antibodies to tissue transglutaminase OR IgA antibodies to endomysium
71
celiac disease diagnosis
biopsy
72
infant with small bowel resection and microcytic anemia
B12 deficiency (pernicious anemia)
73
where is B12 absorbed
terminal ileum
74
medication for IBS
amitriptyline
75
chronic diarrhea, steatorrhea and hyponatremia
CF
76
rectal prolapse think
CF, pertussis or chronic constipation
77
syndrome with extra teeth, pre-malignant polyps in the large and small intestine and osteomas
gardner syndrome
78
syndrome with mucosal pigmentation of the lips and gums and hundreds of colonic polyps
peutz-jeghers syndrome
79
increased risk for UC in
ashkenazi (European) jews
80
treatment of choice for infection with UC
metronidazole
81
first line medical treatment for UC
5-ASA
82
2nd line treatment for UC
steroids, 6-mercaptopurine or azathioprine or MTX, cyclosporine or tacrolimus
83
IBD is associated with
HLA B27 antigen and ankylosing spondylitis
84
risk of cancer in UC
20% per decade after the first 10 years of life
85
extracolonic manifestations of UC
arthritis, mucocutaneous lesions and liver disease
86
crowns disease descriptions
skip lesions on xray, cobblestone and transmural lesions on endoscopy, noncaseating granulomas
87
extra intestinal manifestations of crohns
pyoderma gangrenosum of foot, erythema nodosum, arthritis, uveitis, renal stones
88
IBD with continuous lesions
UC
89
intussusception treatment
air enema
90
must rule out what if child older than 6 presents with intussusception
lymphosarcoma
91
congenital ganglionic megacolon aka
Hirschsprung's disease
92
Hirschsprung's defect
absence of parasympathetic innervation of internal anal sphincter causing constant contraction
93
classic presentation of hirschsprungs
no meconium in the first 48 hours
94
hirschsprungs disease association
down syndrome
95
infants strain to pass small liquid stools with tight band narrowing on the anus, self limited, remits by age 1
anal stenosis
96
first test to distinguish upper vs lower GI bleed
nasogastric lavage
97
hematemesis
bleeding proximal to the ligament of treitz
98
test to determine if blood is babies or moms
apt test (negative = mom)
99
tears in the mucosal lining where the esophagus meets the stomach
mallory-weiss tears
100
causes of false positive guaiac
recent meat ingestion, horseradish, ferrous sulfate
101
causes of false negative guaiac
vitamin C, outdated cards or improper storage
102
hematochezia
bright red or maroon stools from distal bleed or massive proximal bleed (infectious, intussusception, rectal fissure, ingestion, meckel's)
103
painless rectal bleeding in child <2
meckel's diverticulum
104
meckel's diverticulum diagnosis
technetium 99 pertechnetate scintigraphic study (ectopic gastric mucosa lights up)
105
rule of 2's
meckel's diverticulum (age 2, 2 tissues (gastric and intestinal), 2 feet from ileocecal valve, 2 inches long, 2% of population)
106
painless rectal bleeding in school age child
juvenile polyposis
107
cholestatic jaundice diagnostic test
hepatobiliary scintigraphy
108
increase direct bilirubin, pale stools and hepatomegaly
cholestatic jaundice (obstructive)
109
medication to stimulate bile secretion and decrease serum bilirubin
phenobarbital
110
treatment for biliary atresia if <2 months
kasai procedure (joins liver to the intestine)
111
first test when biliary atresia is suspected
US, then HIDA scan, then biopsy
112
most common cause of cholestatic jaundice in newborn
TPN
113
labs to differentiate cholestatic jaundice from hepatocellulr
high alk phos in cholestatic
| high SGPT/SGPOT in hepatocellular
114
neontal jaundice, fever, acholic stools, RUQ pain and palpable mass
choledochal cyst
115
gilbert syndrome defect
glucuronyl transferase deficiency
116
intermittent elevated unconjugated bilirubin with illness or activity
gilbert syndrome (glucuronyl transferase deficiency)
117
recent flu like illness or varicella and now comatose with elevated LFTs and serum ammonia
reye's syndrome
118
hepatolenticular degeneration aka
wilson's disease
119
Wilson's disease diagnosis
low serum copper, elevated hepatic copper and decreased ceruloplasmin
120
Wilson's disease treatment
D-penicillamine to chelate copper and low copper diet
121
side effect of Wilson's disease treatment
D-penicillamine can cause aplastic anemia
122
alpha 1 antitrypsin deficiency presentation
persistent jaundice in newborn
123
organs that alpha 1 anti trypsin deficiency effects
liver (neonatal hepatitis with cholestasis), lung (COPD), skin (necrotizing panniculitis and psoriasis)
124
portal HTN definition
portal venous pressure >5 to portal to hepatic vein pressure gradient >10
125
most sensitive indicator of portal HTN and varices
splenomegaly
126
pancreatitis can be associated with
pulmonary edema and pleural effusions
127
most specific test to diagnose pancreatitis
abdominal US
128
test to follow recurrent pancreatitis
ERCP
129
common cause of recurrent pancreatitis in children
familial dyslipidemia
130
pain radiating to R scapula
cholecystitis
131
things that increase risk for gallstones
CF, ileal resection, TPN, CTX
132
flu like symptoms and elevated LFTs
hepatitis A
133
hepatitis A tranmission
fecal-oral (poor hygiene and sanitation)
134
hepatitis A positive isolation
if works in daycare or food service - no work for one week from onset of symptoms
135
how long can IgM be positive with hepatitis A
6 months
136
hepatitis A treatment
supportive
137
hepatitis B transmission
bodily fluids
138
serologic test for acute hepatitis B
surface antigen, e antigen, HBV DNA
139
HBeAg
indicated high viral load, infectivity, replication
140
when do HBV-DNA and surface antigen disappear
6 months after appearance
141
serologic testing during recovery from hep B
anti-HBc and anti-HBe
142
surface antigen present for >6 months with hep B means
chronic infection
143
serologic findings with hep B vaccination
positive HBsAb
144
HBcAb
tells you they had a previous infection, now resolved
145
complications of chronic HBV infection
fulminant hepatic failure and hepatocellulr carcinoma
146
most common blood borne infection in the US
hepatitis C
147
hep c transmission
bodily fluids
148
hep C is associated with
cirrhosis and hepatocellulr carcinoma
149
hepatitis D requirements
hep B surface antigen must be present (outer coat of D)
150
hepatitis E transmission
fecal-oral
151
pigmented penile lesions and hamartomatous intestinal polyps
Bannayan-Riley-Ruvalcaba syndrome (BRRS)
152
syndrome with hyperkeratotic papillomas of the lips and tongue
cowden syndrome
153
most reliable noninvasive test for lactase deficiency
breath hydrogen test
154
most common anatomical esophageal abnormality
esophageal atresia with distal TE fistula
155
when to preform endoscopy after caustic ingestion
12-24 hours after
156
management of coins in the esophagus
endoscopic removal if still in the esophagus after 24 hours
157
most common identifiable cause of chronic gastritis in children
h. pylori
158
currant jelly stool
intussusception
159
syndrome with hemihypertrophy and hamartomatous polyps
proteus syndrome
160
best diagnostic test for Hirschsprung's
suction rectal biopsy
161
hepatits A prophylaxis
vaccine is >/=12 months, immunoglobulin if <12 months
162
which hepatitis is DNA
B
163
most common infectious cause of chronic liver disease in the US
hepatitis C
164
diagnosis with conjugated hyperbilirubinemia and severe, unremitting pruritic, normal GGT
progressive familial intrahepatic cholestasis type 1 (PFIC1)
165
diagnosis with anti smooth muscle antibodies present
autoimmune hepatitis type 1
166
most common malignant liver tumor in children
hepatoblastoma
