GI Disorders Flashcards
2-5 yo patient, with early morning onset of vomiting attacks >4x in an hour for several hours, preceded by nausea, pallor, noise and light hypersensitivity, lethargy and headache. Attacks have occured more than 5 times in the past 6 mos, precipitated by infection, psychological or physical stress. Careful investigation in the past months ruled out any other cause of vomiting. Px appears well and asymptomatic in between attacks.
What is the probable diagnosis? What is the treatment for this condition?
cyclic vomiting
- Rome III criteria for fcnl GI disorders (FGID) (both must be present)
1. 2 or more periods of intense nausea and unremitting vomiting or retching lasting hours to days
2. return to usual state of health lasting weeks to months
Consensus definition:
• At least 5 attacks in any interval, or a minimum of 3 attacks during a 6-month period
• Episodic attacks of intense nausea and vomiting lasting 1hr to 10 days and occurring at least 1wk apart
• Stereotypical pattern and symptoms in the individual patient
• Vomiting during attacks occurs ≥4 times/hr for ≥1hr
• Return to baseline health between episodes
• Not attributed to another disorder
- tx: hydration and antiemetics, address complications of vomiting
A highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching.
vomiting
- process is coordinated in the medullary vomiting center
What is the definition of acute and chronic diarrhea?
Acute: sudden onset of excessively loose stools of >10 ml/kg/day in infants or >200 g/day in older children, which lasts < 14 days
Chronic: >14 days
- Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea
What are the more probable causes of true constipation in infancy?
Hirschsprung disease
intestinal pseudo-obstruction
hypothyroidism
Two types of nerve fibers transmit painful stimuli in the abdomen. Which pain fibers mediate the following:
- sharp, localized pain
- poorly localized, dull pain
- in skin and muscle - A fibers
2. from viscera, peritoneum, and muscle - C fibers
Acute epigastric and left upper quadrant pain radiating to the back, characterized as constant, sharp, and boring, accompanied by nausea, emesis, tenderness
probable diagnosis?
acute pancreatitis
Acute or gradual periumbilical to lower abdominal pain referred to the back, colicky in character (alternating cramping and painless periods), associated with distention, obstipation, emesis, and increased bowel sounds.
Probable diagnosis?
intestinal obstruction
Acute, sharp and steady periumbilical abdominal pain which localizes to lower right quadrant with generalized peritonitis, which may radiate to back or pelvis, accompanied by anorexia, nausea, emesis, local tenderness, and fever if with peritonitis.
probable diagnosis?
acute appendicitis
Acute periumbilical to lower abdominal pain, characterized as cramping with painless periods, associated with hematochezia, knees usually in pulled-up position
intussusception
Acute and sudden unilateral back pain with referral to the groin, characterized as sharp, intermittent and cramping, associated with hematuria
Probable diagnosis?
urolithiasis
Acute dull to sharp back pain with referral to the bladder associated with fever, CVA tenderness, dysuria and urinary frequency
probable diagnosis?
urinary tract infection
Red or maroon blood in stools, signifies either a distal bleeding site or massive hemorrhage above the distal ileum
a. hematemesis
b. hematochezia
c. melena
b. hematochezia
Moderate to mild bleeding from sites above the distal ileum or major hemorrhages in the duodenum and above tend to cause blackened stools of tarry consistency
a. hematemesis
b. hematochezia
c. melena
c. melena
What is the most common cause of bleeding in the GI tract?
Erosive damage to the mucosa
- variceal bleeding secondary to portal hypertension occurs often enough to require consideration
What are the specific diagnostic modalities utilized in the following cases:
a. UGIB
b. LGIB
c. small intestines
d. occult blood in stool
e. brisk intestinal bleeding of unknown location
a. UGIB - esophagogastroduodenoscooy (EGD)
b. LGIB - colonoscopy
c. small intestines - capsule endoscopy
d. occult blood in stool - guaiac test
e. unknown location of bleed - RBC scan
Prolonged elevation of the serum levels of conjugated bilirubin beyond the 1st 14 days of life
neonatal cholestasis
- Jaundice that appears after 2wk of age, progresses after this time, or does not resolve at this time should be evaluated and a conjugated bilirubin level determined
- mechanical obstruction of bile flow or functional impairment of hepatic excretory function and bile secretion
Idiopathic familial intrahepatic cholestasis associated with lymphedema of the lower extremities
Aagenaes syndrome
- relationship between liver disease and lymphedema is not understood
- Affected patients usually present with episodic cholestasis
Rare autosomal recessive genetic disorder marked by progressive degeneration of the liver and kidneys
Zellweger (cerebrohepatorenal) syndrome
- Affected infants have severe, generalized hypotonia and markedly impaired neurologic function with psychomotor retardation.
- fatal in 6-12 mos
the most common syndrome with intrahepatic bile duct paucity, marked reduction in the number of interlobular bile ducts in the portal triads, with normal-sized branches of portal vein and hepatic arteriole
Alagille syndrome (arteriohepatic dysplasia)
The most common form of biliary atresia, accounting for ∼85% of the cases
obliteration of the entire extrahepatic biliary tree at or above the porta hepatis
Ultrasonographic triangular cord (TC) sign, which represents a cone-shaped fibrotic mass cranial to the bifurcation of the portal vein, may be seen in patients with this condition
biliary atresia
The most valuable procedure in the evaluation of neonatal hepatobiliary diseases and provides the most reliable discriminatory evidence
Percutaneous liver biopsy
- Biliary atresia is characterized by bile ductular proliferation, the presence of bile plugs, and portal or perilobular edema and fibrosis, with the basic hepatic lobular architecture intact.
- In neonatal hepatitis, there is severe, diffuse hepatocellular disease, with distortion of lobular architecture, marked infiltration with inflammatory cells, and focal hepatocellular necrosis; the bile ductules show little alteration
What is the underlying mechanism in diarrhea caused by the ff agents: cholera toxin, ETEC, carcinoid, C. difficile
a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory
f. secretory
- increased secretion, decreased absorption
- watery and large volume
- PERSISTS with fasting
What is the underlying mechanism in diarrhea caused by the ff agents: Salmonella, Shigella, amebiasis, Yersinia
a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory
a. mucosal invasion
- organisms cause inflammation, decreases colonic reabsorption, increases motility
