GI from Book ?s Flashcards
What is the most common pathogen that causes gastroenteritis?
Rotavirus
- affects sm intestine, resulting in the passage of large amts of watery stool
- -in US, affects infants mainly between 3 and 15 months of age
- -transmitted by fecal-oral route; can survive for days on hands and hard surfaces
In a healthy 8 month old with diarrhea but no dehydration, what would be the most appropriate advice to give parents?
a) Encourage strength formula for 12 hrs
b) Give oral rehydration solution (ORT) for 12 hrs
c) Give only fluids until stools return to normal
d) Give bananas and cereal as tolerated
d) Give bananas and cereal as tolerated
- -starvation depresses digestive function and prolongs diarrhea!
- -give ORT only if dehydration is present
When evaluating a child with abdominal pain, what symptom would lead to a likely organic etiology?
a) Night waking
b) Pallor
c) Suprapubic pain
d) Sweating
a) Night waking
–nighttime awakening with abdominal pain usually does not occur with functional disorders
Vomiting in infancy has a long list of differential diagnoses. Which accompanying symptom would most likely point to pyloric stenosis?
a) Diarrhea
b) Appropriate growth
c) Acts hungry after vomiting
d) Sausage-shaped mass in abdomen
c) Acts hungry after vomiting
- -w/pyloric stenosis, vomiting usually starts b/t 1-2 months of age
- -other sx: constipation, fussiness, wt loss
What is appropriate regimen for pinworm tx?
1 dose/1 time, repeat in 2 weeks if needed
–Albendazole 400mg orally as a single dose repeated in 2 weeks if needed
Mrs. D is upset. 2 month old John’s frequent vomiting has convinced her that “something is seriously wrong.” Which of the following is most suggestive of GER?
a) He’s gained 5 ounces this month.
b) He has a slight wheeze today.
c) He eats hungrily after vomiting.
d) He drinks 7 to 8 ounces every 3-4 hours.
d) He drinks 7 to 8 ounces every 3-4 hours.
–> John is being overfed, which can –> GER
–> more appropriate intake for a 2 month old = 4-5 oz every 3-4 hrs
“He eats frequently after vomiting.”
–> this sounds like pyloric stenosis
What is toddler diarrhea caused by? How to resolve?
- -caused by carbohydrate malabsorption
- -will resolve if juice is removed from the diet
(–Crohn’s = rare under 2 yo
- -Celia disease may cause FTT
- -Giardia causes intermittent diarrhea)
What would dehydration of 7% cause?
- -dry mucous membranes
- -normal or sunken fontanelles
- -increased HR
- -prolonged cap refill
What is ORT tx for moderate dehydration?
100mL/kg over 4 hours
Main symptom of pinworms? other sx?
anal itching
also: grinding of teeth at night, wt loss, enuresis
What tests to do in a child with bloody diarrhea?
- -stool cultures to look for an infectious agent
- -hemoccult to prove presence of blood
- -look at growth chart–> suboptimal growth may indicate IBD
If you suspect bloody diarrhea is infectious in nature, what is a likely causative organism?
E. coli
–> undercooked ground beef and leafy greens contaminated with E. coli cause bloody diarrhea
- -S. Aureus causes vomiting and diarrhea, but there is no bleeding
- -Giardia is generally contracted from contaminated water such as lakes and streams
- -Adenovirus is found on hard surfaces and usually affects children
Which of the following conditions would be most likely to occur in a 4yo boy?
a) Pyloric stenosis
b) Recurrent abdominal pain
c) Intussusception
d) Giardia infection
d) Giardia infection
–the highest incidence of Giardia is in children 1-9yo
- -pyloric stenosis: occurs in first few mos of life
- -intussusception mostly in first 2 yrs of life
- -functional abdominal pain unusual in children
Which of the following findings could be expected to occur in a baby with intussusception?
a) Inconsolable screaming
b) Olive-shaped mass
c) left-to-right peristaltic waves
d) wt loss
a) Inconsolable screaming
- -> intussusception causes abdominal pain
–olive-shaped mass, left-to-right peristaltic waves, and wt loss = signs of pyloric stenosis!
What is Enterobius vermicularis?
pinworms!
In the US, parasitic gastroenteritis is most commonly caused by which organism?
Giardia lamblia
…giardia is the most common intestinal parasite infection of humans in the US
What is HBV?
hepatitis B virus
What serological finding indicates chronic HBV infection?
a) HBsAg negative for 6 months
b) Anti-HBc positive and HBsAg positive
c) IgM anti-HBc positive
d) Anti-HBs positive
b) Anti-HBc positive and HBsAg positive
- -HBsAg (hepatitis b surface antigen) is the earliest marker of acute Hep B infection
- -> persistence for > 6 dos indicates chronic infection
- -Total Anti-HBc (total hepatitis B core antibody) appears in acute infection and persists for life
- -> its presence indicates prior or ongoing HBV infection
- -positive IgM anti-HBc indicates acute infection
- -positive Anti-HBs indicates positive immune status after vaccination
Children in child-care facilities are at greater risk of being exposed to which of the following infections?
a) HAV
b) HBV
c) HCV
d) HDV
a) HAV
- -Hep A is the most common form of viral hepatitis in children.
- -transmitted by the fecal-oral route and by contaminated shellfish and water
Infant immunization for HBV often raises many parental questions about the disease. Which of the following is not true about hepatitis B virus?
a) It can survive for more than 1 week on fomites.
b) It is the most common form of hepatitis in the world.
c) Contaminated water and shellfish are the major sources.
d) Perinatally infected infants are likely to become carriers.
c) Contaminated water and shellfish are the major sources.
- -> this is true of Hep A, not Hep B!
What is Hirschsprung disease? Major red flag?
- -the congenital absence of ganglion cells in the colon
- -length of bowel affected varies
- -is present at birth
- -red flag = 2 days old and has not passed meconium
Findings on rectal exam of newborn w/Hirschsprung’s? Tx?
tight anal canal with no stool in vault
–absence of ganglion cells in the rectum prevents the bowel from relaxing to allow the passage of stool
TX: surgical resection of the affected bowel segment (refer to gastro/surgeon!)
When evaluating a child with suspected IBD, which of the following diagnostic tests would not be helpful?
a) Amylase and lipase
b) ESR
c) Serum total protein & albumin
d) CBC w/diff
a) Amylase and lipase
- -> are raised in pancreatitis
IBD may –> anemia, hypoalbuminemia, and ESR elevation
Your pt has IBD. Which finding is most consistent with ulcerative colitis?
a) Occult blood
b) Perirectal ulcers
c) Aphthous ulcers
d) Left-sided abdominal pain
d) Left-sided abdominal pain
- -> UC causes left-sided pain and bloody diarrhea
- -perirectal abscesses are seen w/Crohn’s
- -aphthous ulcers may be found in Crohn’s and Celiac
