GI/ gen surg Flashcards
Life-threatening causes of constipation (list 5)
- Mechanical obstruction
- Hirschprung’s
- Botulism
- abdominal mass
- Anorexia
List red flags for a child presenting with constipation (8)
- constipation in 1st month of life
- delayed meconium (> 48 hrs) - Hirschprung’s
- ribbon-like stools (anal stenosis)
- bloody stool (without fissure)
- FTT
- vomiting
- fever
- severe abdo distension
- abnormal position of anus
- abnormal neuro exam
Life-threatening causes of diarrhea (list 6)
- intussusception
- HUS
- appendicitis
- C. Diff pseudomembranous colitis
- severe dehydration
- salmonella (with bacteremia)
List the three locations where esophageal foreign bodies lodge, with their frequency.
- thoracic inlet (60-80%)
- gastroesophageal junction (10-20%)
- aortic arch (5-20%)
Which esophageal FB should be removed in < 24 hours?
symptomatic, button battery, sharp objects, multiple magnets
Which foreign bodies in the stomach/ lower GI tract should be removed?
- symptomatic
- multiple button batteries/magnets in stomach
- magnet co-ingestion with battery
- sharp and long (greater 5 cm) objects (in stomach – risk of perforation)
At what level of blood loss do vital sign changes start?
15% blood loss = changes in vital signs = resting tachycardia, pallor, prolonged capillary refill, metabolic acidosis
At what level of blood loss does hypotension occur?
30% blood loss = hypotension = late finding = hemorrhagic shock (IV fluids, blood transfusion)
List life-threatening causes of lower GI bleed (list 8)?
- NEC
- Midgut volvulus
- Intussusception
- Meckel diverticulum
- HUS
- Pseudomembranous colitis
- Ischemic colitis
- Peptic ulcer
- Angiodyplasia
- FPIES
- Toxic megacolon
List most common causes of an upper GI bleed (across all age groups)
- gastritis
- esophagitis
- gastric/duodenal ulcers
- Mallory-weiss tears
- coagulopathy
List common causes of upper GI bleed in neonates
- swallowed maternal blood
- NEC
- CMPA
- vitamin K deficiency
List 6 life-threatening causes of conjugated hyperbilirubinemia
o TORCH infections and sepsis/ UTI (infants)
o Biliary atresia
o Acute liver failure
o Metabolic disorders (galactosemia, tyrosinemia, FAOD)
o Gallstones, choledochal cysts
o Acetaminophen toxicity (> 150 mg/kg or > 10 g dose, peak liver damage at 24-48 hours)
Lab work-up for severe hyperbilirubinemia
o Direct/ indirect bili
o CBC, diff, blood smear, retic count
o Blood type, DAT
o G6PD
Risk factors for jaundice requiring phototherapy
- prematurity
- isoimmune hemolytic disease
- G6PD deficiency
- asphyxia
- lethargy
- temp instability
- sepsis
- acidosis
- low albumin
When to treat jaundice with exchange transfusion
- Bilirubin > 375-425 despite adequate intensive phototherapy
- Signs of acute bilirubin encephalopathy( hypertonia, arching, opisthotonos, fever, high-pitched cry)
List 8 conditions in the differential diagnosis of dysphagia
Pre-esophageal - Mechanical • Nasopharynx – choanal atresia • Oropharynx – cleft lip/palate • Laryngeal - laryngomalacia - Inflammatory / infectious (pharyngitis, stomatitis, RPA) - Neuromuscular (CP, any condition with abnormal tone) - Foreign body aspiration/ingestion
Esophageal
- Mechanical / anatomic (TEF, esophageal atresia/ stenosis, esophageal strictures)
- Motility (achalasia, GERD)
- Inflammatory (eosinophilic esophagitis, candida)
List 4 red flags for a vomiting child
bilious vomiting (obstruction), early morning/headache, melena, FTT, severe dehydration
What is the most common cause of acute weight loss in all ages?
dehydration due to acute infectious illness
What medications are used in the management of upper GI bleed?
- IV proton pump inhibitor (pantoprazole 1 mg/kg then infusion 0.1 mg/kg/hr)
- For suspected varices add: octreotide 1-2 ug/kg bolus then 1-2 ug/kg/hr
- Antibiotics (ceftriaxone) (if suspect sepsis or varices)
List causes of portal HTN / esophageal varices (list 8)
- Prehepatic: portal vein thrombosis, portal vein obstruction (ex. Malignancy), splenic vein obstruction, increase portal vein or splenic blood flow, portal vein sclerosis (ex. Schistosomiasis (#1 cause globally), HIV, CF)
- Intrahepatic: cirrhosis from BA, PSC, CF, alpha-1-antitrypsin deficiency, chronic hepatitis B/C, autoimmune hepatitis, chronic alcohol use; idiopathic portal HTN; NAFLD; congenital hepatic fibrosis
- Post hepatic: BCS, inferior vena cava obstruction, constrictive pericarditis, CHF, veno-occlusive disease
Treatment of H. Pylori
PPI plus two antibiotics (amoxicillin, clarithromycin, metronidazole 10-14 days)
Complications of peptic ulcer disease (3)
GI hemorrhage, GI perforation, gastric outlet obstruction (consider if have chronic, nonspecific abdo symptoms and frequent nonbilious emesis)
Complications of IBD (7)
perforation, intraabdominal or perirectal abscess, toxic megacolon (avoid narcotic and anticholinergic), severe anemia, electrolyte imbalance, super-infection, dehydration, massive upper or lower GI bleeding, partial or complete obstruction
Extra-intestinal manifestations of IBD (list 6)
arthritis, muscle disease, erythema nodosum, uveitis, pancreatitis (especially on azathioprine and 6-MP), chronic hepatitis, thrombosis of cerebral/retinal/peripheral vessels may lead to coma, seizures or focal visual or motor deficits, gallstone cholecystitis, renal calculi leading to hematuria
