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elmaya > GI/ gen surg > Flashcards

GI/ gen surg Flashcards

1
Q

Life-threatening causes of constipation (list 5)

A
  • Mechanical obstruction
  • Hirschprung’s
  • Botulism
  • abdominal mass
  • Anorexia
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2
Q

List red flags for a child presenting with constipation (8)

A
  • 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
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3
Q

Life-threatening causes of diarrhea (list 6)

A
  • intussusception
  • HUS
  • appendicitis
  • C. Diff pseudomembranous colitis
  • severe dehydration
  • salmonella (with bacteremia)
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4
Q

List the three locations where esophageal foreign bodies lodge, with their frequency.

A
  1. thoracic inlet (60-80%)
  2. gastroesophageal junction (10-20%)
  3. aortic arch (5-20%)
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5
Q

Which esophageal FB should be removed in < 24 hours?

A

symptomatic, button battery, sharp objects, multiple magnets

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6
Q

Which foreign bodies in the stomach/ lower GI tract should be removed?

A
  • symptomatic
  • multiple button batteries/magnets in stomach
  • magnet co-ingestion with battery
  • sharp and long (greater 5 cm) objects (in stomach – risk of perforation)
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7
Q

At what level of blood loss do vital sign changes start?

A

15% blood loss = changes in vital signs = resting tachycardia, pallor, prolonged capillary refill, metabolic acidosis

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8
Q

At what level of blood loss does hypotension occur?

A

30% blood loss = hypotension = late finding = hemorrhagic shock (IV fluids, blood transfusion)

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9
Q

List life-threatening causes of lower GI bleed (list 8)?

A
  • NEC
  • Midgut volvulus
  • Intussusception
  • Meckel diverticulum
  • HUS
  • Pseudomembranous colitis
  • Ischemic colitis
  • Peptic ulcer
  • Angiodyplasia
  • FPIES
  • Toxic megacolon
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10
Q

List most common causes of an upper GI bleed (across all age groups)

A
  • gastritis
  • esophagitis
  • gastric/duodenal ulcers
  • Mallory-weiss tears
  • coagulopathy
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11
Q

List common causes of upper GI bleed in neonates

A
  • swallowed maternal blood
  • NEC
  • CMPA
  • vitamin K deficiency
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12
Q

List 6 life-threatening causes of conjugated hyperbilirubinemia

A

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)

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13
Q

Lab work-up for severe hyperbilirubinemia

A

o Direct/ indirect bili
o CBC, diff, blood smear, retic count
o Blood type, DAT
o G6PD

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14
Q

Risk factors for jaundice requiring phototherapy

A
  • prematurity
  • isoimmune hemolytic disease
  • G6PD deficiency
  • asphyxia
  • lethargy
  • temp instability
  • sepsis
  • acidosis
  • low albumin
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15
Q

When to treat jaundice with exchange transfusion

A
  • Bilirubin > 375-425 despite adequate intensive phototherapy
  • Signs of acute bilirubin encephalopathy( hypertonia, arching, opisthotonos, fever, high-pitched cry)
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16
Q

List 8 conditions in the differential diagnosis of dysphagia

A 
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)
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17
Q

List 4 red flags for a vomiting child

A

bilious vomiting (obstruction), early morning/headache, melena, FTT, severe dehydration

18
Q

What is the most common cause of acute weight loss in all ages?

A

dehydration due to acute infectious illness

19
Q

What medications are used in the management of upper GI bleed?

A
  • 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)
20
Q

List causes of portal HTN / esophageal varices (list 8)

A
  • 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
21
Q

Treatment of H. Pylori

A

PPI plus two antibiotics (amoxicillin, clarithromycin, metronidazole 10-14 days)

22
Q

Complications of peptic ulcer disease (3)

A

GI hemorrhage, GI perforation, gastric outlet obstruction (consider if have chronic, nonspecific abdo symptoms and frequent nonbilious emesis)

23
Q

Complications of IBD (7)

A

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

24
Q

Extra-intestinal manifestations of IBD (list 6)

A

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

25
Q

What is the triad of HUS, and most common bacterial causes?

A

Acute microangiopathic hemolytic anemia, thrombocytopenia, oliguric renal failure

Causes: Escherichia coli 0157:H7, Shigella, Salmonella, Yersinia; atypical HUS Strep pneumoniae

26
Q

List 4 complications of acute pancreatitis

A
  • Pseudocyst
  • Pancreatic abscess
  • Hypocalcemia
  • Necrotizing pancreatitis
  • Hemorrhagic pancreatitis
  • Secondary bacterial infection (sepsis)
  • ARDS
  • Shock, hypotension
  • Multisystem organ failure
  • Death
27
Q

Differential diagnosis of pancreatitis

A 
Idiopathic
Gallstones
EtOH
Trauma
Scorpion bites
Mumps/ other infections (hepatitis)
Autoimmune
Steroids/ other meds (ie. VPA)
Hypertriglyceridemia, hypercalcemia
ERCP 
Drugs
28
Q

What is Charcot’s triad, and what is it a sign of?

A

Triad: RUQ tenderness, jaundice and fever

Sign of cholangitis

29
Q

Complications of acute liver failure

A
  • infection
  • hypoglycemia
  • coagulopathy
  • encephalopathy
  • ascites
  • Hepatorenal syndrome
  • Hepatopulmonary syndrome
30
Q

Differential diagnosis of acute appendicitis (list 5)

A 
constipation
viral gastro
mesenteric adenitis
lower lobe pneumonia
UTI
strep pharyngitis
ovarian cyst
31
Q

Signs of appendicitis on ultrasound

A

US sensitivity 80-92%, specificity = 86-98%

o Look for inflamed / enlarged / non compressible appendix (> 6 mm), appendicolith
o Look for secondary signs – hyperemia, mesenteric fat, local ileus, free fluid

32
Q

Risk factors that increase the risk of perforation with reduction of intussusception (list 5)

A 
o	Age < 3 months or > 5 years
o	Sx > 48 hours
o	Hematochezia
o	Significant dehydration
o	Small bowel obstruction on AXR
33
Q

Study of choice for malrotation/volvulus, and what it would show

A

Upper GI series (study of choice)– distended proximal bowel, abrupt transition point, abnormal C loop of duodenum (no ligament of Treitz)

34
Q

Lab findings of pyloric stenosis

A

hypoK hypoCl metabolic alkalosis

35
Q

4 conditions that cause rectal prolapse

A 
CF
diarrhea
chronic constipation
neurologic conditions (myelomeningocele, tethered cord)
Hirschprung's
Intestinal polyps
36
Q

4 complications of draining a perianal abscess

A
  1. Scar formation
  2. Injury to local structures surrounding or underlying the abscess (arteries, veins, nerves, tendons)
  3. Fistula formation
  4. Damage to the anal sphincter
37
Q

4 causes of a perianal abscess

A 
●	Crohn’s colitis
●	Chronic granulomatous disease
●	MRSA
●	Pilonidal cyst
●	HIV positive/immunodeficient
●	Diarrhea, chronic
38
Q

4 things to infuse to unblock a G-tube

A

1- Warm water (best as per Fleisher’s)
2- Carbonated drink- coke
3- Pancreatic enzymes (ex cotazyme capsule) dissolved in bicarbonate solution
4- sodium bicarbonate (baking soda) + warm water mixture

39
Q

2 reasons to remove a button battery in the GI tract urgently

A
  1. Lodged in the esophagus
  2. demonstrating signs of GI mucosa damage (hemoptysis, vomiting, abdo/chest pain)
  3. if button battery > 20mm and <5y age
40
Q

Management of C. Diff

A

Mild - stop offending abx
Moderate - flagyl PO
Severe - Vanco PO
Severe w/ complications: Vancomycin PO + flagyl IV

Complications include ileus, toxic megacolon, peritonitis, shock, hypotension

41
Q

Non-intestinal mimics of intussusception

A

Seizures, Ingestion, Sepsis, Meningitis, Bacterial enteritis

42
Q

List 5 pathologic lead points for intussusception

A

polyp, Peutz-Jeghers, mass, lymphoma, inflamed LN, Meckel’s, duplication cyst, HSP, cystic fibrosis

elmaya (5 decks)

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