GI MedStudy Flashcards by Sonia Gera

What are the two centers int he brain that control vomiting?

1) Vomiting center (neural)

2) Chemoreceptor trigger zone (chemical)

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Where is the vomiting center located and what are stimuli to this center?

Located in medulla of brainstem

Stimuli: migraine/increased ICP, vestibular, vagal (gagging), GI tract

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Where is the chemoreceptor trigger zone located? What are the stimuli to it?

Floor of 4th ventricle

Drugs, toxins, metabolic products

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What is the best test for diagnosis of chronic vomiting?

Endoscopy

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What is the median age of onset of cyclic vomiting?

5 years old

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What family history has a strong association with cyclic vomiting?

Migraines

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What are some options for prophylaxis for cyclic vomiting syndrome?

Cyproheptadine
Propranolol
Amitriptyline

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What is the 1st line for prophylaxis for children <5 with cyclic vomiting?

Cyproheptadine

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What is the reliability of a C. diff toxin in children < 1 year ?

Not reliable because enterocytes in infants have not yet developed receptor for toxin

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What kind of diet should be recommended during acute diarrhea

Normal diet

Avoid high sugar foods which can worsen diarrhea

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What medication can lead to flecks of white on patient’s KUB?

Bismuth subsalicylate

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Definition of chronci diarrhea

3x/day for 14 days

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Recommended diet for IBS

FODMAP

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T/F: It can be normal for breastfed infants to pass a stool only once every 5-10 days

True

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What is the treatment for infants who strain with bowel movements? What is it called?

No treatment

Called infant dyschezia

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How is the usual time period of post infectious gastroparesis?

1-3 months

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By what age does functional diarrhea (toddler’s diarrhea) typically obtain normal stool pattern?

4 years of age

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Most common tracheoesophageal abnormality?

Blind upper EA

Fistula between lower esophageal segment and lower trachea

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Prenatal ultrasound finding in TEF

Polyhydramnios

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What fraction of babies with TEF have other congenital anomalies as well ?

1/3

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How to diagnose TEF

Place NG and get X-ray

Coiling of NG and gas in GI tract

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What is achalasia?

Incomplete relaxation of LES and lack of normal esophageal peristalsis

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Two main diagnostic tests for achalasia

Barium swallow

Manometric exam

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What is allgrove syndrome?

Triple A: Achalasia, adrenal insufficiency, alacrima

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Surgical treatment of achalasia

Pneumatic dilation | Laparoscopic surgical myotomy w/ partial fundoplication

Medical treatment for achalasia

Botulinum toxin | Calcium channel blockers

When does GER become GERD?

Failure to thrive, inability to maintain enough calories

What is the 1st test to be done for a vomiting infant?

Upper GI series -- good for anatomic and motility problems only

Only way to definitively diagnose esophagitis

Upper endoscopy with biopsy

What can several years of untreated GERD lead to?

Barrett's esophagus

How many eosinophils per high power field leads to a diagnosis of EOE?

> 15

Treatment of EOE

High dose acid suppression Specific food elimination Swallowed steroids

Most common organisms leading to infections in esphagus

CMV | HSV

After caustic ingestion, what is the recommendation in terms of evaluation?

Upper endoscopy 12-24 hours after ingestion, no later than 48 hours

Main meds that lead to pill esophagitis

Doxy, tetracyclines, aspirin, NSAIDs, slow release potassium

Under what situations should button batteries emergently be removed from stomach or small bowel?

Asymptomatic child < 5 years | Batter width > 20mm

Difference between emergent vs urgent removal of foreign body

Emergent- < 2 hours from presentation | Urgen- < 24 hours from presentation

T/F: If there is a concern of esophageal perforation, perform endoscopy

False- never perform endoscopy on these patients

What kind of contrast material should be used with concern of esophageal perforation

water soluble

Are boys or girls more commonly affected by pyloric stenosis?

Boys -- 6x more likely

Risk factor for pyloric stenosis

Exposure to erythromycin <2 weeks

Time of presentation of pyloric stenosis

3 weeks to 2 months of age

Electrolyte concern with pyloric stenosis, and why?

Nonbilious emesis leading to hypochloremic metabolic acidosis Hypokalemia due to exchange of hydrogen ion and K+ in kidney

What measurements on abdominal ultrasound make pyloric stenosis likely?

pi- 3.14 | >3mm thick and >14mm long

Treatment of pyloric stenosis

Rehydrate to correct electrolyte abnormalities | Pyloromyotomy

Likely cause of GI bleed in sick ICU patient

stress gastropathy

Gastropathy in burn patient

Curling ulcer

Gastropathy in head trauma patient

Cushing ulcer

Main cause of gastric adenocarcinoma

H. pylori

What do biopsy findings show for H. pylori

Gram negative spiral rods

Protein losing gastropathy that results in hypoproteinemia. | Presents with peripheral edema and nausea/vomiting

Menetrier Disease

Cause of menetrier disease

CMV

Best test to know if h. pylori has cleared

stook antigen test

When should H. pylori be treated?

Only in the presence of PUD or MALT lymphoma

Treatment of H. pylori

2 weeks of PPI Clarithromycin Amoxicillin or Metronidazole

When is quadruple therapy used in H. pylori and why?

When there is clarithromycin resistance | PPI + tetracycline + bismuth + amox/metro

What is the best diagnostic test for suspected malrotation/voluvulus?

Upper GI

If malrotation is suspected, where will the ligament of treitz be on upper GI?

On the right side of the abdomen

Most common area of intussusception

Ileocecal junction due to virus induced swelling of Peyer patches

Best initial imaging study for intussusception

Ultrasound

What is the best diagnostic and therapeutic procedure for management of intussusception?

Air contrast enema

Why does a meckel diverticulum develop?

Failure of obliteration omphalomesenteric duct

Test for diagnosis of Meckel's

technetium pertechnetate scan

Common genetic syndrome associated with duodenal atresia

Down's syndrome

KUB findings in duodenal atresia

Double bubble sign

T/F: Duodenal and jejunoileal atresias are both associated with other congenital anomalies

False- duodenal is associate with other abnormalities, JI atresias are not

Most common location of intestinal duplication

ileum

3 characteristics of intestinal duplications

- strongly adherent to some part of GI tract - 2 layered muscular coat - epithelial lining similar to stomach, SI or colon

What is the gold standard study of lactase deficiency?

Endoscopic biopsy with measurement of mucosal enzyme activity

Most common reliable diagnostic test for lactase deficiency

Breath hydrogen test

What rise in hydrogen is required in breath hydrogen test to diagnose lactase deficiency?

Rise of > 10-20 ppm

What is the transport defect in the congenital disorder of hypo and abetalipoproeinemia?

ApoB deficiency

What is the transport defect in the congenital disorder of chylomicron retention?

Chylomicron exocytosis

What is the transport defect in the congenital disorder of Hartnup disease?

Free neutral amino acid transport -- presents like Pellagra

What is the transport defect in the congenital disorder of blue diaper syndrome?

Tryptophan transport | bluish urine stained diaper

What is the transport defect in the congenital disorder of Lowe syndrome?

Lysine and arginine transport | Intellectual desability, cataracts, hypotonia, rickets

What is the transport defect in congenital chloride diarrhea?

Cl-/HCO3- exchanger

What is the transport defect in congenital sodium diarrhea?

Na+/H+ exchanger

What is the transport defect in acrodermatitis enteropathica?

Zinc transport

What RBC abnormality is seen on a blood smear in abetalipoproteinemia?

Acanthocytosis (spurr cells)

What are the deficiencies noted when there is a defect in the ileum with short gut?

Vitamin B12 and bile salts (Vitamin ADEK)

What are the two HLA types associated with celiac disease?

DQ2 and DQ8

Skin manifestation of celiac disease

Dermatitis herpetiformis

Two main diseases commonly associated with celiac disease

T1DM | IgA deficiency

What are the serum studies for celiac disease

IgA ab for tTG | IgA antiendomysial antibodies

Most common cause of congenital diarrhea

Davidson disease (congenital microvillus inclusion disease)

What is the disease with finding of PAS positive granules in lamina propria?

Whipple disease

Is Crohn's or UC transmural?

Crohn's

Does UC or Crohn's have higher risk of colorectal cancer?

Main treatment to induce remission and maintenance remission in mild to moderate cases of UC?

5-ASA