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GI MedStudy Flashcards

1
Q

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

A

1) Vomiting center (neural)

2) Chemoreceptor trigger zone (chemical)

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2
Q

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

A

Located in medulla of brainstem

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

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3
Q

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

A

Floor of 4th ventricle

Drugs, toxins, metabolic products

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4
Q

What is the best test for diagnosis of chronic vomiting?

A

Endoscopy

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5
Q

What is the median age of onset of cyclic vomiting?

A

5 years old

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6
Q

What family history has a strong association with cyclic vomiting?

A

Migraines

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7
Q

What are some options for prophylaxis for cyclic vomiting syndrome?

A

Cyproheptadine
Propranolol
Amitriptyline

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8
Q

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

A

Cyproheptadine

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9
Q

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

A

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

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10
Q

What kind of diet should be recommended during acute diarrhea

A

Normal diet

Avoid high sugar foods which can worsen diarrhea

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11
Q

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

A

Bismuth subsalicylate

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12
Q

Definition of chronci diarrhea

A

3x/day for 14 days

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13
Q

Recommended diet for IBS

A

FODMAP

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14
Q

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

A

True

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15
Q

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

A

No treatment

Called infant dyschezia

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16
Q

How is the usual time period of post infectious gastroparesis?

A

1-3 months

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17
Q

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

A

4 years of age

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18
Q

Most common tracheoesophageal abnormality?

A

Blind upper EA

Fistula between lower esophageal segment and lower trachea

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19
Q

Prenatal ultrasound finding in TEF

A

Polyhydramnios

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20
Q

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

A

1/3

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21
Q

How to diagnose TEF

A

Place NG and get X-ray

Coiling of NG and gas in GI tract

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22
Q

What is achalasia?

A

Incomplete relaxation of LES and lack of normal esophageal peristalsis

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23
Q

Two main diagnostic tests for achalasia

A

Barium swallow

Manometric exam

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24
Q

What is allgrove syndrome?

A

Triple A: Achalasia, adrenal insufficiency, alacrima

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25
Q

Surgical treatment of achalasia

A

Pneumatic dilation

Laparoscopic surgical myotomy w/ partial fundoplication

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26
Q

Medical treatment for achalasia

A

Botulinum toxin

Calcium channel blockers

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27
Q

When does GER become GERD?

A

Failure to thrive, inability to maintain enough calories

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28
Q

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

A

Upper GI series – good for anatomic and motility problems only

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29
Q

Only way to definitively diagnose esophagitis

A

Upper endoscopy with biopsy

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30
Q

What can several years of untreated GERD lead to?

A

Barrett’s esophagus

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31
Q

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

A

> 15

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32
Q

Treatment of EOE

A

High dose acid suppression
Specific food elimination
Swallowed steroids

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33
Q

Most common organisms leading to infections in esphagus

A

CMV

HSV

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34
Q

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

A

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

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35
Q

Main meds that lead to pill esophagitis

A

Doxy, tetracyclines, aspirin, NSAIDs, slow release potassium

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36
Q

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

A

Asymptomatic child < 5 years

Batter width > 20mm

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37
Q

Difference between emergent vs urgent removal of foreign body

A

Emergent- < 2 hours from presentation

Urgen- < 24 hours from presentation

38
Q

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

A

False- never perform endoscopy on these patients

39
Q

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

A

water soluble

40
Q

Are boys or girls more commonly affected by pyloric stenosis?

A

Boys – 6x more likely

41
Q

Risk factor for pyloric stenosis

A

Exposure to erythromycin <2 weeks

42
Q

Time of presentation of pyloric stenosis

A

3 weeks to 2 months of age

43
Q

Electrolyte concern with pyloric stenosis, and why?

A

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

44
Q

What measurements on abdominal ultrasound make pyloric stenosis likely?

A

pi- 3.14

>3mm thick and >14mm long

45
Q

Treatment of pyloric stenosis

A

Rehydrate to correct electrolyte abnormalities

Pyloromyotomy

46
Q

Likely cause of GI bleed in sick ICU patient

A

stress gastropathy

47
Q

Gastropathy in burn patient

A

Curling ulcer

48
Q

Gastropathy in head trauma patient

A

Cushing ulcer

49
Q

Main cause of gastric adenocarcinoma

A

H. pylori

50
Q

What do biopsy findings show for H. pylori

A

Gram negative spiral rods

51
Q

Protein losing gastropathy that results in hypoproteinemia.

Presents with peripheral edema and nausea/vomiting

A

Menetrier Disease

52
Q

Cause of menetrier disease

A

CMV

53
Q

Best test to know if h. pylori has cleared

A

stook antigen test

54
Q

When should H. pylori be treated?

A

Only in the presence of PUD or MALT lymphoma

55
Q

Treatment of H. pylori

A

2 weeks of PPI
Clarithromycin
Amoxicillin or Metronidazole

56
Q

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

A

When there is clarithromycin resistance

PPI + tetracycline + bismuth + amox/metro

57
Q

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

A

Upper GI

58
Q

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

A

On the right side of the abdomen

59
Q

Most common area of intussusception

A

Ileocecal junction due to virus induced swelling of Peyer patches

60
Q

Best initial imaging study for intussusception

A

Ultrasound

61
Q

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

A

Air contrast enema

62
Q

Why does a meckel diverticulum develop?

A

Failure of obliteration omphalomesenteric duct

63
Q

Test for diagnosis of Meckel’s

A

technetium pertechnetate scan

64
Q

Common genetic syndrome associated with duodenal atresia

A

Down’s syndrome

65
Q

KUB findings in duodenal atresia

A

Double bubble sign

66
Q

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

A

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

67
Q

Most common location of intestinal duplication

A

ileum

68
Q

3 characteristics of intestinal duplications

A
  • strongly adherent to some part of GI tract
  • 2 layered muscular coat
  • epithelial lining similar to stomach, SI or colon
69
Q

What is the gold standard study of lactase deficiency?

A

Endoscopic biopsy with measurement of mucosal enzyme activity

70
Q

Most common reliable diagnostic test for lactase deficiency

A

Breath hydrogen test

71
Q

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

A

Rise of > 10-20 ppm

72
Q

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

A

ApoB deficiency

73
Q

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

A

Chylomicron exocytosis

74
Q

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

A

Free neutral amino acid transport – presents like Pellagra

75
Q

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

A

Tryptophan transport

bluish urine stained diaper

76
Q

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

A

Lysine and arginine transport

Intellectual desability, cataracts, hypotonia, rickets

77
Q

What is the transport defect in congenital chloride diarrhea?

A

Cl-/HCO3- exchanger

78
Q

What is the transport defect in congenital sodium diarrhea?

A

Na+/H+ exchanger

79
Q

What is the transport defect in acrodermatitis enteropathica?

A

Zinc transport

80
Q

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

A

Acanthocytosis (spurr cells)

81
Q

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

A

Vitamin B12 and bile salts (Vitamin ADEK)

82
Q

What are the two HLA types associated with celiac disease?

A

DQ2 and DQ8

83
Q

Skin manifestation of celiac disease

A

Dermatitis herpetiformis

84
Q

Two main diseases commonly associated with celiac disease

A

T1DM

IgA deficiency

85
Q

What are the serum studies for celiac disease

A

IgA ab for tTG

IgA antiendomysial antibodies

86
Q

Most common cause of congenital diarrhea

A

Davidson disease (congenital microvillus inclusion disease)

87
Q

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

A

Whipple disease

88
Q

Is Crohn’s or UC transmural?

A

Crohn’s

89
Q

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

A

UC

90
Q

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

A

5-ASA

GI (1 decks)

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