GI Notes Flashcards
Toxic megacolon is a complication of what?
ulcerative colitis
What are the criteria for toxic megacolon?
radiographic evidence of colonic distention >6cm, haustra don't extend across the lumen \+ 3 of the following fever HR>120 neutrophilic leukocytosis anemia \+1 of the following volume depletion AMS electrolyte disturbances hypotension
What is the treatment for toxic megacolon?
bowel rest NPO steroids (IBD) ceftriaxone + metronidazole if super severe & nonresponsive: subtotal colectomy with end ileostomy
What time in utero does anal atresia occur?
5th-7th week of life
What is a low anal atresia?
orifice in perineum somewhere
a lot are continent after surgery, just struggle from constipation
treatment: orogastric tube to monitor for meconium
surgical repair with muscle stimulator
What is high anal atresia?
absence of orifice at perineal level
associated with rectovesicular fistula or rectovaginal fistula
deficiency of pelvic and gluteal nerves, sacral anomalies
meconium in urethral meatus or vagina or something
treatment: surgical repair in multiple steps
won’t have as high a rate of continence following surgery
What does VACTERL stand for?
vertebral defects anal atresia cardiac: VSD Tracheoesophageal fistula Renal Anomalies Limb: hypoplastic thumb, polydactyly, syndactyly
Delayed diagnosis of anal atresia can lead to what?
bowel distention and perforation
rectourinary fistula–recurrent pyelonephritis
Which colon polyps are not premalignant?
hyperplastic
Hamartomatous polyps are associated with what?
Juvenile polyps
Peutz-Jeghers
What are the different types of adenomatous polyps?
sessile or stalked (pedunculated)
tubular (low risk)
tubulovillous intermediate risk
villous high risk
Serrated polyps are what shape, found where?
flat and found in the right colon
What’s the deal with the FAP/APC syndrome?
need proctocolectomy and ileoanal pouch once you see polyps
start screening 10-12 yo
found on chromosome 5, tumor suppressor gene.
What’s the deal with Gardner’s syndrome?
APC gene mutation
need a colectomy
will totally get cancer by your 40s
polyps + osteomas + benign soft tissue tumors + dental stuff + desmoid tumors + sebaceous cysts
What’s the deal with Turcot’s syndrome?
turban goes on your head
APC mutation
polyps + cerebellar medulloblastoma/GBM
What’s the deal with Peutz-Jeghers syndrome?
hamartomas in GI tract-can lead to intussusception
+ pigmented spots
Familial juvenile polyposis syndrome?
thousands of polyps in the colon, but very low risk of colorectal carcinoma
What is the deal with hereditary nonpolyposis CRC?
no adenomatous polyps
3+ relatives with CRC (1 is first degree, 1 is
How does Lynch syndrome relate to hereditary nonpolyposis CRC?
Lynch Syndrome I: early onset CRC w/o polyps
Lynch Syndrome II: early onset CRC with other cancers
What is the most common cause of large bowel obstruction in adults?
CRC
What’s the deal with Celiac disease?
IgA anti-tissue transglutaminase
may be neg. if you have igA deficiency
can also test for IgA deamidated gliadin peptide (
What’s the deal with acute intermittent porphyria?
N/V/D abdominal pain
sweating agitation anxiety paresthesias confusion
NO photosensitivity, NO rash
How might a retrocecal appendicitis present?
periumbilical pain and diarrhea w/o RLQ pain until perforation
usu perfs 36 hours after pain
What is the treatment for a perforated appendicitis?
broad spectrum antibiotics
ampicillin
gentamycin
metronidazole
What are some things that can mimic appendicitis?
yersinia
campylobacter
There is esophageal atresia in all forms of TE fistulas except for which type?
H type
symptoms different-chronic cough w/ feeding
recurrent pneumonia
What is the presentation of a TE fistula?
polyhydramnios excessive oral secretions inability to feed gagging respiratory distress NG tube goes into a blind pouch AND there is air in the GI tract
What is the workup for TE fistula?
barium swallow
perinatal U/S: polyhydramnios w/o stomach bubble
get echo!
eventual endoscopy to check for stricture formation etc.
What do you need for nutrition when you have gastroschisis or omphalocele?
TPN
What are some conditions associated with omphalocele? What is the treatment?
Edwards
Patau
Beckwith-Wiedemann
look for extra genetic defects!!
orogastric to decompress, fluids, antibiotics, surgery
What is the management of gastroschisis?
sterile wrap the bowel orogastric tube to decompress fluids antibiotics surgery
When do you repair an umbilical hernia?
after 2 years of age, when it hasn’t been fixed.
What are some serious causes of vomiting?
esophageal atresia midgut volvulus bowel atresia pyloric stenosis annular pancreas malrotation
What are some possible causes of bilious vomiting and double bubble?
duodenal atresia
annular pancreas
malrotation (most serious-possible strangulatioN)
final way to diagnose: upper GI series (barium)
Vascular accident is the risk factor for jejunal atresia. What might the mom have done?
cocaine and tobacco use
Why does congenital adrenal hyperplasia cause vomiting?
potassium abnormalities
What is the presentation of intussusception?
colicky pain emesis currant jelly stools palpable mass draws legs to abdomen
How is the presentation of Meckel’s different from intussusception?
Meckel’s is usu painless rectal bleeding
intuss is painful
What are some possible causes of intussusception?
Meckel's enterocolitis-hypertrophy of Peyer's patches polyps lymphoma HSP
usu in the ileocolic region
treat with barium or pneumatic enema/reduction
What is cyclic vomiting syndrome?
~abdominal migraine
vomiting without known trigger, at certain time of month, with complete resolution of symptoms in between episodes
diagnosis:
>3 episodes/6months (1-10d)
treatment: fluids and zofran
Workup and treatment for pyloric stenosis?
U/S hypertrophic pylorus
Upper GI series: barium swallow string sign
treatment: NG tube and fluids, pyloromyotomy
What’s the deal with malrotation and volvulus?
bilious vomiting
obstruction series, upper GI series with small bowel f/thru
see weird position for cecum and ligament of trietz
treatment: surgery
What is the cause of nocturnal perianal pruritis? workup? treatment?
enterobius vermicularis
eggs on tape test
albendazole, also for household members
What is the gold standard test for GERD? Achalasia/scleroderma?
GERD: esophageal pH probe
achalasia: manometry to measure LES sphincter pressure
What is the presentation and cause of eosinophilic esophagitis?
GERD refractory to therapy, sometimes associated with dysphagia
cause-associated with milk-protein allergy
What is the workup and treatment for eosinophilic esophagitis?
upper GI endoscopy with biopsy
give topic steroids (fluticasone, budesonide) AA based formula
What is neuronal intestinal dysplasia A,B?
bad innervation of the gut disease
A: has ganglion cells. makes it different from Hirschprung’s
B: can coexist with H
What is small left colon syndrome?
functional obstruction after the passage of meconium
transient dysmotility, usu when born to diabetic moms
give water soluble enemas
What does it tell you when the NG tube reveals coffee ground emesis?
that the bleeding has remitted.
b/c blood turns brown after 5 min of exposure to gastric acid
When do you see a drop in a child’s BP following hemorrhage?
only after they have lost 40% of their intravascular volume.
HOw does EHEC usu present?
nonbloody diarrhea followed by bloody diarrhea
What is the workup for a GI bleed?
stool culture (if bloody diarrhea) abd xray if you suspect necrotizing enterocolitis Apt RBC fragility test if you think blood might be from mom following delivery (mom's rbcs will turn to hematin in the presence of alkali)
What causes the bleeding of Meckel’s? What are the possible complications?
the gastric mucosa there is what causes the bleeding
complications: intussusception, volvulus, diverticulitis (will mimic appendicitis)
do a radionuclide scan for workup.
can initially give H2 blocker and prepentagastrin stimulation
correct with surgery
In patients with functional abdominal pain…besides reassurance and fiber…what else should you give?
if they don’t work:
can try anticholinergics, TCAs, SSRIs, gabapentin to help with the diffuse abdominal pain
can try CBT
When does infantile colic begin to improve?
4-5 months of age.
