GI/Nutrition Flashcards
What are the symptoms of Vit C deficiency?
Anorexia, fatigue, myalgia
Severe: bleeding gums, petechiae, wound healing, joint effusions, weakening of teeth, bones, connective tissue, death
An infant presents at 2 weeks of life with jaundice, what test MUST you do?
Fractionated bilirubin
What is the most sensitive and specific US finding for biliary atresia?
Triangular cord sign
What is the gold standard for diagnosis of biliary atresia?
Intra-operative cholangiogram
What is the most important prognostic finding for patients with Alagille Syndrome?
Cardiac disease - severe cardiac disease is associated with poor outcomes. They are likely to have right sided outflow obstructive processes = PS and TOF.
Name the skeletal findings in rickets.
- Delayed fontanelle closure
- Parietal & frontal bossing
- Craniotabes (soft skull)
- Rachitic rosary (enlarged costochondral junction)
- Widening of the wrist
- Bowing of the distal radius and ulna
- Lateral bowing of femur and tibia
Name the x-ray findings in rickets.
- Widening of the epiphyseal plate, loss of definition at the epiphyseal/metaphyseal interface
- Cupping, splaying, cortical spurs, stippling
- Osteopenia in long bone shaft, thin cortices
- Pathologic fractures
- Looser zones (pseudofractures, radiolucent lines)
What are the lab findings in vitamin D deficiency for calcium, phosphorous, ALP, PTH, 25-Vit D, 1,25-dihydroxyvitamin D?
Calcium = N/L Phosphorous = Low ALP = High PTH = High 25-vitamin D = Low 1,25dihyrdoxyvitamin D = L/N/H
What is the first line management recommendations for GERD treatment in infants as per NASPGHAN? If not improved from this, what is your next step?
-Avoid overfeeding
-Thicken feeds
-Continue breastfeeding
If not improved:
-2-4 wk of protein hydrolysate or amino acid based formula or in breastfed infants, elimination of cow’s milk in maternal diet
What is the first line management recommendations for GERD treatment in children as per NASPGHAN? If not improved from this, what is your next step?
-Lifestyle and dietary modification
If not improved:
-Acid suppression for 4-8 weeks
Which vitamin deficiency in children presents with the following symptoms:
- Ataxia
- Hyporeflexia/loss of DTRs
- Limited upward gaze/opthalmoplegia
- Decreased propioception
Vitamin E deficiency
Clinical presentation in preterm infants:
- Hemolytic anemia
- Thrombocytosis
- Edema
-Can have prolonged PT, abN bone development
Which clotting factors require vitamin K for synthesis?
X, IX, VII, II
Which lab abnormality is first impacted by vitamin K deficiency?
A. Prolonged PT/INR
B. Prolonged PTT
C. Low factor VII
All of these lab abnormalities occur with Vit K def. Low factor VII occurs first as it has the shortest half life.
What element deficiency is associated with a male infant who has sparse/coarse/brittle hair, FTT, seizures, hypotonia, congenital #s, and subdural hematomas?
Menkes Disease
- Mutation in gene for protein needed for intestinal copper absorption, leads to copper deficiency
- X-linked, more common in males
- Part of DDx for NAT considering presentation of subdurals and #s
A 6mo who is transitioning to solids presents with significant perioral and perineal eczematous lesions and diarrhea. What is the most likely element deficiency?
Zinc deficiency Acrodermatitis enteropathica -Often presents when weaning from breast -Cutaneous eruptions -Symmetrically in perioral, acral, perineal areas and on cheeks, knees, elbows -Hair often w/ red tint, alopecia -Photophobia, conjunctivitis, blepharitis -Diarrhea -Stomatitis, glossitis -Paronychia -Delayed wound healing -Super infection w/ Candida
A 16yo female with a history of chronic bloody diarrhea and abdominal pain presents with paresthesias and weakness. What vitamin deficiency is most likely?
Vitamin B12/Cobalamin/Cyanocobalamin
- At risk for deficiency with chronic gastritis, Crohn’s, bariatric surgery, ileal resections
- Irritability, hypotonia, regression, involuntary movements, peripheral neuritis, hyperpigmentation of knuckles and palms
- Macrocytic megaloblastic anemia with MCV >110, low retics
Name 3 medications associated with folate deficiency.
- NSAIDs
- Methotrexate
- Phenytoin
- Phenobarbital
What deficiencies are associated with a vegan diet?
Vitamin B12 and D, calcium, iron
A child is consuming goat’s milk instead of cow’s milk. What deficiency are they at risk for?
Folic acid
A child is on a gluten free diet. What deficiencies are they at risk for?
B vitamins, iron
A neonate develops seizures in the first few days of life which are refractory to multiple anti-epileptics. When considering the differential diagnosis, which vitamin deficiency might be the cause?
Vitamin B6/Pyridoxine Clinical presentation can include: -Seizures -Vomiting -FTT -Cheilosis/glossitis -Seborrheic dermatitis around eyes, nose, mouth -Microcytic anemia -Bladder stones -Hyperglycemia -Lymphopenia -Infections
A child presents with glove and stocking distribution dermatitis. What vitamin deficiency is most likely?
Vitamin B3/Niacin Pellagra: -Dermatitis, diarrhea, dementia -Stomatitis/glossitis -Dermatitis; glove and stocking common, casal necklace is when around neck
A child presents with cheilosis glossitis, angular stomatitis and a normocytic, normochromic anemia. What is the most likely vitamin deficiency?
Vitamin B2/Riboflavin
A 14yo F is admitted with severe malnourishment due to an eating disorder. She develops confusion, ataxia and opthalmoplegia. Subsequently, she develops a polyneuropathy. What vitamin deficiency is most likely the cause?
Vitamin B1/Thiamine
- Fatigue, apathy, irritability, depression, anorexia, poor concentration
- Beriberi: peripheral neuritis, hyporeflexia, loss of vibration sense, leg cramps, ptosis, psychosis, aphonia, ataxia, increased ICP, CHF
- Wernicke: mental status changes, ocular signs, ataxia (rare)
- Korsokoff: progressive (less reversible on spectrum w/ Wernicke), confabulation, amnesia, psychosis, loss of insight
An young boy with autism who is extremely restrictive in food choices presents with vision loss. What vitamin deficiency is most likely?
Vitamin A
-Diarrhea, increased ICP, anemia, wide separation of sutures, eye findings blindness, keratinization of the cornea and conjunctiva, plaques (bitot spots), xeropthalmia
