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Studying > GI, nutrition and surgery > Flashcards

GI, nutrition and surgery Flashcards

1
Q

Pancreatitis

when to start feeds

A
  • within 48-72hrs once hemodynamically stable
    monitor: hyperglycemia, pain
  • contraindications: ileus, complex fistulae, abdominal compartment syndrome
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2
Q

1st line therapy for H. pylori

A

PAM or PAC:
= PPI, amoxil, metronidazole
= PPI, amoxil, clarithromycin

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3
Q

1st steps for surgical abdomen after calling surger

A
  • IV fluid bolus and antibiotics
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4
Q

Carbohydrates malabsorption causes

A

primary causes: enzyme deficiencies (rare)
- e,g, sucrase-isomaltase, trehalase, lactase
Dietary causes: saturation of normal enzyme levels e.g. toddler’s diarrhea

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5
Q

Syndromes associated with increased risk of celiac disease

A
  • down syndrome
  • turner syndrome
  • Williams syndrome
  • Type 1 diabetes
  • IgA deficiency
  • other autoimmune
  • 1st degree relative with celiac
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6
Q

celiac disease extraintestinal manifestations

A
  • dermatitis herpetiformis
  • dental enamel hypoplasia
  • osteopenia/osteoporosis
  • short stature
  • delayed puberty
  • iron defiicency anemia
  • hepatitis
  • arthritis
  • epilepsy with occipital lobe calcifications
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7
Q

Celiac test if < 2 yrs old

A

deaminaded gliadin peptide (DGP)

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8
Q

Difference vs. UC and Crohns

  1. rectum
  2. distribution
  3. terminal ileum
A

UC: rectum involved, difffuse distribution, TI not involved
CD: variable rectum involvement, segmental/diffuse distrubition, thick/stenosed TI

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9
Q

Difference UC vs. Crohns

  1. bowel wall
  2. mucosa
  3. stricture
  4. fistula
A

UC: bowel wall normal, hemorrhagic mucosa, rarely strictures or fistulas
CD: thickened bowel walls, cobblestones/deep ulcers of mucosa and common strictures and fistulas

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10
Q

UC vs Crohns

  • erythema nodosum
  • uveitis
  • PSC
  • granuloma
A

UC: rare erythema nodosum, common uveitis and PSC, NO granulomas
CD: common erythema nodosum, common uveitis, rare PSC, yes granulomas

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11
Q

IBD medications to INDUCE remission

A
  • Tube feeds (Crohns only)
  • 5-ASA (mild - UC only)
  • steroids (common)
  • biologics (severe)
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12
Q

IBD meds to maintain remisison

A
  • tube feeds (Crohns only)
  • 5-ASA (mild, UC only)
  • Azathioprine (moderate)
  • MTX (moderate)
  • biologics (severe)
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13
Q

DDX of terminal ileitis

A
  • Crohns
  • lymphoma
  • yersinia infection
  • TB
  • CGD
  • severe eosinophilic gastroenteropathy
  • lymphonodular hyperplasia (normal finding)
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14
Q

Organic constipation causes

A
  • hypothyroidism
  • celiac disease
  • lead poisoning
  • medications
  • CF
  • HYPERcalcemia
  • HYPOkalemia
  • Hirschprung
  • CP
  • NTD
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15
Q

Treatment guidelines for GER

A
  1. Infants: first trial hydrolyzed protein, AA based formula
  2. acid blockage (H2RB or PPI) for 8 weeks
  3. if no resolution, OR recurrence after weaning meds move to endoscopy and 24hr pH/impedance probe
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16
Q

Bloody diarrhea causes

A
  • salmonella
  • shigella
  • yersinia
  • campylobacter
  • e.coli
17
Q

To treat or not treat

Diarrheal infections

A

Dont treat: e.coli, shigella, salmonella
Support: cholera, yersinia
Consider: campylobacter
Treat: C. diff, parasites

18
Q

Infantile colic definition

A
  • episodes > 3hrs per day for 3days per week for > 1 week

- infant < 5 months of age

19
Q

Irritable bowel syndrome features

A

Abdo pain at least 4x/month with at least 1 of the following symptoms:

  • timing related to defecation
  • change in frequency of stool
  • change in form of stool
20
Q

Common causes of neonatal cholestasis

A
  • infections - UTI, e.coli, TORCH, sepsis, adenovirus
  • biliary atresia
  • choledochal cyst
  • Alpha-1-antityrpsin deficiency
  • hypothyroidism
  • galactosemia
  • mitochondrial
  • PFIC
21
Q

Hep B vaccine and immunoclobulin timing

A
  • HBV within 12 hrs

- HBIG within 12 hours (max 7 days)

22
Q

Treating children with Hep B if…

A
  1. HBsAG + for > 6 months
  2. ALT > 2x normal AND
  3. evidence of viral replication
    OR
  4. chronic hepatitis on liver biopsy
    (treat with IFN-alpha or lamivudine)
23
Q

alpha 1-antitrypsin

A

for protein losing enteropathy

24
Q

fecal elastase

A

pancreatic insufficiency

25
Q 
Alvarado score
(8 items)
A
  • migratory R iliac fossa pain pain
  • N+V
  • anorexia
  • tenderness in R iliac fossa
  • rebound tenderness
  • elevated temp
  • leukocytosis
  • left shift
26
Q

Pyloric stenosis

lab findings

A
  • metabolic alkalosis, hypochloremic

- paradoxical urine aciduria (mediated by aldosterone)

27
Q

Intussusception non-op management and contraindications

A

non-op:
- hydrostatic reduction, pneumatic reduction

contraindications: peritoninitis, persistent hypotension, free air/pneumoperitoneum

28
Q

Meckel’s diverticulum - rule of 2s

A 
2% of population
2:1: male to female
2-6% symptomatic, complicated
most symptoms by age 2 yrs
within 2 feet of ileocecal valve
2 inches long
29
Q

Meckel’s bleed

A
  • painless, episodic, massive LGIB

- diagnose with 99Tc (Meckel’s) scan

30
Q

Management CDH

antenatal diagnosis

A
  • intubation on first breath
  • NG tube to decompress stomach
  • may need: mechanical ventilation, HFV, intropes, iNO, ECLS
  • rule out other anomalies: cardiac echo, chromosomal anomalies
    attempt repair if stable over initial 24-48hrs, or after ECLS decannulation
31
Q

Most frequent associated major anomaly with EA-TEF

A
  • cardiac

and needs work up for VACTERL

32
Q

Bilious emesis in neonate DDX

A
  • Hirschprung disease
  • malrotation + midgut volvulus
  • intestinal atresia
  • ileus
33
Q

Most common cardiac malformation associated with omphalocele

A
  • Tetralogy of Fallot!
34
Q

Gastroschisis vs. omphalocele

A

Gastroschisis: defect R of umbilicus, usually small, angry bowel, 10% associated with atresia and volvulus, prolonged ileus/GI dysfunction
Omphalocele: defect through umbilicus, can be giant, peritoneal sac, 50% associated with other anomalies esp cardiac, prompt recover of bowel function

35
Q

Inguinal hernias

- surgiccal indications and timing

A
  • all hernias should be repaired soon after diagnosis (median 2 weeks) (2x risk of incarceration if wait longer than 30 days)
  • bilateral exploration if infant was prem
36
Q

Cryptorchidism

- treatment

A

Main indication for tx = fertility

- surgical referral by 6-9 months of age

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