GI/Nutritional (10%) Flashcards
1
Q
There is increased incidence of pyloric stenosis with the use of what medication?
A
Erythromycin, in infants <6 months of age
2
Q
What are risk factors for developing Vit C deficiency?
A
diets lacking raw citrus fruits & green vegetables (excess heat denatures vitamin C), smoking, alcoholism, malnourished individuals, elderly
3
Q
What is the incubation period of salmonella gastroenteritis?
A
5-14 days
4
Q
What is the method of transmission for Hep A?
Heb B?
Hep C?
Hep D?
Hep E?
A
A: Feco oral (international travel, water/food)
B: parenteral, sexual, perinatal, percutaneous
C: parenteral (IV drug use)
D: requires Hep B to cause co-infxn or superimposed infxn
E: feco-oral
5
Q
How to make a dx of Crigler-Najjar syndrome?
Type 1 levels of serum indirect bilirubin?
Type 2 levels of serum indirect bilirubin? When may this level increase?
A
Isolated indirect (unconjugated) hyperbilirubinemia with normal LFTs
Type 1: 20-50 mg/dL
Type 2: 7-10 mg/dL (may increase during illness or fasting)
6
Q
A
7
Q
Secretory diarrhea is characterized by (low/normal/high) osmotic gap, (small/large) volume, (decrease/no change/increase) in diarrhea with fasting
A
normal
large
no change
8
Q
Appendicitis most commonly occurs in patients in what age group?
A
10 y/o - 30 y/o
9
Q
If a patient has persistent sx or complications of GERD, what test is often performed first?
A
Endoscopy
10
Q
What is the incubation period of salmonella?
What are some places/things a person might contract it from?
Clinical manifestations? For a patient with sickle cell dz?
Management?
A
6-48 hours
Most common source is poultry products (dairy, meat, eggs), exotic pets (petiles, turtles) –> feco-oral
mucousy-bloody diarrhea
SCD pts: increased risk of osteomyelitis with salmonella
Fluids, if severe: Fluoroquinolones
11
Q
What is the incubation period of enerohemorrhagic E. coli 0157:H7?
What are some places/things a person might contract it from?
Does it produce a (cytotoxin/enterotoxin/exotoxin)?
Clinical manifestations?
Management? What about abx?
A
4-9 days
undercooked ground beef, unpasteurized milk/apple cider, day care centers, contaminated water
cytotoxin
watery diarrhea early on that turns bloody, crampy abd pain, vomiting, fever low grade or absent
Fluid replacement, abx controversial as there is increased incidence of hemolytic uremic syndrome in children
12
Q
What are some examples of protozoans that can cause enterocolitis?
A
Giardia Lamblia
Amebiasis
13
Q
If jaundice occurs in the first 24 hours of life, (physiologic/pathologic) jaundice may be suggested, and usually indicates ______ or ______ _______
A
pathologic
hemolysis or hereditary spherocytosis
14
Q
Pyloric stenosis is caused by _______ & ______ of the muscular layers of the pylorus, causing a functional (inlet/outlet) obstruction
A
Hypertrophy & hyperplasia
15
Q
What is another name for Vitamin C?
A
Ascorbic acid
16
Q
What causes osmotic diarrhea?
A
Malabsorption of nonabsorbalble substances in the intestinal lumen with secondary accumulation of fluid, the increased solutes in the GI tract promotes diarrhea by pulling water into the gut
17
Q
What other sx are commonly associated with GERD?
What are some sx that are atypical?
A
heartburn increased with supine position 30-60 min after a meal
regurgitation
dysphagia
nocturnal cough
Atypical: hoarseness, aspiration PNA, “asthma” (bronchospasm from acid contact with the lung), nocardiac chest pain
18
Q
What is the enzyme required to convert indirect bilirubin into direct bilirubin?
A
Glucuronosyltransferase [UGT]
19
Q
What is often used as an initial screening test to see if a pt has hirschsprung disease?
What is used for definitive diagnosis?
A
Anorectal Manometry
Rectal Bx (can also use rectal suction bx–less invasive and do not need anesthesia)
20
Q
What are possible complications of GERD?
A
esophagitis
stricture
barretts esophagus
esophageal adenocarcinoma
21
Q
What is the incubation period of shigella?
What are some places/things a person might contract it from?
Clinical manifestations?
Complications? In children?
What would be seen on CBC? Sigmoidoscopy?
Management? If severe?
A
1-7 days
feco-oral contamination
lower abd pain, high fever, tenesmus, explosive watery diarrhea that is mucoid and bloody
Complications: severe cases may lead to toxic megacolon, reactive arthritis (Reiter’s syndrome), and neurologic manifestations especially in young children (febrile sz)
CBC shows leukemoid reaction (WBC >50,000)
Sigmoidoscopy: shows punctate areas of ulceration
Fluids, if severe: Trimethoprim-sulfamethoxazole 1st line
22
Q
What are some examples of organisms that can cause invasive infectious diarrhea?
A
Campylobacter enteritis
Shigella
Salmonella
Enterohemorrhagic E Coli 0157:H7
Yersinia enterocolitica
23
Q
What is the infective organsim that causes Whipple’s disease?
In what employment population is this condition most common?
Clinical manifestations?
Dx?
Management?
A
Tropheryma whippelii
Farmers (around contaminated soil)
Malabsorption, wt loss, statorrhea, rhythmic motion of eye muscles while chewing
Duodenal bx, showing periodic acid-schiff + macropgaes, non acid fast bacilli, dilation of lacteals
PCN or tetracycline for 1-2 years
24
Q
There is an increased incidence of duodenal atresia in patients who also have _____ ______
A
Down syndrome
25
Crigler-Najjar Syndrome: Hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia
unconjugated
indirect
*0.6 - 1.0 per million*
26
What is the management for duodenal stresia?
Decompression of the GI tract
electrolyte and IV fluid replacement
Duodenoduodenostomy (surgical repair or anastamosis)
27
Why do newborns present with physiologic jaundice (anatomically)?
Due to increased indirect (unconjugated) or direct (conjugated) bilirubin?
Immature liver uanble to efficiently conjugate bilirubin due to decreased UGT activity
Indirect (unconjugated)
28
T/F: Most patients with Gilbert's syndrome are asymptomatic
True
29
What two findings are needed to make a diagnosis of Dubin-Johnson Syndrome?
What are the three D's of Dubin-Johnson Syndrome?
Mild isolated coniugated (direct) hvperbilirubinemia\* (often between 2 - 5 mg/dL) but can increase with concurrent illness, pregnancy or OCPs.
Grossly black liver on biopsy
3D's: **_D_**ubin, **_D_**ark liver, **_D_**irect hyperbilirubinemiea
30
In a pt with acute Hep A, (IgM HAV Ab/IgG HAVE Ab) is positive, and in a pt with past exposure to Hep A, (IgM HAV Ab/IgG HAVE Ab) is positive
IgM HAV Ab
IgG HAV Ab (with negative IgM)
31
What is the recommended management of Dubin-Johnson syndrome?
None needed
32
What is Reye syndrome?
Fulminant hepatitis most commonly seen in children associated with ASA use during viral infections, but may also occur without ASA use
33
What are some places/things a person might contract vibrio cholerae from?
Clinical manifestations?
Management?
Contaminated food and water
Poor sanitation and overcrowding conditions, especially abroad
Grey, "rice water" stools without blood or pus, producing rapid dehydration, death caused by hypovolemia
Supportive, fluid replacement
Can Rx tetracycline abx as it may shorten dz course
34
What is the incubation period of camplylobacter enteritis?
What are some places/things a person might contract it from?
What would be seen on stool cx?
Clinical manifestations?
Management?
3 days
Contaminated food: i.e. undercooked poultry, raw milk, water, dairy cattle
**"S, Comma, or Seagull Shaped organisms"**
fever, HA, abd pain, may mimic acute appendicitis, **diarrhea initially watery but turns bloody**
Fluids, if severe: Erythromycin is 1st line
35
What is niacin/nicotinic acid (B3) deficiency usually secondary to?
What are the 3 Ds of Pellagra?
diets high in corn (lacks niacin and tryptophan) aor diets which lack tryptophan
Diarrhea, Dementia, Dermatitis, (*Death*)
36
What is the hallmark symptom of GERD?
When and where does this sx present?
Heartburn (pyrosis)
often retrosternal and postprandial
37
If upper endoscopy is normal in a pt with GERD sx, a(n) ______ \_\_\_\_\_ is used to determine if there is decreased LES pressure
esophageal manometer
38
Dubin-Johnson Syndrome: a hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia due to decreased hepatocyte excretion of conjugated bilirubin (gene mutation at gene \_\_\_\_\_)
Usually, patients are (asymptomatic/symptomatic)
conjugated
direct
MRP2
Asymptomatic
39
What are some examples of antiemetic medications?
**Ondansetron** (Zofran)
* Granisetron*
* Dolasetron*
**Dopamine Blockers** (Prochlorperazine [Compazine], Promethazine [Phenergan], Metoclopramide [Reglan])
40
What are the "3 H's" of scurvy?
**_Hyperkeratosis_**: hyperkeratotic follicular papules
**_Hemorrhage_**: vascular fragility, recurrent hemorrhages in gums, skin (perifollicular), and joints, impaired wound healing
**_Hematologic_**: anemia, glossitis, increased bleeding time
41
Children \<6 y/o with Hepatitis ____ are usually aymptomatic
A
42
What condition is the most common cause of noncardiac chest pain?
GERD
43
Who should you not give antimotility agents to? Why?
Patients with invasive diarrhea (may cause toxicity)
44
In physiologic jaundice of a newborn, (indirect/direct) bilirubin rises in days \_\_\_-\_\_\_ & falls in about half of the neonates during the (1st/2nd/3rd) week of life
indirect
3-5 days
1st
45
What are sx of Vit A deficiency?
Visual changes (especially night blindness), xerophthalmia (dry eyes)
Impaired immunity (poor wound healing), dry skin, poor bone growth, taste loss
Squamous metaplasia (conjunctiva, respiratory epithelium, urinary tract)
46
What is the test of choice for dx of lactose intolerance?
Why?
**Hydrogen breath test**
* Hydrogen produced when colonic bacteria ferment the undigested lactose*
* Usually performed after a trial of a lactose-free diet*
47
What is + Psoas sign?
RLQ pain with right hip flexion/extension (raise leg against resistance)
48
Intussusception occurs when an intestinal segment _________ into the adioining intestinal lumen, which leads to obstruction of the \_\_\_\_\_\_\_
2/3 of patients are between _____ to _____ of age
MC in (males/females)
MC occurs at the _______ junction
Often occurs after _____ \_\_\_\_\_
invaginates/"telescopes"
bowel
6 months - 18 months
males
ileocolic
viral infection
49
What are some places/things a person might contract yersinia enterocolitica from?
Clinical manifestations?
Management?
contaminated pork, milk, water, and tofu
fevre, abd pain that mimics acute appendicitis and can cause mesenteric adenitis, producing abd TTP and guarding
Fluid replacement, if severe: fluoroquinolones
50
Management of Acute Hep B?
Management of Chronic Heb B?
Acute: Supportive
Chronic: Alpha interferon 2b, Lamivudine, Adefovir and also newer options such as Tenofovir and Entecavir (very potent)
51
What is the diarrhea described as in a patient with Giardia lamblia?
Frothy, greasy, foul diarrhea
52
What tx is recommended for pts with Gilbert's disease?
None needed, because it is a mild, benign disease
53
What is + Rovsing sign?
RLQ pain with LLQ palpation
54
Appendicitis is caused by _____ of the appendix caused by ....
obstruction
fecalith, FB, malignancy
55
What is the initial course of management for pyloric stenosis?
Definitive management?
_Initial_: ***_Rehydration_*** (IV fluids), potassium repletion if hypokalemic from vomiting
**_Pyloromyotomy_** is the _definitive_ management
56
What is the difference between a direct and an indirect inguinal hernia?
Their relation to the inferior epigastric vessels
57
What is the mainstay of treatment for Type 1 Crigler-Najjar Syndrome?
What is definitive tx?
Phototherapy
Liver transplant
58
What is an umbilical hernia?
Through the umbilical fibromuscular ring
Congenital (failure of umbilical ring closure)
59
In type 1 Crigler-Najjar syndrome, there is (no/very little/a lot) of UGT activity.
What is the inheritance pattern of type 1?
In type 2 Crigler-Najjar syndrome, there is (no/very little/a lot) of UGT activity. Approximately how much (%) of normal?
No
autosomal recessive
very little (\<10% of normal)
60
What will a pt with duodenal stresia present with?
Intestinal obstruction shortly after birth, abd distension and ***_bilious vomiting_***
61
What is osteomalacia?
Diffuse body pains, muscle weakness, and fractures
Looser lines (radiolucencies on XR)
62
What are some examples of organisms that can cause noninvasive infectious diarrhea?
Staphylococcus aureus
Bacillus cereus
Vibrio cholerae and vibrio parahemolyticus
Enterotoxigenic E. Coli
Clostridium Difficile
63
What are the three stages for management of GERD?
1. Lifestyle modifications
2. PRN pharmacological Rx (antacids, H2 receptor antagonists)
3. Initiation of scheduled pharmacologic tx (PPI for moderate-severe dz)
Nissen fundoplicaiton if refractory to tx
64
What is the incubation period of typhoid (enteric) fever caused by S. typhi?
Clinical manifestations?
\>1-2 weeks
Cephalic phase: HA, constipation, pharyngitis, cough, crampy abd pain, diarrhea, and PEA SOUP STOOLS, intractable fever, relative bradycardia, hepatosplenomegaly, blanching "ROSE SPOTS" appear in 2nd week
65
Post exposure prophylaxis for exposure to Hep A is _____ , and should be administered to close contacts
HAV immune globulin
66
Jaundice usually progresses from _____ to ____ in the body with (decreasing/increasing) bilirubin levels
Head to toe
increasing
67
What is + Obturator sign?
RLQ pain with internal and external hip rotation with flexed knee
68
What is considered gold standard for persistent symptomatic GERD?
24 hour ambulatory pH monitoring
69
What infectious organism is the most common antecedent event in post-infectious Guillan Barre syndrome?
Campylobacter enteritis
70
Bilirubin \>\_\_\_\_\_ mg/dL can lead to kernicterus and neurotoxicity, from irreversible depostition of bilirubin in the \_\_\_\_, \_\_\_\_\_, and \_\_\_\_\_.
\>20 mg/dL
basal ganglia, pons, cerebellum
71
What vitamin deficiency is osteomalacia in adults secondary to?
Vitamin D
72
What is the only definitive tx for fulminant hepatitis?
Liver transplant
73
What are risk factors for being deficient in Vitamin A?
liver dz, ETOHics, fat free diets
74
Increased (indirect/direct) bilirubin is always pathologic
direct
75
What are the clinical manifestations of lactose intolerance?
loose stools, abd pain, flatulence, borborygmi after ingestion of milk or milk-containing products
76
What is the incubation period of staphylococcus aureus?
What are some places/things a person might contract it from?
Clinical manifestations?
Management?
IP: onset of sx w/in 6 hours
Food contamination MC: i.e. dairy products, mayo, meats, eggs
VOMITING, cramps, HA, diarrhea
Self limited
77
In a pt with intussusception, what may their abd pain be described as?
"colicky"
78
What are some examples of stool softeners/laxatives that can be used in the management of constipation?
**Fiber**
**Bulk forming laxatives**: Psyllium, methylcellulose (Citrucel), polycarbophil (Fibercon), wheat dextrin (Benefiber)
**Osmotic laxatives**: Polyethylene glycol (Golytely, Miralax,), Lactulose, Sorbitol, Saline laxatives (Milk of Magnesia, Magnesium citrate)
**Stimulant laxatives**: Bisacodyl (Dulcolax), Senna
79
What is the recommended tx for Type 2 Crigler-Najjar syndrome?
Can this tx be used in Type 1?
Tx usually is **not** **necessary**, but if required _Phenobarbital_ has been shown to increase UGT activity
Type 1 is **_NOT_** responsive to Phenobarbital
80
\_\_\_\_% of Hep B and \_\_\_\_% of Hep C infections become chronic
10% B
80% C
81
Chronic Hep B infection is \_\_\_% perinatally acquired
\>90%
82
May develop _____ swelling with indirect hernias
scrotal
83
What are ALARM sx associated with GERD?
dysphagia, odynophagia, weight loss, bleeding (suspect malignancy)
84
Hepatitis ____ is associated with waterborne outbreaks
E
85
What are the possible clinical manifestations of fulminant hepatitis?
Encephalopathy: asterixis
Coagulopathy
Hepatitis
Jaundice (not usually seen in Reye syndrome)
86
Pyloric stenosis is most commonly seen in patients who are (african american/asian/caucasian) and who are (male/female)
If seen in adults, it is associated with _____ \_\_\_\_\_ dz
Caucasians
Males (4:1)
Chronic ulcer dz
87
What is the most common cause of intestinal obstruction in infancy?
Pyloric stenosis
88
What will be seen on Abd XR of a pt with duodenal atresia?
Distended duodenum and distended stomach separated by the pyloric valve causing a ***_"double bubble" sign_***
89
Hirschsprung disease is the congenital absence of ______ cells most commonly in the ____ and ____ causing (dysfunctional/functional) obstruction
Increased incidence in (males/females) and children with what other diagnosis?
Ganglion
distal colon and rectum (75%)
functional
males
Down syndrome
90
What is the management of lactose intolerance?
Lactase enzyme preparations, Lactaid (prehydrolyzed milk), **Lactose free diet**
91
What is the difference between an incarcerated and strangulated hernia?
**_Incarcerated_**: painful, enlargement of an **irreducible** hernia *± nausea & vomiting if bowel obstruction present*
**_Strangulated_**: **ischemic**, incarcerated hernias with **systemic toxicity**, (irreducible hernia with compromised blood supply)
*Severe painful bowel movement (may refrain defecation)*
92
Describe the difference between invasive and noninvasive diarrhea.
**_Noninvasive_**: vomiting, watery, **voluminous** (involves _small intestine_), no fecal WBCs or blood
**_Invasive_**: high fever, blood and fecal leukocytes, **not as voluminous** (_large intestine_), mucus.
93
Osmotic diarrhea is characterized by (decreased/increased) diarrhea with fasting, (decreased/increased) osmotic gap, and (decreased/increased) fecal fat, with a deficiency in what type of vitamins?
increased
increased
increased
fat-soluble
94
What are the three hepatidities that are associated with chronicity?
Hepatitis B, C, and D
95
What is the tx for Vit D deficiency?
Ergocalciferol (Vit D)
96
Hepatitis _____ is the most common source for adults
A
97
What are the peritoneal signs that will be present on PE of the abd in a pt with appendicitis?
Guarding, rebound, rigidity
98
What may a pt present with if they have type 1 Crigler-Najjar syndrome?
Type 2?
**_Type 1_**: ***neonatal jaundice*** w/ ***severe progression*** in the ***2nd week***, leading to **_kernicterus_**
**_Type 2_**: usually ***asymptomatic***. Often an incidental finding on routine lab testing.
99
Gilbert's Syndrome: Hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia that is relatively (uncommon/common) (\_\_\_-\_\_\_% of US population)
unconjugated
indirect
common
5 -10% US population
100
In Gilbert's Syndrome, the patient has (no/reduced/normal/high) UGT activity at \_\_\_% of normal, and (decreased/increased) bilirubin uptake, leading to increased (indirect/direct) bilirubin
reduced
10-30% of normal
decreased
indirect
101
What is the first line test for dx in a patient with pyloric stenosis?
What would be observed?
Ultrasound
elongation/thickening of pylorus
More sensitive and no radiation risk
102
What lab values will be elevated in viral hepatitis?
ALT\>AST
103
What vitamin deficiency causes Rickets in children?
Vit D
104
What is recommended for management of newborn jaundice?
For when bilirubin is \>15 mg/dL
For severe cases?
Phototherapy, when Bili is \>15 mg/dL
Exchange transfusion for severe cases
105
What does Hesselbach's triangle consist of?
"RIP" Rectus Abdominis (medial), Inferior epigastric vessels (lateral) & Poupart's ligament (inferiorly).
106
Describe the vomit of a patient with pyloric stenosis
Will the child be hungry or not?
What else may the pt show signs of?
What may be palpated on the abd of a pt with pyloric stenosis?
**_NON-bilious projectile vomiting after feeding_**
Child remains ***hungry***
*Signs of dehydration & malnutrition, hypochloremic metabolic alkalosis (from vomiting), jaundice*
**_OLIVE-SHAPED non-tender, mobile, hard pylorus_**, 1-2cm in diameter (*palpated especially after the infant has vomited*), hyperperistalsis
107
Constipation is defined as having ____ stools per week
\<2
108
What are sx of Vit A excess?
Teratogenicity, alopecia, ataxia, visual changes skin disorders, hepatotoxicity
109
110
What is the most common cause of diarrhea in children?
Rotavirus
| (70%)
111
In a patient with appendicitis, does vomiting come before or after pain?
after
112
Pts with Gilbert's syndrome have (decreased/increased) isolated indirect bilirubin levels with (abnormal/normal) LFTs
increased
normal LFTs
113
If a pt presents with jaundice without elevated LFTs, what disorders should be suspected?
**_Familial bilirubin d/o_**: Dubin-Johnson Syndrome, Gilbert Syndrome
**_Hemolysis_**
114
Inguinal hernias usually (do/do not) require surgical repair
Do
115
What would be seen on an Upper GI contrast in a pt with pyloric stenosis?
**_STRING SIGN_** (dye through narrowed channel) and delayed gastric emptying
116
By what age does an umbilical hernia usually resolve by?
If it does not resolve by age \_\_\_\_, surgical repair should be done to avoid incarceration or strangulation
2 y/o
5 y/o
117
What does each result correlate with?
+ HBsAg (Surface Antigen) =
+HBsAb (Surface Antibody) =
+HBcAb (Core Antibody) =
+HBeAg (Envelope Antigen) =
+HBeAb (Envelope Antibody) =
+ HBV DNA =
+ HBsAg (Surface Antigen) = 1st evidence of Hep B infection, establishes infection and infectivity
+HBsAb (Surface Antibody) = distant resolved infection (recovery) OR vaccination (sole serologic marker)
+HBcAb (Core Antibody) = IgM indicates acute infection (1st Ab to appear)
IgG indicates chronic infection or distant resolved infection
+HBeAg (Envelope Antigen) = increased viral replication and increased infectivity
+HBeAb (Envelope Antibody) = warning viral replication, decreased infectivity
+ HBV DNA = active replication in the liver
118
119
What infectious organism is the most common cause of traveler's diarrhea?
Enterotoxigenic E. Coli
120
95% of patients with pyloric stenosis present in the 1st \_\_\_-\_\_\_ weeks of life (rare \>\_\_\_\_ months)
3-12 weeks
rare \>6 months
121
Direct inguinal hernias protrude (medial/lateral) to the inferior epigastric vessels within ______ triangle.
(Does not/Does) reach the scrotum
medial
Hesselbach's
Does not
122
What may be seen on PE of the abd in a patient with intussusception?
Dance's sign = SAUSAGE-SHAPED MASS in the RUQ or hypochondrium & emptiness in the right lower quadrant (due to telescoping of the bowel).
123
124
What is Rotor's syndrome?
How is it differentiated from Dubin-Johsnon Syndrome?
Similar to Dubin-Johnson but **_milder_** in nature, associated with conjugated *_and_* unconjugated hyperbilrubinemia and **_not_** associated with grossly black liver on biopsy
125
What is kernicterus?
Bilirubin-induced encephalopathy: increased amounts of bilirubin in CNS and basal ganglia, leading to hypotonia, deafness, lethargy, oculomotor palsy & death [often by 15 months of age in pts with Type 1 Crigle-Najjar syndrome]
126
What is the most common cause of fulminant hepatitis?
Other etiologies?
Acetaminophen
drug reactions, viral hepatitis, Reye syndrome
127
\_\_\_\_\_\_\_\_ ________ should be performed on a patient with intussusception if refractory to air insufflation
Surgical resection
128
What is jaundice?
Is it a disease?
At what bilirubin level is it present?
***_Yellowing of the skin, nail beds and sclera_*** by tissue ***bilirubin deposition*** as a consequence of hyperbilirubinemia
No, but it is a **sign of disease**
Bilirubin \>2.5 mg/dL
129
What is the most common cause of chronic diarrhea in patients with AIDS?
Cryptosporidium
130
What are the clinical manifestations of appendicitis?
Anorexia and periumbilical pain/epigastric pain followed by RLQ pain, nausea, and vomiting
131
What are common lead points for intussusception to occur?
Meckel diverticulum, enlarged mesenteric lymph node, hyperplasia of Peyer's patches, benign/malignant tumor, submucosal hematomas (*Henoch-Schonlein purpura*), FB
132
Chronic hepatitis (disease \> ____ months) may lead to end stage liver disease or hepatocellular carcinoma
6 months
133
What test can be performed on a patient with intussusception that is considered both diagnostic and therapeutic?
Barium contrast enema
134
What are some places/things a person might contract clostridium difficile from?
Clinical manifestations?
Management?
Usually nosocomial/iatrogenic, MC after course of abx (especially Clindamycin) or chemo
Abd cramps, diarrhea, fever, tenderness, striking lymphocytosis, pseudomembranous colitis
*± cause bowel perforation and toxic mega colon*
Metronidazole 1st line for mild dz
Vancomycin PO 2nd line (but 1st line if severe dz)
135
Niacin is otherwise known as?
B3
136
What is the mainstay of gastroenteritis management?
IV Fluid repletion (PO preferred)
137
What are Bitot's spots?
White spots on the conjunctiva due to squamous metaplasia of the corneal epithelium
138
What infectious organism is the most common cause of bacterial enteritis in the US?
Campylobacter enteritis
139
What labs will be elevated in a pt with fulminant hepatitis?
Low?
***_Ammonia_***
PT/INR (\>=1.5)
LFTs
Hypoglycemia
140
What is duodenal atresia?
What does it result in?
Complete absence or closure of a portion of the duodenum that leads to gastric outlet obstruction
141
What are some examples of anti-diarrheal medications?
**Bismuth salicylate** [Pepto bismol, Kaopectate]
**Opioid agonists** [Loperamide (immodium), Diphenoxylate/Atropine (Lomotil)]
**Anticholinergics** [Phenobarbital,/Hyoscyamine/Atropine/Scopolomine (Donnatal)]
142
What are dietary sources of Vitamin A?
found in the kidney, liver, egg yolk, butter, green leafy vegetables
143
What will the liver look like on bx of a pt with Crigler-Najjar syndrome?
Normal
144
If a pt with chronic Hep B is asymptomatic, they (can/cannot) transmit infxn to others
can
145
What is an inguinal hernia?
Protrusion of the abdominal cavity contents through the inguinal ring
146
What is encopresis?
Usually due to what underlying condition?
Fecal incontinence
Constipation
147
What is vomiting usually due to?
vomiting usually due to imbalance of serotonin, acetylcholine, dopamine, and histamine
148
What is the incubation period of Bacillus cereus?
What are some places/things a person might contract it from?
Clinical manifestations?
Management?
IP: 1-6 hours
Contaminated food: i.e. fried rice
VOMITING, cramps, diarrhea
Supportive, fluids
149
What are two types of secretory diarrheas?
**Hormonal**: serotonin (carcinoid syndrome), calcitonin (medullary cancer of thyroid), gastrin (Zollinger-Ellison Syndrome)
## Footnote
**Laxative abuse**
150
What are the two types of jaundice that can be observed in a newborn?
Physiologic
Pathologic
151
IV fluid replacement in children?
20 mL/kg of isotonic saline
152
What are options for treatment of encephalitis caused by fulminant hepatitis?
**Lactulose**: converted into lactic acid by bacteria, neutralizing the ammonia
**Rifaximin, Neomycin**: abx that decrease the bacteria producing ammonia in the GI tract
**Protein restriction**: reduces the breakdown of protein into ammonia
153
What is Rickets?
**_Softening of the bones_** leading to bowing deformities, fractures, costochondral thickening (***rachitic rosary***), dental problems, muscle weakness, and developmental delays
154
Lactose intolerance and celiac sprue are examples of what type of diarrhea?
Osmotic
155
What is the recommended diet for a patient with gastroenteritis?
**_BRAT diet_**
**B**ananas, **R**ice, **A**pplesauce, **T**oast
156
What is the course of tx for Hirschsprung dz?
Surgical resection of the affected bowel
157
When might pts with Gilbert's syndrome develop jaundice?
During periods of stress, fasting, ETOH, or illness
158
Barretts esophagus is when esophageal _______ \_\_\_\_\_\_\_ is replaced by precancerous metaplastic ________ cells from the ______ of the stomach
squamous epithelium
columnar
cardia
159
What are some places/things a person might contract vibrio parahemolyticus from?
Raw shellfish especially in the gulf of Mexico
160
What are two excellent sources of Vitamin D?
Fortified milk
Sun exposure
161
Hirschsprung should be suspected in any full term infant who fails to pass _____ in the first ____ of life
What are other sx that may indicate a pt has Hirschsprung?
What is a potential (serious) complication?
**meconium**
48 hours
*Bilious vomiting, abdominal distention, FTT*
_toxic megacolon_
162
Hep B vaccine is administered at \_\_\_, \_\_\_, and ___ months of age and is contraindicated if the patient is allergic to \_\_\_\_\_\_
0, 1, 6
Baker's yeast
163
What is the function of Vitamin A?
vision, immune function, embryo development, hematopoiesis, skin and cellular health (epithelial cell differentiation)
164
What is lactose intolerance due to?
When does the lactase enzyme level normally drop?
Especially in what populations?
Inability to digest lactose due to low levels of lactase enzyme
Normally decreases in adulthood
Especially in AA, Asians, and South Americans
165
What will be elevated in a pt with appendicitis?
Leukocytosis
166
What are possible etiologies for constipation?
disordered movement of stool through colon/anus/rectum (usually the proximal GI tract is intact)
Slow colonic transit: idiopathic, motor d/o (colorectal CA, DM, hypothyroid), S/E of many drugs (verapamil, opioids, etc)
Outlet delay: Hirschsprung's dz
167
GERD is caused by the relaxation of the \_\_\_\_\_\_, which leads to gastric acid reflux, and ultimately ______ injury
lower esophageal sphincter
esophageal mucosal
168
Highest mortality from Hep E infection is during \_\_\_\_\_, especially in \_\_\_\_\_\_, with an increased incidence of fulminant hepatitis
pregnancy
3rd trimester
169
What is fulminant hepatitis?
Rapid liver failure + hepatic encephalopathy
170
During pregnancy with a baby with duodenal atresia, what is commonly seen?
Polyhydramnios (increased amniotic fluid)
171
What is the management for appendicitis?
Appendectomy (surgical removal)
172
Indirect inguinal hernias protrude at the (internal/external) inguinal ring
The origin of the sac is (lateral/medial) to the inferior epigastric artery
MC in what age groups?
MC in (men/women)
(Right/Left) sided more common
Internal
Lateral
young children & young adults
men
Right
173
Is GERD a clinical dx?
YES
174
What is the most common overall cause of gastroenteritis in adults?
What is its presence usually associated with environmentally?
Norovirus
outbreaks on cruise ships, at hospitals, and at restaurants
175
Hepatitis ____ is the only viral hepatitis associated with spiking a fever
A
176
What is the incubation period of enterotoxigenic E. coli?
What are some places/things a person might contract it from?
Clinical manifestations?
Management?
24-72 hours
unpeeled fruits, unsanitary drinking water/ice
abrupt onset of watery diarrhea, abd cramping, and vomiting
Fluids, bismuths, if severe can Rx fluoroquinolone
177
Where is McBurneys point?
joint 2/3 the distance from the navel to the anterior superior iliac spine
178
What is the classic triad for intussusception?
1. vomiting
2. abdominal pain
3. passage of blood per rectum "CURRANT JELLY STOOL" (stool mixed with blood and mucus)
