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Pediatric EOR > GI / Nutritional > Flashcards

GI / Nutritional Flashcards

1
Q

Most common causes of appendicitis

A
  1. Fecalith (MC)
  2. Inflammation
  3. Malignancy
  4. Foreign Body
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2
Q

Vomiting usually occurs ________ pain in appendicitis

A

After

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3
Q

RLQ with LLQ palpation

A

Rovsing Sign

Appendicitis

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4
Q

RLQ pain with internal and external hip rotation with flexed knee

A

Obturator Sign

Appendicitis

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5
Q

RLQ pain with right hip flexion/extension (right leg against resistance)

A

Psoas Sign

Appendicitis

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6
Q

Diagnosis for appendicitis

A
  1. CT scan
  2. Ultrasound
  3. Leukocytosis
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7
Q

Otherwise healthy infant aged 2-3 months seems to be in pain, cries for more than 3 hours a day for more than 3 days a week, for more than 3 weeks

A

Colic

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8
Q

Severe paroxysmal crying that occurs mainly in late afternoon

A

Colic

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9
Q

Transient relaxation of LES leading to esophageal mucosal injury

A

GERD

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10
Q

Complications of GERD (4)

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
  4. Esophageal carcinoma
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11
Q

Sign/symptoms of GERD

A
  1. Heartburn (hallmark) - sometimes retrosternal and postprandial
  2. Regurgitation (acidic taste)
  3. Dysphagia, cough at night
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12
Q

Alarm symptoms of GERD

A
  1. Dysphagia
  2. Odynophagia
  3. Weight loss
  4. Bleeding (suspect malignancy)
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13
Q

Diagnosis of GERD

A

Clinical diagnosis

  1. Endoscopy often first
  2. Esophageal manometry
  3. 24 hour ambulatory pH monitoring - gold standard
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14
Q

Lifestyle modifications for GERD

A 
Elevation of head of bed by six inches
Avoid recumbency for three hours after eating
Eat small meals
Avoid certain foods
Decrease fat and EtOH intake
Weight loss
smoking cessation
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15
Q

Pharmacological therapy for GERD

A
  1. Antacids and OTC H2 receptor antagonists
  2. PPI and prokinetic agents (cisapride)
  3. Nissen fundoplication if refractory
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16
Q

Dyssynergic defecation, slow transit, and IBS-constipation type

A

Primary causes of constipation

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17
Q

DM, hypothyroid, hypercalcemia, intestinal mass, Parkinson’s disease, anal stricture, and medications

A

Secondary causes of constipation

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18
Q

Alarm symptoms of constipation

A
  1. Hematochezia
  2. Weight loss
  3. Fam hx of colon CA
  4. Anemia
  5. Heme positive stools
  6. Severe persistent constipation
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19
Q

Diagnosis of constipation

A
  1. Rectal exam - r/o masses, fissures, sphincter tone

2. Colonoscopy if alarm sx

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20
Q

Treatment of constipation

A
  1. Increase fluids, exercise, develop bowel pattern
  2. Fiber of 25 g daily
  3. Bulk/osmotic laxatives
  4. Prunes are an alternative
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21
Q

Hypertrophy and hyperplasia of the muscular layers of the pylorus

A

Pyloric Stenosis

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22
Q

Most common cause of intestinal obstructioni n infancy

A

Pyloric stenosis

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23
Q

95% of pyloric stenosis present in the first ___________ of life, and the condition rarely presents after ____________

A

3-12 weeks

> 6 months

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24
Q

Physical exam signs of pyloric stenosis

A

Signs of dehydration/malnutrition
Hypochloremic metabolic acidosis
Jaundice
Olive-shaped, nontender, mobile, hard pyloric

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25
Q

Diagnosis of pyloric stenosis

A
  1. Ultrasound - first line

2. Upper GI contrast (string sign)

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26
Q

Treatment of pyloric stenosis

A
  1. Rehydration

2. PYloromyotomy

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27
Q

Intestinal segment invaginates/telescopes into adjoining intestinal lumen, leading to bowel obstruction

A

Intussusception

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28
Q

Most patients with intussusception are between ______________ of age

A

6-18 months

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29
Q

Intussusception most commonly occurs at the:

A

Ileocolic junction

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30
Q

Intussusception often occurs after:

A

Viral infection

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31
Q

Lead points for intussusception

A
  1. Meckel diverticulum
  2. Enlarged mesenteric lymph node
  3. Hyperplasia of peyer’s patches
  4. Benign/malignant tumor
  5. Henoch-schonlein purpura
  6. Foreign body
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32
Q

Classic triad of intussusception

A
  1. Vomiting
  2. Abdominal pain
  3. Passage of blood per rectum “currant jelly stool”
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33
Q

Physical exam of intussusception

A

“Dance’s Sign”

Sausage-shaped mass in RUQ or hypochondrium and emptiness in RLQ

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34
Q

Diagnosis of intussusception

A

Barium contrast enema (often diagnostic and therapeutic)

Radiographs - lack of gas in the bowels

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35
Q

Management of intussusception

A

Barium or air insufflation
Hydration (IV fluids)
Surgical resection if refractory

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36
Q

Congenital absence of ganglion cells leading to functional obstruction

A

Hirschsprung disease

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37
Q

Hirschsprung disease occurs most commonly in the:

A

Distal colon and rectum (75%)

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38
Q

Increased incidence of hirschsprung disease in:

A

Males and down syndrome

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39
Q

Pathophysiology behind hirschsprung disease

A
  1. Absence of enteric ganglion cells: failure of complete neural crest migration
  2. Functional obstruction due to failure of relaxation of aganglionic segment.
  3. Enterocolitis - vomiting, diarrhea signs of toxic megacolon
40
Q

Signs/symptoms of hirschsprung disease

A
  1. Neonatal intestinal obstruction - failure of meconium passage > 48 hours
  2. Bilious vomiting, abdominal distention, failure to thrive
  3. Enterocolitis - vomiting, diarrhea, signs of toxic megacolon
  4. Chronic constipation
41
Q

Diagnosis of hirschsprung disease

A
  1. Anorectal manometry - lack of relaxation of internal sphincter with balloon rectal distention. Often used as initial screening test
  2. Contrast enema
  3. Abdominal radiographs
  4. Rectal biopsy - definitive - shows absence of ganglion cells
42
Q

Management of hirschsprung disease

A

Surgical resection of the affected bowel

43
Q

Repeated passage of stool into inappropriate places by child chronologically or developmentally > 4 years

A

Encopresis

44
Q

> 90% of cases of encopresis result from

A

Constipation

45
Q

Diagnosis of encopresis

A

Rectal exam

Abdominal XR

46
Q

Treatment of encopresis

A

Oral laxatives or enema
Treatment can be monitored by abdominal XRs
Establish bowel regimen

47
Q

Inflammation of the liver caused by 5 different viruses

A

Viral hepatitis

48
Q

Hepatitis __, __, and __ are transmitted through bodily fluids, while __ and __ are transmitted through the fecal-oral route

A

BCD

AE

49
Q

Hepatitis __ requires co-infection with hepatitis __

A

D

B

50
Q

Signs/symptoms of viral hepatitis

A
  1. Fever, fatigue
  2. N/V
  3. Abd pain
  4. Dark discolored urine (secondary to conjugated hyperbilirubinemia)
  5. Jaundice
51
Q

Hepatitis __ and __ will usually be asymptomatic

A

B and C

52
Q

Diagnosis of hepatitis

A
  1. Elevated LFTs
  2. Elevated PT (if developed cirrhosis)
  3. Antibody testing (IgM and IgG)
53
Q

In hepatitis testing, __ is for acute infection and __ is for chronic infection

A

IgM
IgG
This does not apply to Hep B and Hep C

54
Q

Test for check for active Hepatitis C infection

A

Hep C virus RNA

55
Q

If there is positive Hep C antibody, but negative RNA

A

Pt has cleared Hep C infection

56
Q

If there is positive Hep C antibody and positive Hep C RNA

A

Pt has active Hep C infection

57
Q

Hepatitis B screening:

  1. HbsAg (-)
  2. anti-HBc (-)
  3. anti-HBs (-)
A

Hepatitis B susceptible

58
Q

Hepatitis B screening:

  1. HbsAg (-)
  2. anti-HBc (+)
  3. anti-HBs (+)
A

Immune due to natural infection

59
Q

Hepatitis B screening

  1. HbsAg (-)
  2. anti-HBc (-)
  3. anti-HBs (+)
A

Immune due to vaccination

60
Q

Hepatitis B screening:

  1. HbsAg (+)
  2. anti-HBc (+)
  3. IgM anti-HBc (+)
  4. anti-HBs (-)
A

Acutely infected

61
Q

Hepatitis B screening:

  1. HbsAg (+)
  2. anti-HBc (+)
  3. IgM anti-HBc (-)
  4. anti-HBs (-)
A

Chronically infected

62
Q

Treatment for hepatitis A and E

A

Self-resolve, are not associated with chronic liver disease

63
Q

Treatment for acute hepatitis B

A

Supportive care

64
Q

Treatment for chronic hepatitis B or positive e-antigen

A

Interferon or Nucleoside analogs (entecavir, tenofovir, lamivudine, adefovir, telbivudine)

65
Q

Treatment for hepatitis pts with cirrhosis

A

Transplant required

66
Q

Treatment for hepatitis C

A

Ledipasvir-sofosbuvir OR sofosbuvir and velpatasvir

67
Q

Usually due to increased indirect (unconjugated) bilirubin (the immature liver of a newborn is unstable to efficiently conjugate bilirubin due to decreased UGT enzyme activity)

A

Jaundice

68
Q

Increased indirect bilirubin may be physiologic or pathologic. However, increased direct is always ________

A

Pathologic

69
Q

Bilirubin > 20 mg/dL can lead to:

A

Kernicterus and neurotoxicity

70
Q

Cerebral dysfunction and encephalopathy as a result of bilirubin deposition in the brain tissues (seizures, lethargy, irritability, hearing loss and mental development disorders). Infants are at risk when bilirubin is > ________

A

Kernicterus

> 20-25 mg/dL

71
Q

Management of jaundice in newborns

A

Phototherapy used in all types

Exchange transfusion used in severe cases, ABO incompatibility, RH isoimmunization and hemolysis

72
Q

Complete absence of closure of portion of duodenum leading to gastric outlet obstruction

A

Duodenal atresia

73
Q

Signs/symptoms of duodenal atresia

A

Intestinal obstruction shortly after birth, leading to abdominal distention and bilious vomiting

74
Q

Diagnosis of duodenal atresia

A

Abd XR - causes the double bubble sign

75
Q

Treatment of duodenal atresia

A

Decompression of GI tract - NG tube
Fluid replacement
Surgical repair

76
Q

Hernia that occurs lateral to the inferior epigastric artery

A

Indirect inguinal hernia

77
Q

Indirect hernias are often congenital and occur due to a __________ _________ _________ ___________

A

Persistent patent process vaginalis

78
Q

Most common overall type of hernias in women and men

A

Indirect inguinal hernia

79
Q

Hernia that occurs medial to the inferior epigastric arteries within Hesselbach’s triangle

A

Direct inguinal hernia

80
Q

Signs/symptoms of a strangulated hernia

A

Incarcerated hernia with systemic toxicity. Compromised blood supply - ischemic
Severely painful bowel movement

81
Q

Management of inguinal hernias

A

Often require surgical repair

Strangulated are surgical emergencies

82
Q

Management of umbilical hernias

A

Observation, will usually resolve by 2 years old

Surgical repair if still persistent in children > 5 y/o

83
Q

Niacin (Vitamin B3) deficiencies are often due to:

A

Diets high in corn or diets which lack tryptophan

84
Q

The three D’s of niacin deficiency:

A

Diarrhea
Dementia
Dermatitis

85
Q

Risk factors for vitamin A deficiency:

A

Patients with liver disease, EtOHics, fat free diets

86
Q

Signs/symptoms of vitamin A deficiency:

A
  1. Visual changes (night blindness), xerophthalmia (dry eyes)
  2. Impaired wound healing, dry skin, poor bone growth, taste loss
  3. Squamous metaplasia - Bitot’s spots
87
Q

Bitot’s Spots

A

White spots on the conjunctiva due to squamous metaplasia of the corneal epithelium
Vitamin A Deficiency

88
Q

Risk factors for vitamin C deficiency

A

Diets lacking raw fruits and green vegetables, smoking, alcoholism, malnourished individuals, elderly

89
Q

Signs/Symptoms of vitamin C deficiency

A

Scurvy (3 H’s):

  1. Hyperkeratosis
  2. Hemorrhage (vascular fragility)
  3. Hematologic - anemia, glossitis, malaise, weakness
90
Q

Risk factors for vitamin D deficiency

A

Breastfeeding without vitamin D supplementation

Lack of fortified milk or sun exposure

91
Q

Signs/symptoms of vitamin D deficiency

A
  1. Rickets - bowed legs, fractures, costochondral thickening, dental problems
  2. Osteomalacia (adults): body pains, muscle weakness
92
Q

Management of vitamin D deficiency

A

Ergocalciferol (vitamin D)

93
Q

Loose stools, abdominal pain, and flatulence after ingestion of milk or milk containing products

A

Lactose intolerance

94
Q

White children typically develop signs/symptoms of lactose intolerance ____________ hispanics or blacks

A

After

95
Q

Diagnosis of lactose intolerance

A

Hydrogen breath test - hydrogen produced when colonic bacteria ferment undigested lactose
Usually performed after trial of lactose free diet

96
Q

Treatment of lactose intolerance

A

Lactase enzyme preparations
Lactaid - prehydrolyzed mlk
Lactose free diet

Pediatric EOR (10 decks)

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