GI (Seth's Additional info) (10%) Flashcards
1
Q
MCC of appendicitis in kiddos
A
lymphoid hyperplasia d/t infection
2
Q
when does vomitting happen with appendicitis?
A
AFTER pain (as a result of the pain basically)
3
Q
when does pain from appendicits radiate to the RLQ?
A
Once the parietal peritoneum becomes irritated
4
Q
Explain obturator sign
A
RLQ pain with internal & external hip rotation with flexed knee
5
Q
explain psoas sign
A
RLQ pain with right hip flexion/extension (raise leg against resistance)
6
Q
Imaging of choice for appendicitis in kiddos
A
US
followed by surgical consult
7
Q
what is colic 2ndary to GI problem? When is there relief?
A
Sudden onset of loud crying (paroxysms may persist for several hours) with facial flushing & circumoral pallor
* Abdomen is distended, tense – legs drawn up
* Temporary relief with passage of feces or flatus
8
Q
MC age of colic
A
< 3 months old
9
Q
Management of colic
A
Symptomatic as it goes away
Burping, proper feeding, exam to r/o other causes
10
Q
Constipation is not having a bowel movement after ____ days or ____/week
A
3 days
or <2/week
or s/s of constipation
11
Q
An outlet delay etiology for constipation makes you think of
A
Hirschsprung’s disease
12
Q
Overview of management of constipation
A
Fiber, water, bulk forming laxatives, osmotic laxatives, stimulant laxatives
13
Q
MOA of fiber
A
retains water & improves GI transit
14
Q
What are the bulk forming laxatives?
A
Think the names of things that are bulky (wheat/sugar names)
Psyllium, Methylcellulose, Polycarbophil, Wheat dextran
15
Q
MOA of bulk forming laxatives
A
absorbs water & increases fecal mass –↑ frequency & softens the stool consistency w/ minimal effects
16
Q
What are the osmotic laxatives?
A
polyethylene glycol (PEG, mirilax), lactulose, sorbitol, saline laxatives (milk of magnesia, magnesium citrate)
can cause hyperMg
think milk / mg2+
17
Q
MOA of osmotic laxatives
A
causes H2O retention in the stool (osmotic effect pulls H2O into gut)
18
Q
What are the stimulant laxatives?
A
Bisacodyl, Senna
busy senna is stimulated
19
Q
MOA of stimulant laxatives
A
increases acetylcholine-regulated GI motility (peristalsis) & alters electrolyte transport in the mucosa
20
Q
all of the laxatives may cause bloating/flatulence, but stimulant lax (busy senna) may cause ____
A
diarrhea
think of the MOA of increasing gut transit
21
Q
what is the % bw loss of the following lvls of dehydration?
mild:
mod:
severe:
A
mild: 3-5%
mod: 6-9%
severe: 10%+
memorize mod, then the others are just above or below
22
Q
cap refill for the following lvls of dehydration
mild:
mod:
sev:
A
mild: <2 seconds
mod: 2-3 seconds
sev: 3+ seconds
23
Q
what is the double bubble sign seen in
A
Duodenal Atresia
24
Q
what is the pathophy of duodenal atresia?
A
complete abscence or closure of a portion of the duodenum, leading to a gastric outlet obstruction
25
what is the presentation of duodenal atresia upon birth?
**bilious vomitting** paired with abd distension
26
diagnosis of duodenal atresia
abd xray showing double bubble
## Footnote
upper GI series preop to assess GI tract
27
what is the structure that seperates bilious from nonbilious vomitting?
**Ampulla of vater**
| of the descending duodenum
## Footnote
**at or distal = bilious**
28
what exactly is the double bubble sign?
distended **air-filled stomach** + **smaller
distended duodenum** separated by the pyloric valve
29
Intial management of duodenal atresia
decompression of GI tract + electrolyte and fluid replacement
30
definitive mng of duodenal atresia
Duodenoduodenostomy
31
what is encopresis?
Repeated passage of feces into inappropriate places (clothing or floor) whether involuntary or intentional
## Footnote
typically d/t anx causing overflow incontinence from chronic constipation
32
minimum requirement to be dx with encopresis
age
frequency
4+ yo
once a month for 3 months
33
is encopresis mc in males or females
males
## Footnote
associated with ADHD and conduct d/order
34
Mng of encopresis
behavorial and r/u other etioligies
35
MC age for FB ingestion
6 months - 3 yo
36
once beyond the ____ objects typically pass but with an increased risk of complications such as bowel obstruction,
perforation, erosion to adjacent organs – abdominal pain, N/V, fever, hematochezia, melena
esophagus
37
imaging for inhaled FB
bronchosopy if not seen on xray
38
mng of FB in esophagus with no s/s and known time of ingestion
1) observe for 24 hr with serial xray
2) remove obj with endoscopy if it does not pass into the stomach by 24 hours
39
what point should a FB be immediately removed with endoscopy (4)?
____ time of ingestion
____ s/s
the object is a ___ or _____
1) unknown time of ingestion
2) ANY s/s
3) battery
4) sharp obj
40
when would you NOT need to remove a battery ASAP?
if it is **distal to the pylrous** (in the small intestine basically)
## Footnote
same for any obj
41
an asympomatic small blunt obj in stomach should be monitored for ___ days but should be removed if it does not pass the pylorus by then
21-28 days (**3-4 weeks**)
42
if an obj is this size ___ it should be removed endoscopically if in the stomach
> 3 cm
| monitor w/ serial imaging if beyond pylorus
## Footnote
same management as a sharp obj!
43
t/f you should induce emesis immediately if a patient consumed acid/alkali
FALSE
## Footnote
ABCs
44
Abrupt onset of watery non-bloody diarrhea, abdominal cramping, vomiting
E coli
## Footnote
probs traveling
45
MCC of gastroenteritis in adults in NA
norovirus
| fecal-oral and just hydrate
## Footnote
dem cruiseships
46
t/f although vomitting is common, the predominant symptom for norovirus is diarrhea
FALSE
| vomitting is
## Footnote
diarrhea non-bloody, watery, and no leukocytes
47
Rotavirus is MC in
young **unimmunized** children between 6 months – 2 years of age
48
MC outbreak of rotovirus
daycare
## Footnote
common cause of diarrhea outbreak here
49
why do we vaccinate for rotovirus?
more severe s/s in childhood (still nonbloody diarrhea)
50
dx of rotovirus
PCR
51
common food ingested that cause staph GE
think dairy/eggs at room temp
| egg salad picnic = buzz phrase
## Footnote
**dairy, mayo, meat, egg, salad**
52
MC symptom of staph poisoning
vomitting
## Footnote
somtimes diarrgea
53
Abx treatment of staph poisoning
NONE
| **symptomatic** fluid replacement
## Footnote
gottem ;)
54
MCC of traveler's diarrhea
E coli
55
how do you typically get an E coli poisoning?
Contaminated food & water
56
dx of e coli GE
Gram-stain & cultures
## Footnote
it's a bacterium
57
MCC of bacterial enteritis
Campylobacter Enteritis
58
ricewater stools
V cholerae
## Footnote
copious watery diarrhea = “rice water stools” (gray with flecks of
mucus & has a “fishy odor” but no fecal odor, blood or pus)
59
V cholerae GE is gram ____
negative
60
what typically causes a v cholera outbreak
contaminate food/water (**shellfish**)
**poor sanitation and overcrowding**
61
Pathophys of v cholera
exotoxin causing secretory diarrhea leading to profound dehydration
62
dx of v cholera GE
PCR or stool cultures
63
typically mng of V cholera is symptomatic like most nonbloody diarrhea, but consider these abx:
tetracyclines (-cycline)
## Footnote
typically if severe illness, comorbid conditions, or high fever
64
MCC of death from seafood consumption in US
V. vulnificus: gastroenteritis, necrotizing fasciitis, cellulitis
65
test of choice for C diff
C. difficile toxin (stool)
66
what might sigmoidoscopy show for c dif?
psedomembranosus
67
apart from vanc, ___ can be used for c dif
metroniadozle (flagyl)
68
the go to for recurrence of c dif is vanc, but after ____ recurrences, consider _____
3 recurrences
fecal microbiota transplant
69
this GE mimics appendicitis
Yersinia Enterocolitica
## Footnote
your son has appendicitis
70
MCC of Yersinia Enterocolitica
**contaminated pork**
poultry
71
complication of Yersinia Enterocolitica
mesenteric lymphadenitis
72
treatment of Yersinia Enterocolitica
**Fluid & electrolyte replacement mainstay** of treatment
**Severe**: Fluoroquinolones, Bactrim
73
MC antecedent event in post-infectious Guillain-Barre syndrome
Campylobacter Enteritis
## Footnote
camping near the bar
74
MCC of Campylobacter Enteritis
eating undercooked turkey
75
upon stool culture of Campylobacter Enteritis, you will see oragnisms with this buzzword
gram-negative, “**S, comma or seagull shaped**” organisms
76
mainstay of mng of Campylobacter Enteritis like most diarrhea is fluid replacement - but consider these abx
**erythromycin**
## Footnote
my son is camping
77
what bacterial GE can lead to GI hemorrage?
in the name
**Enterohemorrhagic E. Coli O157:H7**
78
MC age of Enterohemorrhagic E. Coli O157:H7
extremes of age (old/young)
79
Abx for Enterohemorrhagic E. Coli O157:H7 are ____
**CONTRAINDICATED**
| may lead to HUS d/t release of shiga-like toxins
## Footnote
only Bactrim is an option, but firstline is **fluid replacement **
80
pea soup diarrhea is seen in ___
also, you often see _____ in this condition
typhoid/ enteric fever
| **rose spots/ salmon colored spots** from trunk to extremeitis
## Footnote
green and non-bloody paired with **bradycardia and fever**
81
Abx for typhoid fever are
-floxacin
## Footnote
oral rehydration is the go to
82
MCC of foodborne disease in US
nontyphoid **salmonella**
83
classic diarrhea of salmonella
also **peasoap** (more brown/green though and may be bloody)
84
MC type of shigellosis seen in US
Shigella sonnei
## Footnote
fecal oral and highly virulent
85
How does shigella affect the host
Highly virulent - “Shiga” toxin that is neuro, entero, and cytotoxic
## Footnote
fecal oral
86
Explain the classic s/s of a shigella infection
Lower abd pain
**explosive watery diarrhea that progress to mucoid and bloody**
febrile seizures
87
classic CBC finding of shigella
Leukemoid reaction showing **WBC > 50k**
88
treatment of shigella
like everything, fluids + electrolytes and abx if severe
89
what is heartburn aka?
pyrosis
90
gs dx of typical GERD
24-hour ambulatory pH monitoring
91
gs dx of GERD with alarm symptoms
endoscopy
92
MC sex for autoimmune hep
female
## Footnote
young women
93
Autoantibody findings of autoimmune hep type 1
positive ANA and smooth muscle antibodies
94
Autoantibody findings of autoimmune hep type 2
anti-liver/kidney microsomal antibodies,
increased IgG
95
treatment of autoimmune hep
Corticosteroids 1st line
## Footnote
also can do: CS + Azathioprine, or 6-Mercaptopurine
96
suddenly, your patient has jaundice, URI symptoms, and a decreased desire to smoke - you are thinking ____ so you decide to treat with _____
Acute viral hep
Conservative mng
97
what type of condition is Rey's syndrome and what is the typical history?
fulminant hepatitis in children given ASA after a viral infection
98
explain the s/s of Rey's syndrome
rash of hands + feet
vomiting
liver dmg
encepholpathy
dilated pupils
multi organ failure
hypoglycemia (hepatic gluconeogensis)
increased ammonia (encepholapthy)
99
treatment of reye syndrome
symptomatic
## Footnote
definitive = liver transplant
100
Hirschsprung Disease is a congenital _____ d/t absence of ____, leading to a functional obstruction
megacolon
ganglion cells
101
Hirschsprung Disease is a failure of complete____ migration leads to an absence of ________ (Auerbach & Meissner plexuses), which leads to failure of relaxation of the aganglionic segment & subsequent functional obstruction
neural crest
enteric ganglion cells
102
what is a key finding of Hirschsprung Disease during the first couple days of life?
Neonatal intestinal obstruction: meconium ileus (**failure of meconium passage 48+ hours**) in a full-term infant
## Footnote
leads to Bilious vomiting, abdominal distention, no stool in rectal vault, failure to thrive
(Abdominal distention → decreased blood flow → deterioration of mucosal barrier → bacterial proliferation →..)
103
What does a contrast enema show for Hirschsprung Disease?
**transition zone** (caliber change) between normal & affected bowel
## Footnote
helpful for sx planning
104
what can you use as a screening test for Hirschsprung Disease and what does it show?
**Anorectal manometry**: as a screening test (measures anal sphincter pressure); **increased anal sphincter pressure & lack of relaxation of the internal sphincter** with balloon rectal distention
105
definitive dx of Hirschsprung Disease
rectal biopsy
106
mng for Toxic Megacolon
bowel rest, bowel decompression w/ NG tube, broad-spectrum antibiotics (Ceftriaxone + Metronidazole),
fluid & electrolyte replacement
107
what type of hernia is most often d/t a patent process vaginalis?
indirect inguinal
108
Hessel bach's triangle is associated with a ___ hernia and is comprised of _____
direct inguinal hernia
RIP
rectus abdominus
inferior epigastric vessels
pouparts (inguinal) ligament
109
when is surgical repair indicated for congenital umbilical hernia?
**at 5+ yo**
usually resolves by 2 yo
110
MCC of bowel obstruction in children 6 months to 4 yo
**intussception** (telescoping of proximal intestinal segment into adjoining distal lumen → bowel obstruction)
111
MC location of intussuception
ileocolic junction
112
MC etiology of intussception
idiopathic
113
Classic triad of intussception
vomiting + abdominal pain + passage of blood per rectum
“currant jelly” stools
114
for intussception, on PE you feel a _____ shaped mass in the _________or hypochondrium
sausage-shaped
right upper quadrant
115
what do you feel in the RLQ of intussecption and why?
emptiness (**Dance's sign**)
d/t telescoping of bowel that is no longer there
116
____ is the preferred intial test for intusseception which shows ____
US
donut/target sign
117
118
Pneomatic dilation and fluid/electrolyte correction is typically preferred for intussception, but _______ is diagnostic and theraputic
**air** or contrast **anema**
119
what is normal, physiologic jaundice of a newborn
seen on days 3-5
decrease in UGT (enzyme that conjugates bilirubin)
breast milk / feeding jaundice - should still breast feed0
120
when are you worried about pathologic jaundice?
within first 24 hours
persists 10-14+ days
increase in bilirubin daily
121
what bilirubin lvl do you see jaundice?
5+
122
what is kernicterus?
cerebral dysfunction and encephalopathy due to bilirubin deposition in brain tissue – can manifest as seizures,
lethargy, irritability, hearing loss, mental developmental delays
123
what bilirubin lvl do you see kernicterus?
20+
124
initial management of pathologic jaundice
phototherapy to conjugate the bilirubin
125
Four Ds of Dubin Johnson syndrome
Dubin
Direct bilirubinemia (isolated)
Dark liver (dx)
Don't need to treat (avoid triggers)
126
Dubin Johnson syndrome is hyperbilirubinemia d/t decreased hepatocyte excretion of conjugated bilirubin d/t gene mutation _______.
MRP2
127
Pathophys of Crigler-Najjar Syndrome and what type of bilirubin prob it leads to
no UGT activitiy leading to to uncongugated (indirect) hyperbilirubinemia
## Footnote
no mng needed
128
inheritance of Crigler-Najjar Syndrome
autosomal recessive
## Footnote
spells CAR
129
what is the difference between Gilbert Syndrome and Crigler-Najjar Syndrome
very sim, but there is **just reduced UGT activity**
## Footnote
transient episodes of jaundice during periods of stress, fasting, alcohol, or illness
130
test of choice for lactose intolerance and what it shows and why
hydrogen breath test showing presents of hydrogen
## Footnote
hydrogen produced when colonic bacteria ferment the undigested lactose
131
Abd US for pyloric stenosis
“double-track”
132
barium GI series of pylroic stenosis (2)
**String sign** (thin column of barium through narrow pyloric channel), delayed gastric
emptying
**Railroad track sign**: excess mucosa in the pyloric lumen → 2 columns of barium
133
what vitamin is niacin/nicotinic acid?
B3
134
sources of niacin
meats
grains
legumes
135
3 Ds of niacin deficiency
dermatitis (photosensitivity)
diarrhea
dementia
136
overall functin of vitamin A
HIVES
Hematopoiesis
Immune function
Vision
Embryo dev
Skin/cellular health
137
Sources of vit A
Kidney/liver
Yolk
Leafing greens
138
common presentation of vitamin A def
Night blindness (or other ocular manifestation)
Impaired immunity
Squamous metaplasia
Bilot's spots
## Footnote
think of HIVES
139
What are bilot's spots?
white spots on the conjunctiva due to squamous metaplasia of the corneal epithelium
## Footnote
assocaited with metaplasia 2ndary to vit A def
140
3 H's of scurvy (vit C def)
**Hyperkeratosis** (hairs with hemorrage)
**Hemorrhage**: vascular fragility of gums/skin/wound
**Hematologic**: anemia/ etc
141
most accurate dx of vit C def
**Leukocyte ascorbic levels** more accurate than serum ascorbic acid
142
Ricket's is vit ___ def
D
143
presentation of Vit D def leading to osteomalacia
BONE ISSUES
**asympomatic** at first, but then
**osteomalacia**
bone pain/tenderness
**bowing** of long bones
decreased calcium/ phosphate / 25-hydroxyvitamin D levels
XR: **looser lines **and **psedofractures**
treatment = vit D with (Ergocalciferol)
144
presentation of Vit D def leading to rickets
3 months - 3 yo (need a lot of Ca2+ at this age)
can be d/t phophate wasting (Fanconi syndrome)
**Delayed fontanel closure**
**genu varum** (lateral bowing of femur and tibia)
**XR costochondral junction enlargamen**t
long bones with** fuzzy cortex**
decreased calcium/ phosphate / 25-hydroxyvitamin D levels
**Vit D supplementation** with (Ergocalciferol)
