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EOR - Pediatrics (Alice copy + Seth's) > GI (Seth's Additional info) (10%) > Flashcards

GI (Seth's Additional info) (10%) Flashcards

1
Q

MCC of appendicitis in kiddos

A

lymphoid hyperplasia d/t infection

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2
Q

when does vomitting happen with appendicitis?

A

AFTER pain (as a result of the pain basically)

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3
Q

when does pain from appendicits radiate to the RLQ?

A

Once the parietal peritoneum becomes irritated

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4
Q

Explain obturator sign

A

RLQ pain with internal & external hip rotation with flexed knee

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5
Q

explain psoas sign

A

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

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6
Q

Imaging of choice for appendicitis in kiddos

A

US

followed by surgical consult

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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

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8
Q

MC age of colic

A

< 3 months old

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9
Q

Management of colic

A

Symptomatic as it goes away

Burping, proper feeding, exam to r/o other causes

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10
Q

Constipation is not having a bowel movement after ____ days or ____/week

A

3 days
or <2/week

or s/s of constipation

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11
Q

An outlet delay etiology for constipation makes you think of

A

Hirschsprung’s disease

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12
Q

Overview of management of constipation

A

Fiber, water, bulk forming laxatives, osmotic laxatives, stimulant laxatives

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13
Q

MOA of fiber

A

retains water & improves GI transit

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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

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15
Q

MOA of bulk forming laxatives

A

absorbs water & increases fecal mass –↑ frequency & softens the stool consistency w/ minimal effects

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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+

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17
Q

MOA of osmotic laxatives

A

causes H2O retention in the stool (osmotic effect pulls H2O into gut)

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18
Q

What are the stimulant laxatives?

A

Bisacodyl, Senna

busy senna is stimulated

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19
Q

MOA of stimulant laxatives

A

increases acetylcholine-regulated GI motility (peristalsis) & alters electrolyte transport in the mucosa

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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

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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

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22
Q

cap refill for the following lvls of dehydration
mild:
mod:
sev:

A

mild: <2 seconds
mod: 2-3 seconds
sev: 3+ seconds

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23
Q

what is the double bubble sign seen in

A

Duodenal Atresia

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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

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25
Q

what is the presentation of duodenal atresia upon birth?

A

bilious vomitting paired with abd distension

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26
Q

diagnosis of duodenal atresia

A

abd xray showing double bubble

upper GI series preop to assess GI tract

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27
Q

what is the structure that seperates bilious from nonbilious vomitting?

A

Ampulla of vater

of the descending duodenum

at or distal = bilious

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28
Q

what exactly is the double bubble sign?

A

distended air-filled stomach + smaller
distended duodenum separated by the pyloric valve

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29
Q

Intial management of duodenal atresia

A

decompression of GI tract + electrolyte and fluid replacement

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30
Q

definitive mng of duodenal atresia

A

Duodenoduodenostomy

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31
Q

what is encopresis?

A

Repeated passage of feces into inappropriate places (clothing or floor) whether involuntary or intentional

typically d/t anx causing overflow incontinence from chronic constipation

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32
Q

minimum requirement to be dx with encopresis
age
frequency

A

4+ yo
once a month for 3 months

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33
Q

is encopresis mc in males or females

A

males

associated with ADHD and conduct d/order

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34
Q

Mng of encopresis

A

behavorial and r/u other etioligies

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35
Q

MC age for FB ingestion

A

6 months - 3 yo

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36
Q

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

A

esophagus

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37
Q

imaging for inhaled FB

A

bronchosopy if not seen on xray

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38
Q

mng of FB in esophagus with no s/s and known time of ingestion

A

1) observe for 24 hr with serial xray
2) remove obj with endoscopy if it does not pass into the stomach by 24 hours

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39
Q

what point should a FB be immediately removed with endoscopy (4)?
____ time of ingestion
____ s/s
the object is a ___ or _____

A

1) unknown time of ingestion
2) ANY s/s
3) battery
4) sharp obj

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40
Q

when would you NOT need to remove a battery ASAP?

A

if it is distal to the pylrous (in the small intestine basically)

same for any obj

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41
Q

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

A

21-28 days (3-4 weeks)

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42
Q

if an obj is this size ___ it should be removed endoscopically if in the stomach

A

> 3 cm

monitor w/ serial imaging if beyond pylorus

same management as a sharp obj!

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43
Q

t/f you should induce emesis immediately if a patient consumed acid/alkali

A

FALSE

ABCs

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44
Q

Abrupt onset of watery non-bloody diarrhea, abdominal cramping, vomiting

A

E coli

probs traveling

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45
Q

MCC of gastroenteritis in adults in NA

A

norovirus

fecal-oral and just hydrate

dem cruiseships

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46
Q

t/f although vomitting is common, the predominant symptom for norovirus is diarrhea

A

FALSE

vomitting is

diarrhea non-bloody, watery, and no leukocytes

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47
Q

Rotavirus is MC in

A

young unimmunized children between 6 months – 2 years of age

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48
Q

MC outbreak of rotovirus

A

daycare

common cause of diarrhea outbreak here

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49
Q

why do we vaccinate for rotovirus?

A

more severe s/s in childhood (still nonbloody diarrhea)

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50
Q

dx of rotovirus

A

PCR

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51
Q

common food ingested that cause staph GE

A

think dairy/eggs at room temp

egg salad picnic = buzz phrase

dairy, mayo, meat, egg, salad

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52
Q

MC symptom of staph poisoning

A

vomitting

somtimes diarrgea

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53
Q

Abx treatment of staph poisoning

A

NONE

symptomatic fluid replacement

gottem ;)

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54
Q

MCC of traveler’s diarrhea

A

E coli

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55
Q

how do you typically get an E coli poisoning?

A

Contaminated food & water

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56
Q

dx of e coli GE

A

Gram-stain & cultures

it’s a bacterium

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57
Q

MCC of bacterial enteritis

A

Campylobacter Enteritis

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58
Q

ricewater stools

A

V cholerae

copious watery diarrhea = “rice water stools” (gray with flecks of
mucus & has a “fishy odor” but no fecal odor, blood or pus)

59
Q

V cholerae GE is gram ____

A

negative

60
Q

what typically causes a v cholera outbreak

A

contaminate food/water (shellfish)
poor sanitation and overcrowding

61
Q

Pathophys of v cholera

A

exotoxin causing secretory diarrhea leading to profound dehydration

62
Q

dx of v cholera GE

A

PCR or stool cultures

63
Q

typically mng of V cholera is symptomatic like most nonbloody diarrhea, but consider these abx:

A

tetracyclines (-cycline)

typically if severe illness, comorbid conditions, or high fever

64
Q

MCC of death from seafood consumption in US

A

V. vulnificus: gastroenteritis, necrotizing fasciitis, cellulitis

65
Q

test of choice for C diff

A

C. difficile toxin (stool)

66
Q

what might sigmoidoscopy show for c dif?

A

psedomembranosus

67
Q

apart from vanc, ___ can be used for c dif

A

metroniadozle (flagyl)

68
Q

the go to for recurrence of c dif is vanc, but after ____ recurrences, consider _____

A

3 recurrences
fecal microbiota transplant

69
Q

this GE mimics appendicitis

A

Yersinia Enterocolitica

your son has appendicitis

70
Q

MCC of Yersinia Enterocolitica

A

contaminated pork
poultry

71
Q

complication of Yersinia Enterocolitica

A

mesenteric lymphadenitis

72
Q

treatment of Yersinia Enterocolitica

A

Fluid & electrolyte replacement mainstay of treatment

Severe: Fluoroquinolones, Bactrim

73
Q

MC antecedent event in post-infectious Guillain-Barre syndrome

A

Campylobacter Enteritis

camping near the bar

74
Q

MCC of Campylobacter Enteritis

A

eating undercooked turkey

75
Q

upon stool culture of Campylobacter Enteritis, you will see oragnisms with this buzzword

A

gram-negative, “S, comma or seagull shaped” organisms

76
Q

mainstay of mng of Campylobacter Enteritis like most diarrhea is fluid replacement - but consider these abx

A

erythromycin

my son is camping

77
Q

what bacterial GE can lead to GI hemorrage?

A

in the name
Enterohemorrhagic E. Coli O157:H7

78
Q

MC age of Enterohemorrhagic E. Coli O157:H7

A

extremes of age (old/young)

79
Q

Abx for Enterohemorrhagic E. Coli O157:H7 are ____

A

CONTRAINDICATED

may lead to HUS d/t release of shiga-like toxins

only Bactrim is an option, but firstline is **fluid replacement **

80
Q

pea soup diarrhea is seen in ___
also, you often see _____ in this condition

A

typhoid/ enteric fever

rose spots/ salmon colored spots from trunk to extremeitis

green and non-bloody paired with bradycardia and fever

81
Q

Abx for typhoid fever are

A

-floxacin

oral rehydration is the go to

82
Q

MCC of foodborne disease in US

A

nontyphoid salmonella

83
Q

classic diarrhea of salmonella

A

also peasoap (more brown/green though and may be bloody)

84
Q

MC type of shigellosis seen in US

A

Shigella sonnei

fecal oral and highly virulent

85
Q

How does shigella affect the host

A

Highly virulent - “Shiga” toxin that is neuro, entero, and cytotoxic

fecal oral

86
Q

Explain the classic s/s of a shigella infection

A

Lower abd pain
explosive watery diarrhea that progress to mucoid and bloody
febrile seizures

87
Q

classic CBC finding of shigella

A

Leukemoid reaction showing WBC > 50k

88
Q

treatment of shigella

A

like everything, fluids + electrolytes and abx if severe

89
Q

what is heartburn aka?

A

pyrosis

90
Q

gs dx of typical GERD

A

24-hour ambulatory pH monitoring

91
Q

gs dx of GERD with alarm symptoms

A

endoscopy

92
Q

MC sex for autoimmune hep

A

female

young women

93
Q

Autoantibody findings of autoimmune hep type 1

A

positive ANA and smooth muscle antibodies

94
Q

Autoantibody findings of autoimmune hep type 2

A

anti-liver/kidney microsomal antibodies,
increased IgG

95
Q

treatment of autoimmune hep

A

Corticosteroids 1st line

also can do: CS + Azathioprine, or 6-Mercaptopurine

96
Q

suddenly, your patient has jaundice, URI symptoms, and a decreased desire to smoke - you are thinking ____ so you decide to treat with _____

A

Acute viral hep
Conservative mng

97
Q

what type of condition is Rey’s syndrome and what is the typical history?

A

fulminant hepatitis in children given ASA after a viral infection

98
Q

explain the s/s of Rey’s syndrome

A

rash of hands + feet
vomiting
liver dmg
encepholpathy
dilated pupils
multi organ failure
hypoglycemia (hepatic gluconeogensis)
increased ammonia (encepholapthy)

99
Q

treatment of reye syndrome

A

symptomatic

definitive = liver transplant

100
Q

Hirschsprung Disease is a congenital _____ d/t absence of ____, leading to a functional obstruction

A

megacolon
ganglion cells

101
Q

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

A

neural crest
enteric ganglion cells

102
Q

what is a key finding of Hirschsprung Disease during the first couple days of life?

A

Neonatal intestinal obstruction: meconium ileus (failure of meconium passage 48+ hours) in a full-term infant

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
Q

What does a contrast enema show for Hirschsprung Disease?

A

transition zone (caliber change) between normal & affected bowel

helpful for sx planning

104
Q

what can you use as a screening test for Hirschsprung Disease and what does it show?

A

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
Q

definitive dx of Hirschsprung Disease

A

rectal biopsy

106
Q

mng for Toxic Megacolon

A

bowel rest, bowel decompression w/ NG tube, broad-spectrum antibiotics (Ceftriaxone + Metronidazole),
fluid & electrolyte replacement

107
Q

what type of hernia is most often d/t a patent process vaginalis?

A

indirect inguinal

108
Q

Hessel bach’s triangle is associated with a ___ hernia and is comprised of _____

A

direct inguinal hernia
RIP
rectus abdominus
inferior epigastric vessels
pouparts (inguinal) ligament

109
Q

when is surgical repair indicated for congenital umbilical hernia?

A

at 5+ yo
usually resolves by 2 yo

110
Q

MCC of bowel obstruction in children 6 months to 4 yo

A

intussception (telescoping of proximal intestinal segment into adjoining distal lumen → bowel obstruction)

111
Q

MC location of intussuception

A

ileocolic junction

112
Q

MC etiology of intussception

A

idiopathic

113
Q

Classic triad of intussception

A

vomiting + abdominal pain + passage of blood per rectum
“currant jelly” stools

114
Q

for intussception, on PE you feel a _____ shaped mass in the _________or hypochondrium

A

sausage-shaped
right upper quadrant

115
Q

what do you feel in the RLQ of intussecption and why?

A

emptiness (Dance’s sign)
d/t telescoping of bowel that is no longer there

116
Q

____ is the preferred intial test for intusseception which shows ____

A

US
donut/target sign

117
Q
A
118
Q

Pneomatic dilation and fluid/electrolyte correction is typically preferred for intussception, but _______ is diagnostic and theraputic

A

air or contrast anema

119
Q

what is normal, physiologic jaundice of a newborn

A

seen on days 3-5
decrease in UGT (enzyme that conjugates bilirubin)
breast milk / feeding jaundice - should still breast feed0

120
Q

when are you worried about pathologic jaundice?

A

within first 24 hours
persists 10-14+ days
increase in bilirubin daily

121
Q

what bilirubin lvl do you see jaundice?

A

5+

122
Q

what is kernicterus?

A

cerebral dysfunction and encephalopathy due to bilirubin deposition in brain tissue – can manifest as seizures,
lethargy, irritability, hearing loss, mental developmental delays

123
Q

what bilirubin lvl do you see kernicterus?

A

20+

124
Q

initial management of pathologic jaundice

A

phototherapy to conjugate the bilirubin

125
Q

Four Ds of Dubin Johnson syndrome

A

Dubin
Direct bilirubinemia (isolated)
Dark liver (dx)
Don’t need to treat (avoid triggers)

126
Q

Dubin Johnson syndrome is hyperbilirubinemia d/t decreased hepatocyte excretion of conjugated bilirubin d/t gene mutation _______.

A

MRP2

127
Q

Pathophys of Crigler-Najjar Syndrome and what type of bilirubin prob it leads to

A

no UGT activitiy leading to to uncongugated (indirect) hyperbilirubinemia

no mng needed

128
Q

inheritance of Crigler-Najjar Syndrome

A

autosomal recessive

spells CAR

129
Q

what is the difference between Gilbert Syndrome and Crigler-Najjar Syndrome

A

very sim, but there is just reduced UGT activity

transient episodes of jaundice during periods of stress, fasting, alcohol, or illness

130
Q

test of choice for lactose intolerance and what it shows and why

A

hydrogen breath test showing presents of hydrogen

hydrogen produced when colonic bacteria ferment the undigested lactose

131
Q

Abd US for pyloric stenosis

A

“double-track”

132
Q

barium GI series of pylroic stenosis (2)

A

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
Q

what vitamin is niacin/nicotinic acid?

A

B3

134
Q

sources of niacin

A

meats
grains
legumes

135
Q

3 Ds of niacin deficiency

A

dermatitis (photosensitivity)
diarrhea
dementia

136
Q

overall functin of vitamin A

A

HIVES

Hematopoiesis
Immune function
Vision
Embryo dev
Skin/cellular health

137
Q

Sources of vit A

A

Kidney/liver
Yolk
Leafing greens

138
Q

common presentation of vitamin A def

A

Night blindness (or other ocular manifestation)
Impaired immunity
Squamous metaplasia
Bilot’s spots

think of HIVES

139
Q

What are bilot’s spots?

A

white spots on the conjunctiva due to squamous metaplasia of the corneal epithelium

assocaited with metaplasia 2ndary to vit A def

140
Q

3 H’s of scurvy (vit C def)

A

Hyperkeratosis (hairs with hemorrage)
Hemorrhage: vascular fragility of gums/skin/wound
Hematologic: anemia/ etc

141
Q

most accurate dx of vit C def

A

Leukocyte ascorbic levels more accurate than serum ascorbic acid

142
Q

Ricket’s is vit ___ def

A

D

143
Q

presentation of Vit D def leading to osteomalacia

A

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
Q

presentation of Vit D def leading to rickets

A

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 enlargament
long bones with** fuzzy cortex**
decreased calcium/ phosphate / 25-hydroxyvitamin D levels
Vit D supplementation with (Ergocalciferol)

EOR - Pediatrics (Alice copy + Seth's) (22 decks)

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