GIT Flashcards
Some abbreviations and their meaning
(GE) - Gastroesophageal reflux
(GER) - Uncomplicated gastroesophageal reflux
(ALTEs) - Apparent life-threatening events
(EoE) - Eosinophilic esophagitis
(APFED) - American Partnership for Eosinophilic Disorders
(POEM) - Per-oral endoscopic myotomy
(CrD) - Crohn disease
(ALF) Acute Liver Failure
What is Uncomplicated gastroesophageal reflux (GER) ?
GER) refers to recurrent postprandial spitting and vomiting in healthy infants that resolves spontaneously
When does infant GER usually resolve?
By 12-18 months
What is important to determine regarding vomited material in GER?
Does it contain bile.
If it does, this is important as it may be a symptom of intestinal obstruction
Symptoms of GER in infants
heartburn, regurgitation, mucosal complications
less common:
include failure to thrive, food refusal, pain behavior, GI bleeding, upper or lower airway-associated respiratory symptoms, or Sandifer syndrome.
Children with what diseases (5) are at increased risk of GERD and esophagitis?
asthma
cystic fibrosis
developmental handicaps
hiatal hernia
repaired trachoesophageal fistula
Some extra esophageal manifestations of GERD are (3)?
GERD has been linked to the occurrence of apnea or apparent life-threatening events (ALTEs),
although the majority of pathologic cases are not reflux associate
lower airway symptoms (asthma, pneumonnia, cough), dental erosions, Sandifer syndrome
Treatment of GERD (4)
85% spontaneously resolves
small feedings
PPIs and histamine-2 receptor antagonists
Antireflux surgery, if meds fail
Complications of GERD (3)
feeding dysfunction
esophageal stricture
anemia
Eosinophilic esophagitis (EoE)
a chronic immune-mediated inflammatory disorder of the esophagus, characterized by infiltration of eosinophils into the esophageal tissue
EoE symptoms
feeding dysfunction, dysphagia, esophageal food impaction, heartburn
EoE lab findings (4)
peripheral eosinophilia may or may not be present
mucosa is usually thickened or with fissures
esophagus is often sprinkled with pinpoint exudates that look like candida (but are eosinophils)
IgE may be elevated, but this is not diagnostic
EoE treatment (3)
dietary exclusion of allergens
steroids from inhaler
esophaheal dilation
Achalasia
distal esophageal obstruction and high resting pressure on the lower esophageal spinchter
Symptoms of achalasia
dysphagia, esophageal food impaction, weight loss, chronic cough and chronic pulmonary aspiration
Achalasia diagnosis
barium esophagram shows a dilated esophagus with a tapeerd beak at the GE junction
Caustic burns of the esophagus
after ingestion of lye or battery acid
Are esophageal injuries worse with acid or basic solutions?
Acidic substances typically lead to limited injury because of the small volume ingested due to the sour taste.
Conversely, the more benign taste of alkali ingestions may allow for larger volume ingestions, subsequent liquefactive necrosis that can lead to deeper mucosal penetration.
Treatment for caustic burns (2)
IV corticosteroids
3rd gen cephalosporins
Regarding foreign bodies, what needs to be removed immediately?
Esophageal button batteries must be removed emergently because of their ability to cause lethal injury.
Most common symptoms of ingestion of foreign body
dysphagia, odynophagia, drooling, regurgitation, and chest or abdominal pain
With larger batteries ________ and in younger children __________endoscopic evaluation with gastric batteries may still be considered in order to evaluate the esophagus for signs of injury and risk of aortoesophageal fistula.
> 20mm
< 5 years
Presence of a _________ on upper GI has been found to be associated with hiatal hernia in 96% of children and should increase the index of suspicion.
Schatzki ring
What is pyloric stenosis and what are its symptoms
Postnatal muscular hypertrophy of the pylorus
Progressive gastric outlet obstruction, nonbilious vomiting, dehydration, and alkalosis in infants younger than 12 weeks.
Pyloric stenosis
Postnatal muscular hypertrophy of the pylorus.
Classic lab finding of pyloric stenosis
hypochloremic alkalosis with potassium depletion
treatment of pyloric stenosis
Ramstedt pyloromyotomy - incision down to the mucosa alon the pyloric length
alternative is pyloromyotomy
Treatment of dehydration and electrolyte imbalance is mandatory before surgical treatment, even if it takes 24–48 hours.
most common causes of gastric and duodenal ulcer
Underlying severe illness, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common causes.
The first attack of acute H pylori gastritis may be accompanied by
vomiting and hematemesis.
gastric/duodenal ulcer diagnostics
Upper GI endoscopy is the most accurate diagnostic examination.
The typical endoscopic appearance of an ulcer is a white exudative base with erythematous margins
treatment of ulcer
and H pylori
H2 receptor antagonist and PPIs
adjunct therapy sucralfate
triple combination of amoxicillin, clarithromycin, and PPI.
Inflammatory bowel disease (IBD), a chronic relapsing inflammatory disease, is most commonly differentiated into _______ and _______.
Crohn disease and ulcerative colitis
Treatment of IBD
- Diet
- Aminosalicylates (ASA)
- Corticosteroids
- Immunomodulators: azathioprine (AZA),
- Antibiotics
- Biologicals
- Other agents
- Surveillance
Clinical findings of acute liver failure
Acute hepatitis with deepening jaundice.
Extreme elevation of AST and ALT.
Prolonged PT and INR.
Encephalopathy and cerebral edema.
Asterixis and fetor hepaticus.
In acute liver hepatitis, Without liver transplantation, mortality is approximately ___ in children.
50%
Acute liver hepatitis LAB
elevated serum bilirubin levels (usually > 15–20 mg/dL), sustained elevations of AST and ALT (> 3000 U/L), low serum albumin, hypoglycemia, and prolonged PT and INR. Blood ammonia levels become elevated, whereas blood urea nitrogen is often very low.
major prognostic factors in acute liver failure
The development of renal failure and depth of hepatic coma are major prognostic factors
Illnesses predisposing to secondary ulcers include…
central nervous system (CNS) disease,
burns,
sepsis,
multiorgan system failure,
chronic lung disease,
Crohn disease (CrD),
cirrhosis, and
rheumatoid arthritis.
For severe or recurrent ulcerations not caused by H pylori, stress, or medications, a serum gastrin level may be considered to evaluate for…
a gastrin- secreting tumor (Zollinger-Ellison syndrome), though mild to moderate elevation in gastrin levels can be seen with use of PPI drugs.
Some complications of Crohn disease
Nutritional complications from chronic active disease, malabsorption, anorexia, protein-losing enteropathy, bile salt malabsorption, or secondary lactose intolerance include failure to thrive, short stature, decreased bone mineralization, and specific nutrient deficiencies, including iron, calcium, zinc, vitamin B12, and vitamin D.
Growth failure is more common in CrD than UC : True or False
True
Acute Liver Failure (ALF) is defined as …
Acute Liver Failure (ALF) is defined as acute liver dysfunction associated with significant hepatic synthetic dysfunction evidenced by a vitamin K–resistant coagulopathy (INR > 2.0) within 8 weeks after the onset of liver injury.
____________and _________are seen before the onset of encephalopathy.
Hyper-reflexia and positive extensor plantar responses are seen before the onset of encephalopathy.
_and _________are seen before the onset of encephalopathy.
signs and symptoms of acute liver failure
Children may present with flu-like symptoms, including malaise, myalgias, jaundice, nausea, and vomiting. Tender hepatomegaly is common, which may be followed by progressive shrinking of the liver, often with worsening hepatic function.
Treatment of acute liver failure
Excellent critical care is paramount, including careful management of hypoglycemia, bleeding and coagulopathy, hyperammonemia, cerebral edema, and fluid balance, while systematically investigating for potentially treatable causes.
Spontaneous survival may occur in up to 50% of patients.
Liver transplant may be lifesaving in patients without signs of spontaneous recovery
Corticosteroids may be harmful, except in autoimmune hepatitis for which steroids may reverse ALF.
Acyclovir is essential in herpes simplex or varicella-zoster virus infection.
For hyperammonemia, oral antibiotics are used to reduce blood ammonia levels and trap ammonia in the colon.
