GIT / Nutrition Flashcards
Xerophthalmia, corneal opacity, bitot spots, night blindness, growth failure, and recurrent infection
Vitamin A deficiency
Gingival bleeding, anemia, corkscrew-coiled hairs, anorexia, and irritability
Vitamin C deficiency
Breastfed children should be supplemented with which vitamin from birth?
Vitamin D
Child with a history of cystic fibrosis presents with ataxic gait, diminished deep tendon reflexes in the lower extremities, as well as generalized weakness in the lower extremities
Vitamin E deficiency
Vitamin that affects prothrombin, factor VII, factor IX, factor X
Vitamin K
Child is receiving a prophylactic antibiotic for the last few months. Prothrombin time (PT) and partial thromboplastin time (PTT) are mildly prolonged
Vitamin K deficiency
Foot and wrist drop, ataxia, ophthalmoplegia, confusion, abnormal sensation, heart failure, dyspnea, and edema
Vitamin B1 deficiency (thiamine)
Redness and fissuring of lips (cheilitis), soreness of tongue, anemia, fatigue
Vitamin B2 deficiency (riboflavin)
Diarrhea, dementia, dermatitis, and death in severe cases
Vitamin B3 deficiency (niacin) pellagra disease
Which vitamin is needed to supplement a child on a strict vegan diet?
Vitamin B12 (other supplements to consider: iron, zinc, and calcium)
The site of vitamin B12 absorption
Ileum
Infant drinks goat’s milk, looks pale, CBC shows macrocytic anemia
Folic acid deficiency
Acute illness with diarrhea, fever, and vomiting for 2days, followed by persistent diarrhea for 3weeks, 6–9 episodes of liquid stools without visible blood or mucus, associated with generalized abdominal pain, distended and flatulent since the acute illness. A positive reducing substance in the stool. What is the best management?
Lactose-free diet and lactase supplement (lactose intolerance)
Taste and smell impairment, night blindness, and depressed immunity
Zinc deficiency
Deficiency associated with recurrent diarrhea, alopecia, and rash (acrodermatitis enteropathica)
Zinc deficiency
Child previously healthy is living with stepfather, generalized loss of muscle mass, and no subcutaneous fat
Marasmus and possible calorie deprivation
Child lives in a shelter, poor nutrition, failure to thrive, weakness, edema, moon facies, a swollen abdomen (potbelly), dark, dry skin, with pale areas between the cracks, depigmentation of hair, and fatty liver
Kwashiorkor (protein-energy malnutrition)
An exclusively breastfed infant has not stooled for 5days with no other symptoms. The stool is soft with no rectal bleeding. The infant is gaining weight
Reassurance (breastfed infants may go several days or even a week between bowel movements)
A 1-week-old child with frequent spit-ups, otherwise doing well
Reassurance (newborn reflux is normal)
What are the upper GI series useful for?
To rule out anatomic or motility problems. Does not diagnose reflux
A 3-week-old first newborn boy presents with nonbilious projectile vomiting, hypochloremic, hypokalemic metabolic alkalosis, and dehydration
Pyloric stenosis
What is the next best step in cases with suspected pyloric stenosis?
Abdominal US (pylorus)
Weight loss, abdominal pain, nausea, effortless postprandial regurgitation after at least 1 meal daily for 1month, regurgitated food occasionally reswallowed, rechewed, or spit out
Rumination syndrome
Child with no known health problem woke up suddenly vomiting blood. The child is stable and acting normal. What is the most likely cause?
Epistaxis (nose bleeding is the most common source in healthy children)
Nausea and vomiting every 1–2months, each episode lasts for few hours, otherwise healthy, no symptoms in-between episodes, positive family history of migraine
Cyclic vomiting syndrome
A 7-year-old healthy child, with periumbilical abdominal pain worse in the morning prior to school, improves during weekends with normal growth parameters
Reassurance (functional abdominal pain)
High achieving adolescent complains of crampy abdominal pain, diarrhea, and at other times, constipation; pain is relieved with stooling
Irritable bowel syndrome
Adolescent presents with recurrent episodes of abdominal pain, diarrhea, and sometimes constipation in the previous 3months. No weight loss and all labs are normal. What is the best treatment?
Peppermint oil, diet modifications, cognitive behavioral therapy
A mother brought her toddler with a diaper full of undigested food, the child is holding a large bottle of apple juice
Toddler diarrhea
The best management of toddler’s diarrhea
Juice restriction and allow normal dietary fat
Child with a low-grade fever, 6 episodes of diarrhea, otherwise reassuring medical exam. What is the treatment of choice?
Oral rehydration therapy (avoid anti-diarrheal agents)
What is the major concern of using antimotility drugs such as Loperamide?
May induce ileus
An infant presents with bright red blood stool, poor weight gain, diarrhea, and fussiness; the infant is breastfeeding, supplemented with standard infant formula; stool guaiac test is positive
Cow milk protein intolerance
Child with dysphagia, recurrent food impaction; biopsy shows an increased eosinophil?
Eosinophilic esophagitis
Adolescent with recurrent headaches takes ibuprofen as needed, presents with dysphagia and chest discomfort (does not like to drink water with medicine)
Pill-induced esophagitis
Child accidentally swallowed caustic liquid 6h ago, presents with dysphagia, oral pain, chest pain, nausea, and vomiting
Endoscopy in 12–24h after ingestion
Swallowed a coin, no symptoms, and radiograph showed the coin still in the esophagus
Observe for 12–24h, removal of the coin if it does not pass to the stomach or if the patient became symptomatic
Swallowed a coin, no symptoms, and radiograph showed the coin in the stomach
Checking the stool for passage for 4weeks, with weekly radiographs, if indicated
4 weeks passed and the coin still in the stomach with no symptoms
If the coin does not pass through the stomach by 4weeks or if the patient is symptomatic, removal by endoscopy should be considered
Swallowed a coin, excessive drooling, and chest pain, and radiograph showed the coin still in the esophagus
Immediate removal
Swallowed a button battery (BB), and passed to the stomach with symptoms
Immediate removal
Swallowed a BB, and passed to the stomach without symptoms
Urgent removal (if age
Swallowed a BB that got stuck in the esophagus
Immediate removal
Swallowed small pieces of magnet metals; the abdominal radiograph showed the pieces in the stomach
Immediate removal
An older child with bloating, constant burping, sharp epigastric pain that awakens the child from sleep
Helicobacter pylori infection
The most common cause of chronic gastritis in pediatrics
H. pylori
The best and most definitive test for peptic ulcer disease
Endoscopy
What is the treatment of H. pylori infection?
Amoxicillin or metronidazole + clarithromycin + PPI for 2weeks
Infant suddenly develops bilious vomiting, abdominal distension, tenderness, and fussiness. What is the diagnostic test of choice?
Upper GI series with follow through
In the infant above, the GI series shows a bird’s beak sign of the second portion of the duodenum
Volvulus
Intermittent crampy abdominal pain, lethargy, bilious vomiting, and a palpable mass in the right upper quadrant
Intussusception
What is the best initial diagnostic test of choice in cases of intussusception?
Abdominal US (target sign, reflecting a segment of bowel trapped within a distal segment of bowel)
What is the therapeutic procedure of choice in cases of intussusception?
Air contrast enema (diagnostic and therapeutic)
Down syndrome, bilious vomiting, double bubble sign on KUB
Duodenal atresia
A mother brought her 9-month-old girl with a diaper full of red, maroon stool; the physical exam is normal, and the infant is feeding well and smiling (she is receiving an antibiotic for AOM)
Most likely the medicine, e.g., cefdinir may change the stool color to maroon color (bloodlike color)
A 2-year-old boy, frank rectal bleeding, anemia, no pain, no other symptoms
Meckel diverticulum
What are the 2 most common ectopic tissues found in Meckel diverticulum?
Gastric and pancreatic
How is Meckel diverticulum diagnosed?
Technetium 99 scan
Infant, failure to thrive, rectal prolapse
Cystic fibrosis
Most common cause of rectal prolapse in the USA
Constipation
Rectal bleeding, large and hard stool in the diaper
Anal fissure
The most common cause of rectal bleeding in infants
Anal fissures
A 2-year-old boy with chronic constipation, ineffective laxatives, fails to pass meconium in the first 48h of life, explosive stools on rectal exam, KUB showed very distended colon
Hirschsprung disease
A 48-h old boy did not pass the meconium; the abdomen is slightly distended
Hirschsprung disease
Most accurate diagnostic test for Hirschsprung disease
Full-thickness rectal biopsy performed by surgery
Persistent epigastric abdominal pain, vomiting; the pain is referred to the back, tenderness in the epigastric region, elevated amylase, and lipase enzymes
Acute pancreatitis
Child with Down syndrome, intermittent abdominal pain, and failure to thrive
Celiac disease
Child with type 1 diabetes mellitus and recurrent abdominal pain
Celiac disease
Child with a history of recurrent abdominal pain presents with fever, abdominal pain, bloody diarrhea, migratory arthritis, erythema nodosum, ankylosing spondylitis, elevated ESR, positive P-ANCA
Ulcerative colitis
Recurrent aphthous ulcers, abdominal pain, weight loss, perianal lesions, positive antiSaccharomyces antibodies
Crohn’s disease
Jaundice, abdominal pain, and fever
Cholangitis
Jaundice, abdominal pain, and a palpable mass in the right upper quadrant
Choledochal cyst
Hydrops of the gallbladder can be seen in
Kawasaki disease
Conditions associated with an increased incidence of cholelithiasis
Sickle cell anemia, chronic total parenteral nutrition (TPN), adolescent pregnant females
What is the most common complication of cholelithiasis?
Pancreatitis
A 3-year-old boy presents with failure to thrive, difficulty walking; the metabolic panel shows elevated aspartate transaminase (AST) and alanine transaminase (ALT). Total bilirubin, prothrombin time, blood glucose, TSH and free T4 are all normal, negative hepatitis viral panel. What is the test of choice in this case?
Creatinine phosphokinase (CK) (muscular dystrophy most likely)
What are the sources of transaminases (ALT and AST)? It is important to consider other sources of transaminases if they are elevated and the liver function is normal
Liver, heart, muscles, kidney, and brain
The best laboratory test for acute hepatitis A
Anti-HAV IgM
A mom is asking about prophylaxis for her 4-month-old child after she was recently diagnosed with hepatitis A?
Administer IG as prophylaxis (
Prophylaxis of a 3-year-old child exposed to a documented case of hepatitis A in a child care center
Hepatitis A vaccine (>1year)
All hepatitis viruses are composed of RNA exceptH
Hepatitis B virus is composed of DNA
Which virus infection must have hepatitis B?
Hepatitis D
Child with a family history of lupus disease presents with jaundice, hepatomegaly, weight loss, loss of appetite, positive anti-smooth muscle antibodies
Autoimmune hepatitis
One week with jaundice, hepatomegaly, slightly elevated ALT and AST, prolonged PT that is not responding to IV vitamin K, and recurrent hypoglycemia
Acute hepatic failure
An 8-year-old boy has recurrent jaundice, slightly elevated indirect bilirubin; physical examination and all other labs are normal
Gilbert syndrome
A 1-day-old boy with intense jaundice, unconjugated bilirubin is 25mg/dL, and no conjugated bilirubin; and poor response to phototherapy
Crigler–Najjar syndrome type I (exchange transfusion is warranted)
Mild conjugated hyperbilirubinemia with black liver
Dubin–Johnson syndrome
An infant with jaundice, dark urine, light-colored stool, hepatomegaly, and elevated conjugated bilirubin
Biliary atresia
What is the most valuable study for neonatal biliary atresia?
Percutaneous liver biopsy
If liver biopsy confirmed biliary atresia, what is the next appropriate test?
Intraoperative cholangiography
Adolescent presents with depression, psychosis, and elevated liver enzymes
Wilson disease
Which mineral is affected in Wilson disease?
Copper (excess)
How to establish the diagnosis of Wilson disease
Ceruloplasmin 250ug/g dry weight. Urine copper >100ug/24h. Presence of Kayser–Fleischer rings
Broadened forehead, jaundice, pulmonary stenosis, and butterfly hemivertebrae
Alagille syndrome
Abdominal mass, elevated liver enzyme, and high serum alpha-fetoprotein
Hepatoblastoma
A 3-month-old, failure to thrive, extreme pruritus, steatorrhea, very high- conjugated bilirubin, hepatosplenomegaly, mutilated skin, elevated serum alkaline phosphatase, and normal gammaglutamyl transferase (GGT)
Progressive familial intrahepatic cholestasis (PFIC) type 1
Prognosis of all forms of PFIC
Lethal during childhood unless treated early
Hematochezia, intestinal polyp, pigmented penile lesion, large head, café-au-lait spots, intellectual disability
Bannayan–Riley–Ruvalcaba syndrome
> 5 juvenile polyps
Juvenile polyposis
What is the next step in children with ≥5 juvenile polyps or any number of adenomatous intestinal polyps?
Genetic testing
100 or more adenomatous polyps in the large and/ or small intestines
Familial adenomatous polyposis
Intestinal polyps, osteoma of the mandible, papillary carcinoma of thyroid, and hepatoblastoma
Gardner syndrome
Intestinal polyps and brain tumor
Turcot syndrome
Intestinal polyps, hematochezia, mucocutaneous freckling, and a family history of polyposis
Peutz–Jeghers syndrome (increases the risk of cancer)
Hamartomas involving many areas of the body, e.g., skin, oral mucosa, thyroid, breast, and colon
Cowden syndrome
Associated risks of Cowden syndrome
Cancer, e.g., thyroid cancer
Hemihypertrophy, very large extremities, epidermal nevus, hamartomatous polyps, intellectual disability
Proteus syndrome
Potential risks of Proteus syndrome
Deep vein thrombosis (DVT) and thromboembolism
The best diagnostic test for lactose intoleranceH
Hydrogen breath test
