Lec 34 Flashcards
What matters about growth curve?
rate of weight gain and growth not where on the curve you are just that your curve is parallel to normal curve
What is usual cause of poor weight gain in kid?
rarely due to malabsorption; usually due to poor caloric intake
Whats on the differnetial?
- GE reflux
- celiac
- IBD
- food allergy
- parasite
What is 72 hr fecal fat test?
see what percent of fat intaak comes out in stool; should be < 10%
What does D-xylose test tell us?
give D-xylose then measure level in blood; level , 20 tells you problem with absorption
If abnormal fecal fat and abnormal serum d-xylose what should you do next?
small intestine biopsy
If abnormal fecal fat and normal serum d-xylose what should you do next?
pancreatic work up; sweat test
How is CF inherited? genetics?
autosomal recessive due to mutation in the CFTR gene
What is normal function of CFTR gene?
regulate secretion of chloride ion from pancreas, bile duct, intestine, lung; reabsorb Cl from sweat
What is most common mutation in CF?
delF508
What is possible rectum complication in CF?
rectal prolapse = may be presenting sign
due to passage large bulky stools
What should you rule out in a patient with recurrent pancreatitis?
cystic fibrosis
What is the most common structural cause of neonatal jaundice?
extra hepatic biliary atresia
What happens in extra hepatic biliary atresia?
begins at birth and progresses to complete obstruction –> biliary cirrhosis and portal htn
ultimately get end stage liver disease and need transplant
How does patient present with extra hepatic biliary atresia?
jaundice
direct hyperbilirubinemia
failure to thrive
hepatosplenomgealy
What is HIDA scan?
hepatobiliary scan
give technecium 9 –> gets taken up by liver without excretion into duodenum tells you there is obstruction
What is kasai procedure?
excise obliterated extrahepatic duct and attach to the small bowel; only a bridge to liver transplant not a permanent solution
best outcome if you do it within 2 months
Who gets hirschprugns?
more males than females
associated with downs
What is pathogenesis of hirschprungs?
failure of migration ganglion cell precursors; absence of ganglion cells in messners and auerbachs plexus distally
have lack of relaxation of rectum
