Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal II Exam 2 > Lecture 5 - Pediatric GI > Flashcards

Lecture 5 - Pediatric GI Flashcards

1
Q

Which type of bilirubin is toxic to the CNS? (Be specific!)

A

FREE (not bound to albumin); UNCONJUGATED bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The large amounts of unconjugated bilirubin in the blood of a new baby is due to what factors?

A
  • Due to hemolysis
  • Due to inadequate conjugation and clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of unconjugated hyperbilirubinemia in an infant?

A

Hemolysis of RBC’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differentiate breast feeding jaundice vs. breast milk jaundice?

A
  • Breast feeding jaundice is more of a function of dehydration and decreased excretion of bilirubin in the stool (related to the supply of the breast milk, which is sometimes low in first few days)
  • Breast milk jaundice is due to presence of deconjugating enzymes in milk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which type of hyperbilirubinemia is never non-pathologic?

A

Conjugated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Rh and why should Rh testing be done on all pregnant women?

A
  • Rh is inherited and found on surface of RBC’s
  • If mom is Rh (-) and baby is Rh (+) –> some of babies RBC’s get into Mom’s circulation during pregnancy and Mom develops Rh antibodies
  • No big deal in 1st pregnancy, but w/ subsequent pregnancies the Rh antibodies can cross placenta and wreak havoc on Rh (+) baby (hydrops fetalis or erythroblastosis fetalis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If Mom is blood type O or if Mom is Rh negative, the infant’s cord blood should be evaluated for what 3 things/how?

A
  1. A direct antibody (Coomb’s) test = DAT
  2. Blood type
  3. Rh determination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a newborn has conjugated hyperbilirubinemia in the first few post-natal weeks what is the first thing you should think?

A

Biliary atresia/cholestasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is seen in Phase 1 (the first 1-2 days) of acute bilirubin toxicity in an infant (w/ high unconjugated bilirubinemia)?

A
  • Poor suck
  • High pitched cry
  • Stupor
  • Hypotonia
  • Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is seen in Phase 2 (middle of first week of life) of acute bilirubin toxicity in an infant (w/ high unconjugated bilirubinemia)?

A
  • Hypertonia of extensor ms.
  • Opisthotonus
  • Retrocollis
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is seen in Phase 3 (after first week of life) of acute bilirubin toxicity in an infant (w/ high unconjugated bilirubinemia)?

A

Hypertonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the chronic and permanent sequelae of Bilirubin Induced Neurologic Dysfunction (BIND)?

A

Kernicterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some of the main signs of Kernicterus in a newborn?

A
  • Choreoathetotic movements
  • Ballismus
  • Upward gaze
  • Dental dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If there is jaundice in the first 24 hrs or the jaundice is excessive for infants age; which tests should be run?

When should Total Serum Bilirubin (TSB) be rechecked?

A

1) Bloody type and Direct Antibody (Coomb’s) test
2) CBC and peripheral blood smear
3) Conjugated bili level
4) Reticulocyte count
- Repeat TSB in 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If there is prolonged jaundice in an infant and you are approaching 2 months, what should you start thinking about?

A

Gilbert’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 3 signs/symptoms of Biliary Atresia in an infant?

A
  • Cholestatic jaundice (conjugated hyperbilirubinemia)
  • Hepatomegaly
  • Acholic stools
17
Q

Extrahepatic biliary atresia occurs where in the hepatobilirary system?

A

Common bile duct

18
Q

Crigler-Najjar Type 1 and Type 2 differ in their response to what drug?

A
  • Type 1 has NO bilirubin decrease w/ phenobarbital
  • Type 2 the bilirubin levels will decrease with phenobarbital
19
Q

Which clinical test is the most definitive way of determining if someone is having clinically significant reflux?

A
  • Esophageal pH monitoring w/ multichannel intraluminal impedance testing (MII)
  • Measures frequency of GER and association of low esophageal pH w/ sx’s
20
Q

Surgery as a treatment for GERD in a child should only be considered after what has been done first?

More commonly done in which children?

Usually only done if the GERD is severe enough to cause?

A
  • pH /MII esophageal study has been completed
  • More common in developmentally delayed childre
  • Only if GERD is putting the child’s nutrition or respiratory status at risk
21
Q

What is the most common location for intussusception in infancy?

A
  • ileocolic
  • Ileum invaginates into colon at the ileocecal valve/junction
22
Q

What is the consistency of the stools associated with intussusception?

A
  • Bright red blood and mucous
  • “Currant jelly stools”
23
Q

Which other symptom is often times seen intermittently in children with intussusception?

A

Striking lethargy is present intermittently

24
Q

2 types of treatment for Intussuception?

A
  • Hydrostatic reduction w/ a contrast enema (less common)
  • Pneumatic reduction with an AIR enema
25
Q

What are the 3 classic metabolic findings associated with Pyloric Stenosis?

A
  • Hypochloremic
  • Hypokalemic
  • Metabolic alkalosis

*Due to all the vomiting!

26
Q

What are 4 pathologic abnormalities resulting in increased production unconjugated bilirubin in a new born?

A
  1. Erythrocyte-enzyme deficiencies
  2. Blood group incompatibility (ABO)
  3. Structural defects in RBC’s
  4. G6PD deficiency (enzyme deficiency)
27
Q

If you see an infant with elevated conjugated bilirubin, what do you thing of?

A

biliary Atresia

28
Q

What are the s/s of biliary atresia?

A

cholestatic jaundice

hepatomegaly

acholic stools

29
Q

Babies are most at risk for hyperbilirubinemia when born to mom’s with which blood types?

A

O and Rh-

30
Q

What are some indications of Hirschprung’s disease?

What test is diagnostic?

A

Fails to pass meconium in first 24-48hrs

Palpable stool in abdomen

Empty rectal vault

hx of no unassisted bm’s

Rectal bx is diagnostic

31
Q

What are chloride and potassium levels like in someone with pyloric stenosis?

Metabolic acidosis or alkalosis?

A

Hypochoremia

Hypokalemic

Metabolic Alkalalosis

Gastrointestinal II Exam 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions