Paediatric Gastroenterology 1 Flashcards
What does bifid uvula signify?
- normal or associated with a submucous cleft of the soft palate
What are the diagnostic criteria for cyclical vomiting sydrome?
- At least 5 attacks in any interval OR 3+ episodes during a 6-mo period
- Recurrent intense vomiting and nausea lasting 1 hr to 10 days, at least 1 wk apart
- Each “attack”/”episode is similar
- Vomiting occurs ≥4 times/hr for ≥1 hr
- Return to baseline health between episodes
- Not attributed to another disorder
How does erythromycin work to stimulate gastric motility?
Motilin agonist
How does metoclopramide work?
Dopamine ANTagonist
What is the mechanism of action of ondansetron?
Serotoninergic 5-HT 3 antagonist
What is normal stool output for an infant?
5 mL/kg/day
What is GDNF/RET and what is it associated with?
- glial derived neurotrophic factor / receptor
- neurocyte migration for gut
- Hirschsprung
What are the essential amino acids?
- Phenylalanine
- Valine
- Tryptophan
- Threonine
- Isoleucine
- Methionine
- Histidine
- (Arginine - can be synthesized from glutamine but premmies can’t do this)
- Leucine
- Lysine
What is the ion gap formula for stool?
Ion gap=Stool osmolality−[(Stool Na+stool K]×2]
What are the clinical findings with Peutz-Jeghers syndrome?
- hyperpigmented macules
- GI polyps
- usually STK11 gene
What is the marker of active replication and infectivity for Hepatitis B?
HBeAg
What does HbSAg positivity indicate?
Infected with hepatitis B
What cancer do you get with h.pylori?
Gastric Lymphoma
Where do foreign bodies get stuck in the oesophagus?
- Cricoid (most common)
- Aortic arch
- Lower oesophageal sphincter
What is the “6 food elimination diet”?
Exclude: dairy, egg, soy, treenut and peanut, wheat, seafood
Treatment for EO
What are the macroscopic and microscopic features of EO?
- Macro: linear erosions, white patches, textbook describes circumferential
- Micro: >15 eosinophils per HPF, often transmucosal infiltration with microabscesses
What is the major protein component of cow’s milk?
Casein
Which autoantibody is most specific for
coeliac disease?
IgA endomysial.
Where is iron absorbed?
Duodenum (and upper jejunum)
Where is zinc absorbed?
Jejunum via Zip4 transporter
When does nutritive sucking start?
34/40
Which syndromes are associated with coeliac disease?
Down, Williams, and Turner
What are the biopsy findings in coeliac disease?
- partial to total villous atrophy
- elongated crypts
- increased mitotic index in the crypts
- infiltrations of plasma cells,lymphocytes, mast cells, eosinophils, basophils in lamina propria
- increased intraepithelial lymphocytes
- flattened, cuboidal, and pseudostratified epithelium.
What other illnesses have similar biopsy findings to coeliac?
- cow’s milk or soy protein hypersensitivity
- heavy infestation with Giardia lamblia
- primary immunodeficiencies
- tropical sprue
- small bowel bacterial overgrowth
- intestinal lymphoma
What does SGLT1 transport?
Na-glucose and galactose
What HLA is associated with coeliac?
HLADQ2 and DQ8
Where are bile salts reabsorbed?
Ileum
Which bug mimics appendicitis?
Yersinia
Where is calcium mostly absorbed?
Duodenum and upper small intestine
Which vitamins help with chronic diarrhoea in malnourished children?
Vitamin A supplementation reduces diarrhoea-related mortality and diarrhoeal severity in developing countries. Similarly, zinc supplementation during diarrhoeal illness shortens the illness duration.
What is sucrose?
Glucose and fructose
What is lactose?
Glucose and galactose
Most common sugar in milk
What is maltose?
Two glucoses
What is absorbed in the duodenum and proximal jejunum?
Ca Mg Phosphate Iron Folic acid.
What is absorbed in the distal ileum?
B12
Bile acids
What does glucokinase do?
Enzyme helping glucose phosphorylate to G6P
In liver, pancreas, gut and brain
How common is growth failure in Crohn’s?
15-40%
Inheritance of IBD?
30-35% monozygotic twins
8-10% other 1st degree relatives
What autoantibodies are associated with type 1 autoimmune hepatitis?
ANA and SMA
What autoantibodies are associated with type 2 autoimmune hepatitis?
LKM
What is the difference between Type 1 and 2 IBD associated arthritis?
Type 1 related to flare of disease - pauciarticular, large joints, HLAB27/HLAB35/HLADR related
Type 2 more chronic - polyarticular, small joints, upper limbs/MCPJs, maybe a/w uveitis
KCal per g for carbs, protein and fats…
4, 4, 9
Having primary sclerosing cholangitis puts you increased risk for which Ca?
Cholangiocarcinoma
Colorectal cancer
What does calprotectin show?
Neutrophil mediated inflammation in the gut
Low albumin with high protein is a clue for…?
Autoimmune process as may have high IgG pushing total protein up
What do you chelate copper with?
Penicillamine
Trientine
Crohn’s v.s. UC histology - cardinal differences?
Crohn’s - transmural, granulomas,
UC - mucosal layer only,
What is the gender distribution of IBD?
Crohn’s is male dominant
UC equal
What % of primary sclerosing cholangitis have IBD?
40%, usually UC
However only 4% of IBD have PSC
How does azathioprine work?
Inhibition of purine metabolism and DNA synthesis
Suppresses bone marrow (can be toxic!)
