Ped's GI Flashcards
1
Q
What is the underlying cause of infectious esophagitis
A
Most common in immunocompromised patients
2
Q
What are the types of Infectious esophagitis
A
- Candida
- CMV
- HSV
3
Q
Key terms for this diagnosis- odynophagia, endoscope shows linear yellow-white plaques
A
Candida
4
Q
Key terms for this diagnosis- odynophagia, endoscope shows large superficial shallow ulcers
A
CMV
5
Q
Key terms for this diagnosis- odynophagia, endoscope shows small deep ulcers
A
HSV
6
Q
What is the treatment for Candida
A
Fluconazole PO
7
Q
What is the treatment for CMV
A
Ganciclovir
8
Q
What is the treatment for HSV
A
Acyclovir
9
Q
key terms for this diagnosis- history of atopic disease - allergies, asthma, eczema, allergic inflammatory esophageal inflammation causing dysphagia
A
Eosinophilic esophagitis
10
Q
Eosinophilic esophagitis will show what on an endoscope?
A
multiple conrrugated rings
11
Q
Treatment for Eosinophilic esophagitis
A
Remove foods that cause allergic response
topical steroids with an inhaler without a spacer
12
Q
What is causing pyloric stenosis?
A
hypertrophy and hyperplasia of the muscular layers of the pylorus causing a functional outlet obstruction
13
Q
what is the most common cause of intestinal obstruction in infancy
A
pyloric stenosis
14
Q
When is pyloric stenosis most common ?
most common in whom?
A
95% is present in the first 3-12 weeks of life
rare in older than 3 months
most common in white males
15
Q
What are the s/s of pyloric stenosis?
what is the physical s/s
A
*NON-bilious vomiting regurgitation projectile vomiting vomiting after feedings dehydrated malnutrition jaundice metabolic alkalosis -Right of the umbilicus= olive shaped non-tender mobile hard pylorus, felt especially after the infant has vomited
16
Q
What is the best imaging for Pyloric stenosis?
what is the second line imaging?
What will both show?
A
Ultrasound = elongation and thick pylous
upper GI = string sign from and delayed gastric emptying
17
Q
Treatment for Pyloric stenosis
A
Pyloromyotomy
re-hydrate
18
Q
What is the rule of “2’s” with Meckle’s Diverticulum
A
2% of the population 2% symptomatic 2 feet from the iloeocecal valve 2 inches in lenght 2 types of ectopic tissue- gastric or pancreatic 2 years of age * most common 2 times more common in boys
19
Q
What is Meckel’s diverticulum actually made of?
A
Persistent portion of embryonic vitteline duct - yolk stalk
20
Q
What are the s/s of Meckel’s diverticulum
A
Usually asymptomatic - may be seen incidentally during abdominal surgery
- PAINLESS rectal bleeding or ulceration - if there is ectopic gastric tissue
- periumbilical pain that radiates to right lower quad
- can cause intussusception, volvulus or obstruction
- adults = divercitulitis
21
Q
What is the best diagnostic test for Meckel’s diverticulum
A
Meckel’s scan - looks for ectopic gastric tissue in the ileal area
22
Q
Treatment for Meckel’s diverticulum
A
surgery- excision
23
Q
What is intussuscepiton ?
when is it common to occur?
A
Common after a viral infection
intestinal segment invaginates “telescopes” into adjoining intestinal lumen causing a bowel obstruction
24
Q
At what ages is intussuscepiton most common
A
2/3 of children
common between 6 months - 18 months of age
usually less than <1 year old
25
What area is intussusception most common?
ileocolic junction
*lead points: meckel diverticulum, enlarged lymph node, hyperplasia of peyer's pathces, bening tumors, malignant tumors, hematomas, foreign body
26
What are the s/s of intussusception
| what are physical sign/symptoms
```
TRIAD :
1. vomiting
2. abdominal pain - colicky
3. blood in poop "current jelly stools"
usually lethargic
Sausage-shaped mass in right upper abdomen or hypochondrium and emptiness in RLQ
```
27
What is the Dance sign?
| What condition is it seen in?
intussusception
| Sausage-shaped mass in right upper abdomen or hypochondrium and emptiness in RLQ
28
What is the best imaging to diagnosis intussusception
Barium contrast enema * boht diagnostic and therapeutic
29
Treatment for intussusception
Barium or air insufflation enema
(both diagnostic and therapeutic)
surgery if refractory
IV fluids
30
What is an autoimmune inflammatory disease secondary to alpha-gliadin
Celiac disease
| alpha-gliadin is in gluten
31
Exposure to alpha-gliadin is in gluten will lead to what in the intestines in celiac disease
loss of villi and absorptive area
| impaired fat absorption
32
celiac disease is common in whom?
females
| european descent - irish and finnish
33
Key terms for this diagnosis- diarrhea, bloating, steatorrhe, growth delays, weight loss, pruritic rash that is papulovesicular on extensor surfaces, neck, truck and scalp
celiac disease
34
Malabsorption and Dermatitis herpetiformis are diagnostic for what?
celiac disease
35
Endomysial IgA antibody
Transglutaminase Antibody
both positive in what disease ?
celiac disease
36
What is the definitive diagnosis for celiac disease
small bowel disease
37
Treatment for celiac disease
gluten free diet- NO wheat, rye, barley
| CAN HAVE- oats, rice, corn
38
What is the most common cause of Appendicitis
Feacalith *
inflammation
malignancy
foreign body
39
What are all the physical exam findings for Appendicitis
1. Rovsing sign
2. Obturator sign
3. Psoas sign
4. McBurney's point
40
What is Rovsing sign
| what is most indicate ?
RLQ pain with LLQ palpation
| Appendicitis
41
What is Obturator sign
| what is most indicate ?
RLQ pain with internal and external hip rotation with bent knee
42
What is Psoas sign
| what is most indicate ?
RLW pain with right hip flexion/extension- raise leg with resistance
43
What is McBurney's point
| what is most indicate ?
1/3 distance from the anterior superior iliac spine and navel
44
What is the best diagnostic imaging for Appendicitis
CT scan
ultrasound
leukocytosis
45
Treatment for Appendicitis
Appendectomy
46
What is a chronic idiopathic disorder with NO organic cause
Irritable bowel syndrome
47
What is the hallmark s/s of Irritable bowel syndrome
abdominal pain associated with altered defecation (bowel habits)
diarrhea & constipation or alternation between the two
48
Who is Irritable bowel syndrome most common in?
most common in women
| Late teens - early 20's
49
What is the patho of Irritable bowel syndrome
chemical imbalance in the intestines - serotonin and acetylcholine causing abnormal movements and spasm = abdominal pain "visceral hypersensitivity"
50
What is the ROME II criteria
| what condition is it seen in ?
Irritable bowel syndrome
1. Abominal pain or discomfort with 2/3 for 12 weeks
doesn't have to be 12 weeks in row
2. relief with defecation
3. change in stool frequency and formation
51
What are ALARM symptoms of Irritable bowel syndrome
1. Bleeding - occult blood stool, anemia, blood in stool
2. anorexia or loosing weight, night time pain, family history of cancer
3. diarrhea causing dehydration, severe constipation or fecal impaction
52
Treatment of Irritable bowel syndrome
1. lifestyle change- stop smoking, eat low fat unprocessed food
2. Diarrhea- Dicyclomine, loperamide
3. Prokinetics, bulk-forming laxatives, saline or osmotic laxatives
4. TCA- Amitriptyline & Serotonin receptor for pain
53
Key terms for this diagnosis- RLQ pain that is crampy, weight loss, diarrhea with no blood, malabsoprtion of B12 & Fe deficiency
Chron's Disease
54
What area are most commonly affected in Chron's Disease
ANY segment of the GI tract
Mouth to anus
Transmural level
55
What are complications of Chron's Disease
```
Perianal disease
fistulas
stricture
abscesses
granulomas
```
56
What is the best diagnostic imaging for Chron's Disease
| what will it show?
Skipped lesions - normal areas interspersed between inflamed areas with cobblestone appearance
Barium = string sign
labs- ASCA +
57
What is the best drug for chron's disease- treats anti-immatory
Oral mesalamine - Asacol
58
what are the topical mesalamines effective in the distal colon
Mesalamine
59
What medication works mainly in the Colon
Sulfasalazine
60
what drug has rapid acting on anti-inflammation and used for acute flares of chron's disease
Corticosteroids
61
Azathrioprine and Methotrexate are steroid spraing agents for what GI disorder?
Immune Modifying agents
| Chron's disease
62
What is the most common type of hernia present in children?
| what ages to repair?
umbilical - usually resolves by 2
| if still present at age 5 surgery
63
What food have Vitamin C in them?
Raw citrus fruits and green vegetables
64
Which Vitamin deficiency- malasie, wakenss, vascular fragility, recurrent hemorrhages in gums, skin (perifollicular), impaired wound healing and hyperkaratoic papules
Vitamin C - ascorbic acid
| - Scurvy
65
Ascorbic acid is also known as what ?
Vitamin C
66
Scurvy is seen in what vitamin deficiency?
Vitamin C
67
Key terms for this vitamin deficiency
| Hyperkeratosis, Hemorrages, Hematolgic (anemia)
Vitamin C
68
RIckets is what?
Vitamin D deficiency- softening of bones in children
69
Osteomalacia is what?
Vitamin D deficiency in adults- diffuse point pains, muscle weakness and fractures
*looser lines
70
Treatment for Vitamin D deficiency
Ergoclciferol
71
What vitamin- helps with vision, immune function, embryo development, hematopoiesis, skin and cellular health
Vitamin A
72
Key terms for this vitamin deficiency- vision changes especially night blindness, impaired wound healing, squamous metaplasia*, bitot spots (white spots on conjunctiva)
Vitamin A deficiency
73
Thiamine is what vitamin?
B1
74
Riboflavin is what vitamin?
B2
75
Niacin or Nicotinic acid is waht vitamin?
B3
76
Pyridoxine is what vitamin?
B6
77
Cobalamine is what vitamin?
B12
78
What is the most common cause of B1 deficiency?
Thaiamine- Alcohol abuse will decrease thiamine intake
79
What are the 3 types of Thiamine deficiencies?
1. Beriberi
2. Wernicke's Encephalopathy
3. Korsakoff's Dementia
80
Key terms for this condition caused by a vitamin deficiency-
DRY: parathesias, demyelination, peripheral neuropathy, symmetric impariment of sensory, motor reflexes, anorexia, muscle cramps and wasting
WET: high output failure, dilated cardiomyopathy, edema
Beriberi- Thiamine B1 deficiency
81
Key terms for this condition caused by a vitamin deficiency- Ophthalmoplegia (paralysis of ocular muscles)
ataxia and global confusion
Wernicke's encephalopathy - Thiamine B1 deficiency
82
Key terms for this condition caused by a vitamin deficiency- Memory loss especially short term, confabulation this condition is irreversible
Korsakoff's Dementia - Thiamine B1 deficiency
83
```
Key term for this vitamin deficiency-
oral lesions
magenta colored tongue
angular cheilitis
photophobia- corneal lesions
Genital scrotal dermatitis
```
Riboflavin- B2
| oral-ocular-genital syndrome
84
Key term for this vitamin deficiency- Diarrhea, dementia and dermatitis
Niacin- Nictoinic acid -B3
Seen in people with high corn diets
3'Ds
85
Key term for this vitamin deficiency- Alcoholism, isoniazid, oral contraceptives, peripheral neruopahty, flaky skin, heaches, anemia, sore tongue, stomatitis and seizures
Pyridoxine - B6
86
Key term for this vitamin deficiency- parasthesias, gait, memory loss, dementia, glossitis, GI problems, macrocytic anemia wiht hypersegmented neutrophils
Cobalamine B12
87
What condition- Autoimmune destruction or loss of gastric pariteal cells that secrete intrinsic factor
Pernicious anemia
| Cobalamine B12 deficiency
88
Pernicious anemia will have what vitamin deficiency?
Cobalamine B12 deficiency
89
Schilling test is used to diagnosis what?
Pernicious anemia
90
Cobalamine B12 deficiency is seen in what kinds of people?
Strict vegans
Alcoholics
Malabsorption - celiac or croh's disease
91
What condition- Autosomal recessive disorder of amino acid metabolism?
Phenylketonuria- PKU
92
Phenylketonuria- lacks what enzyme ? inabilty to metabolize what amino acid?
lacks- Phenylalanine hydroxlayase that breaks down
Phenylalaine into tyrosine
when its not broken down leads to accumulation of phenylalanie in body
93
When is screening for PKU done?
24 weeks gestation
| will lead to irreversible damage if not caught by 3
94
key terms for this diagnosis- Blonde blue-eyed fair skin baby with vomiting, mental retardation, irritability, convulsion, increased deep tendon reflexes, urine has mousy odor
Phenylketonuria
95
Treatment for Phenylketonuria
LIFETIME diet restriction of phenlyalnine
increase tyrosine intake
foods with phenlyalnine - cheese, ntus, fish, meat, eggs, chicken, milk, legumes, aspartame
96
What is the main treatment for gastroenteritits
```
Fluid replacents ! PO or IV
sport drinks
broth
IV saline
pedialyte
ceralyte
DIET- bland low residue BRAT diet
ANTIMOTILITY (dont give if invasive aka bloody poop)
```
97
what is the most common cause of diarrhea in children?
Rotavirus
98
Key terms for this diagnosis- ingested contaminated dairy, mayonnaise, meat or egg
Staphylococcus
99
Treatment for Staphylococcus gastroenteritis
Self-limiting
supportive
should last 1-2 days
100
Key terms for this diagnosis- ingested contaminated food especially fried rice 1-6 hours later have vomiting, cramps, diarrhea
Bacillus Cereus
101
Treatment for Bacillus Cereus gastroenteritis
Self-limiting
| supportive
102
Key terms for this diagnosis- ingested a gram neg rod found in water in poor sanitary overcrowded areas leading to rice water stools
Virbrio Cholera
103
which type of diarrhea is fatal due to severe hypovolemia because of severe dehydration
Virbrio Cholera
104
Treatment for Virbrio Cholera
self-limiting
fluid replacement *
if high fevers-> fluroquinolone or doxycycline
105
Key terms for this diagnosis- most common cause of travelers diarrhea from unsanitary drinking water/ice
Enterotoxogenic E. coli
106
Treatment for Enterotoxogenic E. coli
Fluroquinolone BID x3 days
107
Key terms for this diagnosis-is a nosocomial infection secondary to alteration of normal flora. common after course of antibiotics
Clostridium Difficile
| *clindamycin
108
Treatment for Clostridium Difficile
Metronidazole
| second- vancomycin
109
What makes a gastroenteritis invasive?
1. High fevers
2. bloody diarrhea
3. fecal leukocytes
4. mucus
* do NOT give anti-motility drugs
110
Key terms for this diagnosis- highly virulent gram neg rod that causes watery diarrhea that is mucoid and bloody. In young children can cause febrile seizures
Shigella
111
Shigella will have what apprearnce on a sigmoidoscopy?
Puncatate areas of ulceration
112
Treatment for Shigella
Bacrium
| Trimethoprim-Sulfamethoxazole
113
Key terms for this diagnosis- ingestion of contaminated pork, milk, water or tofu. can appear like an acute appendicitis
Yersinia Enterocolitica
114
Treatment for Yersinia Enterocolitica
Fluoroquinolones
115
Key terms for this diagnosis- ingestion of contaminated poultry, dairy, meat, eggs, exotic pets (reptiles/turtles) causing pea soup
Salmonella
116
What are high risk groups for Salmonella
1. Immunocompromised
2. Sickle cell* risk of osteomyelitis
3. post splenectomy
4. AIDS
5. Children
6. Elderly `
117
What are the two types of Salmonella
1. Salmonella gastroenteritis
| 2. Typhoid Enteric fever
118
Treatment for Salmonella
Fluoroquinolones
119
Key terms for this diagnosis- ingestion of undercooked ground beef, unpasturized milk or apple cider, day care, contaminated water. Produces a cytotoxin
Enterohemorrhagic E. Coli 0157: H7
120
Treatment for Enterohemorrhagic E. Coli 0157: H7
Controversial
| if antibiotics could lead to Hemolytic uremic syndrome in kids
121
Key terms for this diagnosis- most common cause of bacterial enteritis in the U.S.
ingested contaminated poultry, raw milk, water, dairy
Camplyobacter Enteritis
122
What type of gastroenteritis will possibly lead to Gullain Barre syndrome
Camplyobacter Enteritis
123
What gastroenteritis is caused by a gram negative S or seagull shaped organism
Camplyobacter Enteritis
124
Treatment for Camplyobacter Enteritis
Erythromycin
| Fluroquinolones
125
Key terms for this diagnosis- ingestion of contaminated water from streams or wells causing frothy, greasy, foul diarrhea
Giardia Lamblia
126
Treatment for Giardia Lamblia
kids - Furazolidone
127
Key terms for this diagnosis- fecal oral contaminated, common in immigrant populations. Causes Gi colitis, dysentery and amebic liver abscess
Amebiasis- entamoeba histolytica
128
Key terms for this diagnosis- Diarrhea caused by a malabsoprtion of nonabsorbable substances leading to large amounts of watery diarrhea. decreased amount of diarrhea if fasting
Ostomtic Diarrhea
129
What are types of Ostomtic Diarrhea
1. Celiac
2. lactose intolerance
3. pancreatic insufficiency
130
Key terms for this diagnosis- Diarrhea caused by hormones like serotonine, calcitonin, gastring, thyroxine leading to large volume diarrhea
doesnt change with fasting
Secretory Diarrhea
| example- laxative abuse
131
What is the definition of constipation
< 2 poops in a week
straining
hard stools
feeling of incomplete evacuation
132
What is an outlet delay disorder that will lead to constipation in kids?
Hirschsprung's
133
What types of medications can be used to treat constipation
1. Fiber
2. Osmotic laxatives - miralax, lactulose, sorbitol, milk of magnesia
3. Stimulant laxatives- dulcolax, senna
4. bulk forming laxatives- benefiber, citrucel, fibercon
134
```
what class of medication?
Psyllium
```
Bulk forming laxative
135
```
what class of medication?
Methylcellulose - citrucel
```
Bulk forming laxative
136
```
what class of medication?
Polycarbophil
```
Bulk forming laxative
137
```
what class of medication?
Wheat Dextran
```
Bulk forming laxative
138
what class of medication?
golytely
miralax
Osmotic laxative
| type of Polyethylene Glycol - PEG
139
```
what class of medication?
Lactulose
```
Osmotic laxative
140
```
what class of medication?
Sorbitol
```
Osmotic laxative
141
what class of medication?
Milk of magnesia
magnesium citrate
Osmotic laxative
| Saline laxatives
142
```
what class of medication?
Bisacodyl- Dulcolax
```
stimulant laxative
143
```
what class of medication?
Senna
```
stimulant laxative
144
What is Encopresis
Encopresis sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing.
Typically it happens when impacted stool collects in the colon and rectum: the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling (distention) of the bowels and loss of control over bowel movement
145
Treatment for Encopresis
laxatives
Rectal suppositories
Enemas
146
what is a diagnostic PKU value?
> 600
normal 30-60
goal 120-360
147
Diagnostic criteria for failure to thrive
1. weight falls below the 3rd percentile for age
2. weight decreases by 2 major lines on the growth chart
3. weight for length decreases below the 10th percentile
148
What is the most common reasons for failure to thrive
1. Most common envirmoental- feeding technique, improper formula, maternal depression, emtional.
2. organic- CF, celiac, GERD, infection, heart diease
149
What labs do you want to order if you suspect failure to thrive?
```
CBC
lead level
UA - urine culutre
CMP
TSH
consider vitamin testing
```
150
Treatment for suspected failure to thrive?
FEED THEM!
1.5 times usual calories and protein for their age
sometimes have to admit to monitor feedings
151
IN a mother concerned about "GER" what do you tell her about spitting up ?
normal if maintaing weight
| no sign of respirtory problems
152
What causes spitting up? or GER
immature LES
liquid meals
large and frequent meals
horizontal body position
153
What is the difference between GER and GERD
GER is normal spitting up
| GERD is a disease state causing poor growth, pain, breathing problems
154
What are some ways GERD can present in an infant?
```
poor weight gain
breathing problems
recurrent pneumonia
cough
wheezing
apneic spells
```
155
What is the best imaging for GERD
upper Barium swallow to look for obstruction or anatomic problem
24HR pH monitoring
Endoscopy
156
Treatment for GERD in an infant
- if otherwise healthy- no treatment
- lifestyle changes first - thicker feeds, smaller meals, keep upright
- if complications- H2 blocker or PPI
157
What is Tracheoesophaeal fistula ? TEF
a connection between the trachea and esophagus due to defect during development
158
what is the most common type of Tracheoesophaeal fistula
distal Esophageal atrisa with TEF
159
key terms for this diagnosis- polyhydramnios (excess aminotic fluid), infant drooling, mucous and saliva tends to bubble from month
Tracheoesophaeal fistula
| with or without a Esophageal atrisa
160
What is the best diagnostic test for Tracheoesophaeal fistula
if you try to advance an endoscope it will stop
| CXR can show the tube coiled in esophagus
161
What is the most common complication of Tracheoesophaeal fistula
Aspiration pneumonia
162
Treatment for Tracheoesophaeal fistula
Surgery
