Pediatric Gastroenterology Flashcards
1
Q
Neonatal cholestasis is the prolonged elevation of serum levels of conjudated bilirubin beyond the ____ days of life
A
first 14 days of life
2
Q
Non-cystic obliterative cholangiopathy is also called ___
A
Biliary atresia
3
Q
What is the most common form of biliary atresia
A
Obliteration of the entire extrahepatic biliatry at or above the prota hepatis
4
Q
___ sign
seen in both biliary atresia and neonatal hepatitis; cone shaped fibrotic mass cranial to the bifurcation of the portal vein
A
Triangular cord sign
5
Q
What is the most common cause of acute diarrhea in infants?
A
Rotavirus
6
Q
Acute diarrhea is defined as ____ in infants
A
Loose stools >10mL/kg/day
lasting <14 days
7
Q
Acute diarrhea is defined as ____ in older children
A
> 200g/day
lasting <14 days
8
Q
Cut of days for chronic or persistent diarrhea
A
> 14 days
9
Q
[Non-inflammatory diarrhea]
Watery, vomiting
Day care center, infants and toddlers
A
- Rotavirus
2. ETEC
10
Q
[Non-inflammatory diarrhea]
Watery, vomiting
profuse diarrhea, flecks of mucous on voluminous diarrhea
A
Cholera
11
Q
[Non-inflammatory diarrhea]
Watery, vomiting
eating raw oysters or undercooked shellfish
A
V. parahaemolyticus
12
Q
[Non-inflammatory diarrhea]
Watery, vomiting
greasy stool after camping
A
Gardiasis
13
Q
[Non-inflammatory diarrhea]
Watery, vomiting after history of travel
A
ETEC
14
Q
When do you use antibiotics fro diarrhea?
A
- Shorten the duration of illness
- Reduce period of excretion of the organism
- Decrease the requirements for fluid therapy
15
Q
Tetracycline to treat cholera should not be given to patients age ___
A
<9 years old
Tetracycline 12.5mg/kg/dose QID PO x 3 days
16
Q
Alternative drug used for cholera
A
- Doxycycline 5mg/kg PO SD (max 200mg/day)
17
Q
[Diagnose]
High grade fever, malaise, myalgia, cough, abdominal pain, hepatosplenomegaly, anorexia, diarrhea/constipation
rose spots
A
Enteric Fever
18
Q
What are the complications of Typhoid Fever?
A
- Intestinal hemorrhage
2. Perfiration
19
Q
[Typhoid fever
treatment]
Uncomplicated typhoid fever
A
Chloramphenicol
20
Q
[Typhoid fever
treatment]
Uncomplicated typhoid fever, multidrug resistant
A
- Amoxicillin
2. Fluoroquinolone or Cefixime
21
Q
[Typhoid fever
treatment]
Uncomplicated typhoid fever, quinolone resistant
A
- Azithromycin
2. Ceftriaxone
22
Q
[Typhoid fever
treatment]
Severe typhoid fever
A
Fluoroquinolone
23
Q
[Diagnose]
Bloody diarrhea, pus and WBC in stool
Trophozoites with ingested RBCs
A
Amoebiasis
24
Q
[Diagnose]
Bloody diarrhea, pus and WBC in stool
abdominal cramps, recent use of systemic antibiotics
A
C. defficile
25
[Diagnose]
Bloody diarrhea, abundant pus and WBC in stool
abdominal cramps, tenesmus, painfull defecation, urgency
Shigella
26
[Diagnose]
Bloody diarrhea, pus and WBC in stool
high fever, headache, drowsiness, confusion, meningismus,
history of eating eggs, poultry, unpasturized milk
Salmonella
27
[Diagnose]
Bloody diarrhea, pus and WBC in stool
after eating hamburger
EHEC
28
[Diagnosis]
abdominal cramps, diarrhea, sweating, no fever
after eating ham, potato salad, cream pastires
staphylococcus
29
[Diagnosis]
abdominal cramps, diarrhea, sweating, no fever
after eating reheated fried rice
B. aureus
30
[Diagnosis]
abdominal cramps, diarrhea, sweating, no fever
after eating home-canned foods
Diplopia, BOV, muscle weakness
Botulism
31
Shiga-toxin producing E. coli
EHEC
32
What serotype of shigella produce Shiga toxin that can cause HUS
S. dysenteriae serotype 1
33
What are the criteria for presumptive diagnosis of shigella
1. Fecal leukocytes > 50 to 100 PMNS/hpf
2. Fecal blood
3. Increased WBC in CBC
34
What are the criteria for definitive diagnosis of Shigella?
1. Culture of stool and rectal swab
35
How will you empirically treat shigella
WHO:
1. Ciprofloxacin 30mg/kg/day in2 divided doses
2. Zinc 20mg/day for 14 days
OR
1. Cefixime 8mg/kg/day PO every 12 hours for 5 days
36
[Intestinal Obstruction]
Early onset vomiting
Duodenal atresia
37
[Intestinal Obstruction]
Which is associated with obstruction, bilous or non-bilous vomiting
Bilous
38
What is the most common cause of intestinal obstruction between 3 months to 6 years of age
Intussusception
39
[Diagnose]
Severe paroxysmal colicky pain that recurs at frequent intervals with straining efforts;
legs and knees are flexed with loud crying;
currant jelly stools
Intussusception
40
What is the classic finding of intussusception in barium enema?
Coiled-spring sign
41
What is the classic finding of intussusception in ultrasound?
1. Tubular mass
| 2. Doughnut or target sign
42
Modality of reducing intussusception with the highest chance of bowel perforation
Barium + hydrostatic reduction
43
What is the confirmatory test for pyloric stenosis
Ultrasound
Pyloric thickness >4mm or length >14mm
44
[Pyloric stenosis: Findings in barium swallow]
___ sign
Elongated pyloric channel
Bulge of the pyloric muscle into the antrym
Shoulder sign
45
[Pyloric stenosis: Findings in barium swallow]
___ sign
elongated pyloric channel, streaks of barium in the narrowed channel
Double tract sign
46
[Diagnose]
irritable, slightly tachycardic, no retraction, CBS, (+) firm movable 2x2 mass on the abdomen
pyloric stenosis
47
Duodenal atresia is due to failure to recanalize the lumen during the ____ week of gestation
4th to 5th week
48
What is the hallmark of duodenal atresia>
Bilous vomiting without abdominal distention on the first day of lige
49
What is the pathognomonic abdominal x-ray finding in Duodenal atresia?
Double bubble sign
50
What is the most common cause of lower intestinal obstruction in neonates?
Hirschsprung disease
51
Genes affected in Hirschsprung disease
1. RET genes on Chr 10q11
| 2. EDNRB gene on Chr 13q22
52
What is the gold standard in diagnosing hirschsprung disease?
Rectal Suction Biopsy
53
Age at which a definitive repair can be done in patients with Hirschsprung disease
6-12 months
Temporary colostomy for the mean time
54
[Diagnose: intestinal obstruction]
Coffee bean sign or omega sign on AXR
Volvulus
55
[Diagnose: intestinal obstruction]
sausage-shaped RUQ mass, absence of bowel sounds on RLQ
coiled spring sign on AXR
Intussusception
56
[Diagnose: intestinal obstruction]
olive shaped mas
Barium: Shoulder sign, double tract sign
pyloric stenosis
57
[Diagnose: intestinal obstruction]
Normal history or recurrent obstructive, painless rectal bleeding, intermittent pain
Meckel
58
What is the rule of 2 in Meckel Diverticulum
```
2% of the population
2 years old on presentation
2 times more common in males
2 inches long
2 feet from the ileocecal valve
2 types of common ectopic tissue (gastric, pancreatic)
```
59
Definition of constipation
Delay or difficulty in defecation present for 2 weeks or longer; cause significant distress to the patient
60
____ voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months
encopresis
61
___ ecnopresis + overflow incontinence
Retentive encopresis
62
___ without constipation and incontinence
Non retentive encopresis
63
[Rome III Criteria]
For infants and toddlers
1 month of at least 2:
1. 2 defecations per week
2. >/ 1 episode of incontinence after the acquisition of toilet training skills
3. Hx of excessive stool retention
4. Hx of painful or hard bowel movements
5. Presence of large fecal mass in the rectum
6. History of a large-diameter stool that might obstruct the toilet
64
[Rome III criteria]
children with developmental age of 4-18 years old
2 or more, developmental age of at least 4 years old
1. 2 defecations per week
2. >/ 1 episode of fecal incontinence per week
3. Retentive posturing or excessive volitional stool retention
4. Painful or hard bowel movement
5. large fecal mass in the rectum
6. Large-diameter stool that might obstruct the toilet
65
What are the preferred stool softener in patients with functional constipation
1. Polyethylene glycol
2. Lactulose
3. Mineral oil
Prolonged use of Senna or Bisacodyl should be avoided
66
[Osmotic vs secretory diarrhea]
```
Stool <200mL/day
stops when fasting
Stool Na<70 mEq/L
Reducing substances positive
Stool pH <5
```
Osmotic
67
[Osmotic vs secretory diarrhea]
```
Stool >200mL/day
Diarrhea continues despite fasting
Stool Na >70 mEq/L
Reducing substance negative
Stool pH >6
```
Secretory
68
When is endoscopy indicated in FBO?
1. Sharp objects, disc button batteries
2. If with respiratory symptoms
3. Failure to visualize object + symptomatic
69
If blunt object was ingested + asymptomatic, what will you do?
Observe up to 24 hours
70
[Caustic Ingestion]
Ingestion of liquid alkali produces ____
liquefaction necrosis
71
[Caustic Ingestion]
Ingestion of acid causes
coagulation necrosis
72
Presence of circumferential ulcers, white plaques, sloughing of mucosa increases the risk for ____
strictures
73
[Severity of Esophageal Injury by endoscopic appearance]
Erythematous mucosa
Grade 1
74
[Severity of Esophageal Injury by endoscopic appearance]
Erythema, sloughing, ulceration, exudates
Grade 2
75
[Severity of Esophageal Injury by endoscopic appearance]
Eschar, full thickness injury, perforation
Grade 4
76
What are the common causes of acute pancreatitis?
1. Blunt abdominal injury
2. Mumps and other viral illnesses
3. Multisystem disease
4. Congenital anomalies
5. Biliary microlithiasis
6. Drugs and toxins
77
[Acute pancreatitis]
What activates the proenzymes leading to autodigestion?
cathepsin
78
What enzyme activates lecithin to its toxic form which is implicated in acute pancreatitis?
Phospholipase A2
Toxic: lysolecithin
79
[Diagnose]
epigastric pain radiating to the back, steady kind, persistent vomiting, fever,
pain increases in intensity for 24 to 48 hours with vomiting
Acute Pancreatitis
80
Enzyme found in pancreas implicated in hemorrhage secondary to acute pancreatitis
elastase
81
What is the criteria of acute pancreatitis in children
2 of 3
1. Abdominal pain
2. Serum amylase and/or lipase at least 3 times greater than the upper limit
3. Imaging compatible with acute pancreatitis
82
[Amylase vs lipase]
serum amylase remain elevated for up to how many days
4 days
83
[Amylase vs lipase]
which is more specific
Serum lipase
rises by 4-8 hours, weeks at 24 to 48 hours, remains elevated for 8 to 14 days
84
[Acute pancreatitis]
___ sign
refers to a dilated transverse colon
cutoff sign
85
[Acute pancreatitis]
AXR findings suggestive of Acute Panc
1. Sentinel loop
2. Dilated transverse colon
3. Ileu
4. Blurring of the left psoas margin
5. Peripancreatic extraluminal gas bubbles
86
[Acute pancreatitis]
___ focal dilated proximal jejunal loop in the left upper quadrant
sentinel loop
87
[Abd CT: Acute pancreatitis]
what are the abd CT findings of Acute Pancreatitis
1. Pancreatic enlargement
2. Hypoechoic, sonolent, edematous
3. Pancreatic masses
4. Fluid collections
5. Abscess
88
When will you refeed patients with acute pancreatitis?
1. Vomiting has resolved
2. Serum amylase is falling
3. Clinical symptoms resolving
89
What is the first clinical evidence of HBV infection
Elevated ALT
which occurs about 6-7 weeks after exposure
90
What is the most valuable single serologic marker of acute HBV infection since it present as early as HbsAg
Anti-HBcAg
91
___ is the inner portion of the BV that encodes viral DNA
HBcAg
92
____ serves as a marker of active viral infection
HBeAg
93
___ first serologic marker to appear and its rise coincides with the onset of symptoms
HBsAg
94
____ serologic marker that identifies people who have resolved infections with HBV
Anti-HBs
95
___ identifies people with acute, resolved, or chronic HBV infection
Anti-HBc
96
Only serologic marker in HBV that is positive during the window period
Anti-HBc IgM
