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Pediatrics > Pediatric Gastroenterology > Flashcards

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

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2
Q

Non-cystic obliterative cholangiopathy is also called ___

A

Biliary atresia

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3
Q

What is the most common form of biliary atresia

A

Obliteration of the entire extrahepatic biliatry at or above the prota hepatis

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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

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5
Q

What is the most common cause of acute diarrhea in infants?

A

Rotavirus

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6
Q

Acute diarrhea is defined as ____ in infants

A

Loose stools >10mL/kg/day

lasting <14 days

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7
Q

Acute diarrhea is defined as ____ in older children

A

> 200g/day

lasting <14 days

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8
Q

Cut of days for chronic or persistent diarrhea

A

> 14 days

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9
Q

[Non-inflammatory diarrhea]

Watery, vomiting

Day care center, infants and toddlers

A
  1. Rotavirus

2. ETEC

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10
Q

[Non-inflammatory diarrhea]

Watery, vomiting

profuse diarrhea, flecks of mucous on voluminous diarrhea

A

Cholera

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11
Q

[Non-inflammatory diarrhea]

Watery, vomiting

eating raw oysters or undercooked shellfish

A

V. parahaemolyticus

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12
Q

[Non-inflammatory diarrhea]

Watery, vomiting

greasy stool after camping

A

Gardiasis

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13
Q

[Non-inflammatory diarrhea]

Watery, vomiting after history of travel

A

ETEC

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14
Q

When do you use antibiotics fro diarrhea?

A
  1. Shorten the duration of illness
  2. Reduce period of excretion of the organism
  3. Decrease the requirements for fluid therapy
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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

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16
Q

Alternative drug used for cholera

A
  1. Doxycycline 5mg/kg PO SD (max 200mg/day)
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17
Q

[Diagnose]

High grade fever, malaise, myalgia, cough, abdominal pain, hepatosplenomegaly, anorexia, diarrhea/constipation

rose spots

A

Enteric Fever

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18
Q

What are the complications of Typhoid Fever?

A
  1. Intestinal hemorrhage

2. Perfiration

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19
Q

[Typhoid fever
treatment]

Uncomplicated typhoid fever

A

Chloramphenicol

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20
Q

[Typhoid fever
treatment]

Uncomplicated typhoid fever, multidrug resistant

A
  1. Amoxicillin

2. Fluoroquinolone or Cefixime

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21
Q

[Typhoid fever
treatment]

Uncomplicated typhoid fever, quinolone resistant

A
  1. Azithromycin

2. Ceftriaxone

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22
Q

[Typhoid fever
treatment]

Severe typhoid fever

A

Fluoroquinolone

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23
Q

[Diagnose]

Bloody diarrhea, pus and WBC in stool

Trophozoites with ingested RBCs

A

Amoebiasis

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24
Q

[Diagnose]

Bloody diarrhea, pus and WBC in stool

abdominal cramps, recent use of systemic antibiotics

A

C. defficile

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25
Q

[Diagnose]

Bloody diarrhea, abundant pus and WBC in stool

abdominal cramps, tenesmus, painfull defecation, urgency

A

Shigella

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26
Q

[Diagnose]

Bloody diarrhea, pus and WBC in stool

high fever, headache, drowsiness, confusion, meningismus,

history of eating eggs, poultry, unpasturized milk

A

Salmonella

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27
Q

[Diagnose]

Bloody diarrhea, pus and WBC in stool

after eating hamburger

A

EHEC

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28
Q

[Diagnosis]

abdominal cramps, diarrhea, sweating, no fever

after eating ham, potato salad, cream pastires

A

staphylococcus

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29
Q

[Diagnosis]

abdominal cramps, diarrhea, sweating, no fever

after eating reheated fried rice

A

B. aureus

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30
Q

[Diagnosis]

abdominal cramps, diarrhea, sweating, no fever

after eating home-canned foods

Diplopia, BOV, muscle weakness

A

Botulism

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31
Q

Shiga-toxin producing E. coli

A

EHEC

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32
Q

What serotype of shigella produce Shiga toxin that can cause HUS

A

S. dysenteriae serotype 1

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33
Q

What are the criteria for presumptive diagnosis of shigella

A
  1. Fecal leukocytes > 50 to 100 PMNS/hpf
  2. Fecal blood
  3. Increased WBC in CBC
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34
Q

What are the criteria for definitive diagnosis of Shigella?

A
  1. Culture of stool and rectal swab
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35
Q

How will you empirically treat shigella

A

WHO:
1. Ciprofloxacin 30mg/kg/day in2 divided doses

  1. Zinc 20mg/day for 14 days

OR

  1. Cefixime 8mg/kg/day PO every 12 hours for 5 days
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36
Q

[Intestinal Obstruction]

Early onset vomiting

A

Duodenal atresia

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37
Q

[Intestinal Obstruction]

Which is associated with obstruction, bilous or non-bilous vomiting

A

Bilous

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38
Q

What is the most common cause of intestinal obstruction between 3 months to 6 years of age

A

Intussusception

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39
Q

[Diagnose]

Severe paroxysmal colicky pain that recurs at frequent intervals with straining efforts;

legs and knees are flexed with loud crying;

currant jelly stools

A

Intussusception

40
Q

What is the classic finding of intussusception in barium enema?

A

Coiled-spring sign

41
Q

What is the classic finding of intussusception in ultrasound?

A
  1. Tubular mass

2. Doughnut or target sign

42
Q

Modality of reducing intussusception with the highest chance of bowel perforation

A

Barium + hydrostatic reduction

43
Q

What is the confirmatory test for pyloric stenosis

A

Ultrasound

Pyloric thickness >4mm or length >14mm

44
Q

[Pyloric stenosis: Findings in barium swallow]

___ sign

Elongated pyloric channel
Bulge of the pyloric muscle into the antrym

A

Shoulder sign

45
Q

[Pyloric stenosis: Findings in barium swallow]

___ sign

elongated pyloric channel, streaks of barium in the narrowed channel

A

Double tract sign

46
Q

[Diagnose]

irritable, slightly tachycardic, no retraction, CBS, (+) firm movable 2x2 mass on the abdomen

A

pyloric stenosis

47
Q

Duodenal atresia is due to failure to recanalize the lumen during the ____ week of gestation

A

4th to 5th week

48
Q

What is the hallmark of duodenal atresia>

A

Bilous vomiting without abdominal distention on the first day of lige

49
Q

What is the pathognomonic abdominal x-ray finding in Duodenal atresia?

A

Double bubble sign

50
Q

What is the most common cause of lower intestinal obstruction in neonates?

A

Hirschsprung disease

51
Q

Genes affected in Hirschsprung disease

A
  1. RET genes on Chr 10q11

2. EDNRB gene on Chr 13q22

52
Q

What is the gold standard in diagnosing hirschsprung disease?

A

Rectal Suction Biopsy

53
Q

Age at which a definitive repair can be done in patients with Hirschsprung disease

A

6-12 months

Temporary colostomy for the mean time

54
Q

[Diagnose: intestinal obstruction]

Coffee bean sign or omega sign on AXR

A

Volvulus

55
Q

[Diagnose: intestinal obstruction]

sausage-shaped RUQ mass, absence of bowel sounds on RLQ

coiled spring sign on AXR

A

Intussusception

56
Q

[Diagnose: intestinal obstruction]

olive shaped mas

Barium: Shoulder sign, double tract sign

A

pyloric stenosis

57
Q

[Diagnose: intestinal obstruction]

Normal history or recurrent obstructive, painless rectal bleeding, intermittent pain

A

Meckel

58
Q

What is the rule of 2 in Meckel Diverticulum

A 
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
Q

Definition of constipation

A

Delay or difficulty in defecation present for 2 weeks or longer; cause significant distress to the patient

60
Q

____ voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months

A

encopresis

61
Q

___ ecnopresis + overflow incontinence

A

Retentive encopresis

62
Q

___ without constipation and incontinence

A

Non retentive encopresis

63
Q

[Rome III Criteria]

For infants and toddlers

A

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
Q

[Rome III criteria]

children with developmental age of 4-18 years old

A

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
Q

What are the preferred stool softener in patients with functional constipation

A
  1. Polyethylene glycol
  2. Lactulose
  3. Mineral oil

Prolonged use of Senna or Bisacodyl should be avoided

66
Q

[Osmotic vs secretory diarrhea]

Stool <200mL/day
stops when fasting
Stool Na<70 mEq/L
Reducing substances positive
Stool pH <5
A

Osmotic

67
Q

[Osmotic vs secretory diarrhea]

Stool >200mL/day
Diarrhea continues despite fasting
Stool Na >70 mEq/L
Reducing substance negative
Stool pH >6
A

Secretory

68
Q

When is endoscopy indicated in FBO?

A
  1. Sharp objects, disc button batteries
  2. If with respiratory symptoms
  3. Failure to visualize object + symptomatic
69
Q

If blunt object was ingested + asymptomatic, what will you do?

A

Observe up to 24 hours

70
Q

[Caustic Ingestion]

Ingestion of liquid alkali produces ____

A

liquefaction necrosis

71
Q

[Caustic Ingestion]

Ingestion of acid causes

A

coagulation necrosis

72
Q

Presence of circumferential ulcers, white plaques, sloughing of mucosa increases the risk for ____

A

strictures

73
Q

[Severity of Esophageal Injury by endoscopic appearance]

Erythematous mucosa

A

Grade 1

74
Q

[Severity of Esophageal Injury by endoscopic appearance]

Erythema, sloughing, ulceration, exudates

A

Grade 2

75
Q

[Severity of Esophageal Injury by endoscopic appearance]

Eschar, full thickness injury, perforation

A

Grade 4

76
Q

What are the common causes of acute pancreatitis?

A
  1. Blunt abdominal injury
  2. Mumps and other viral illnesses
  3. Multisystem disease
  4. Congenital anomalies
  5. Biliary microlithiasis
  6. Drugs and toxins
77
Q

[Acute pancreatitis]

What activates the proenzymes leading to autodigestion?

A

cathepsin

78
Q

What enzyme activates lecithin to its toxic form which is implicated in acute pancreatitis?

A

Phospholipase A2

Toxic: lysolecithin

79
Q

[Diagnose]

epigastric pain radiating to the back, steady kind, persistent vomiting, fever,

pain increases in intensity for 24 to 48 hours with vomiting

A

Acute Pancreatitis

80
Q

Enzyme found in pancreas implicated in hemorrhage secondary to acute pancreatitis

A

elastase

81
Q

What is the criteria of acute pancreatitis in children

A

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
Q

[Amylase vs lipase]

serum amylase remain elevated for up to how many days

A

4 days

83
Q

[Amylase vs lipase]

which is more specific

A

Serum lipase

rises by 4-8 hours, weeks at 24 to 48 hours, remains elevated for 8 to 14 days

84
Q

[Acute pancreatitis]

___ sign

refers to a dilated transverse colon

A

cutoff sign

85
Q

[Acute pancreatitis]

AXR findings suggestive of Acute Panc

A
  1. Sentinel loop
  2. Dilated transverse colon
  3. Ileu
  4. Blurring of the left psoas margin
  5. Peripancreatic extraluminal gas bubbles
86
Q

[Acute pancreatitis]

___ focal dilated proximal jejunal loop in the left upper quadrant

A

sentinel loop

87
Q

[Abd CT: Acute pancreatitis]

what are the abd CT findings of Acute Pancreatitis

A
  1. Pancreatic enlargement
  2. Hypoechoic, sonolent, edematous
  3. Pancreatic masses
  4. Fluid collections
  5. Abscess
88
Q

When will you refeed patients with acute pancreatitis?

A
  1. Vomiting has resolved
  2. Serum amylase is falling
  3. Clinical symptoms resolving
89
Q

What is the first clinical evidence of HBV infection

A

Elevated ALT

which occurs about 6-7 weeks after exposure

90
Q

What is the most valuable single serologic marker of acute HBV infection since it present as early as HbsAg

A

Anti-HBcAg

91
Q

___ is the inner portion of the BV that encodes viral DNA

A

HBcAg

92
Q

____ serves as a marker of active viral infection

A

HBeAg

93
Q

___ first serologic marker to appear and its rise coincides with the onset of symptoms

A

HBsAg

94
Q

____ serologic marker that identifies people who have resolved infections with HBV

A

Anti-HBs

95
Q

___ identifies people with acute, resolved, or chronic HBV infection

A

Anti-HBc

96
Q

Only serologic marker in HBV that is positive during the window period

A

Anti-HBc IgM

Pediatrics (15 decks)

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