Peds GI Flashcards
Swenson procedure
rectosigmoidectomy for HD
Management suspected retained segment in HD
full thickness biopsy
Enteric ganglion cells enable ___ relaxation of the smooth muscle in the intestinal wall
Parasympathetic
Enteric ganglia, nerves, and glial cells develop from what?
enteric neural crest–derived cells (ENCDCs)
Inactivating mutations in this gene –> 15% of sporadic and 50% of familial forms of HD?
RET (tyrosine kinase receptor for glial cell line–derived neurotrophic factor)
Assesses the rectoanal inhibitory reflex.
Anorectal manometry (ARM)
Increased rectal distention -> IAS relaxation
rectoanal inhibitory reflex
Mutated gene a/w HD I/s/o Waardenburg syndrome
Endothelin receptor type B (EDNRB)
Rectoanal inhibitory reflex in HD s/p pull through
Abnormal or absent (some ganglionic rectum in place)
Enteric neural crest–derived cells progress in what direction?
Rostrocaudal
Aganglionosis in retained bowel after surgical resection for HD –>
obstructive symptoms and enterocolitis
Acute radiation enteropathy is due to?
Interruption of normal enterocyte replacement and villous atrophy
MMCs are ____ in radiation enteropathy
Normal
laxative that can cause skin desquamation and blistering
Senna
Stimulant laxatives
Senna, bisacodyl
delayed gastric emptying in the absence of mechanical obstruction
gastroparesis
D/c motility meds __ before gastric emptying study
2 days
Imaging at __ hours after ingestion in adult gastric emptying study
1,2,4
Adult delayed gastric emptying is __ at 2 hours or >10% at 4 hours
> 60%
Adult delayed gastric emptying is >60% at 2 hours or __ at 4 hours
> 10%
FNRFI
functional nonretentive fecal incontinence
FIC1 deficiency
PFIC1
PFIC1
FIC1 deficiency
PFIC2
BSEP deficiency
PFIC3
MDR3 deficiency
PFIC4
TJP2 deficiency
BSEP
bile salt excretory pump
PFIC w/ recurrent disease in allograft liver
PFIC2 (BSEP deficiency)
Treatment of BSEP recurrence
IVIG, ritux, plasmapheresis
PFIC w/ high GGT cholestasis
PFIC3
PFIC w/ low GGT cholestasis
PFIC1, PFIC2, and PFIC4
Canalicular membrane protein that transports bile acids from hepatocyte to canalicular space
BSEP
Initial tx BSEP deficiency
external or internal biliary diversion
Systemic PFIC
PFIC1 (chronic diarrhea, hearing loss, pancreatitis, and asthma-like symptoms)
Tx PFIC3
ursodeoxycholic acid
Bowel lengthening procedures used in short gut
serial transverse enteroplasty (STEP)
Bowel diameter requirement for STEP in short gut
> 4cm
Lactulose decreases ammonia by
acidifying colon (NH4+ not absorbed as well) and osmotic catharsis (expelling urease-producing bacteria)
Tx hepatic encephalopathy
enteral lactulose, enteral rifaxamin
Tx giardia
metronidazole
GERD w/ symptoms without significant evidence of esophageal damage
Nonerosive reflux disease (NERD)
GERD w/ symptoms are related to acid exposure damage to the esophageal epithelium
Erosive reflux disease (ERD)
GERD symptoms w/o acid exposure, reflux correlate, or esophageal motility disorder
functional heartburn
prolonged pH/MII testing
24-hour combined esophageal impedance and pH study
colic tx
lactobacillus reuteri or fennel extract; reassurance
Risk factors associated with CFLD
severe mutation of the CFTR gene, meconium ileus, male sex, and pancreatic insufficiency
inspissated bile and diminished bile flow in apical membrane of cholangiocytes –>
focal biliary cirrhosis in CF
Patients with FBC and large intrahepatic bile duct disease with cirrhosis are at risk for
HCC and cholangiocarcinoma
Patients with CFLD at risk for development of
hepatopulmonary syndrome and portopulmonary hypertension
Prophylaxis for viral gastro
lactobacillus rhamnosus GG
Infants with cholestasis can be at risk for what trace element deficiency?
Copper
Cobalamin (b12) bound to intrinsic factor is absorbed where?
Ileum
Tx esophageal diverticulum 2/2 stricture
dilation
Polyps plus mucocutaneous pigmentation
Peutz-Jeghers syndrome
Peutz-Jeghers gene
STK11
FAP gene
APC (or MUTYH)
JPS gene
SMAD4
WCE approved in older than _ yo
2
In Crohn disease, giving __ w/ infliximab increases duration of response
MTX
Hepatosplenic T-cell lymphoma is a/w
thiopurines
___ phenotype in Crohn disease a/w favorable response to infliximab
inflammatory
the presence of __ or more juvenile polyps suggests polyposis syndrome
5
Thyroid ultrasonography is indicated in children with FAP because of the increased risk of ___
papillary thyroid cancer
incidental malro
surgical consultation for ?Ladd
preferred diagnostic modality for suspected cholelithiasis, cholecystitis, or choledocholithiasis
US
RUQ pain, fever, jaundice, acholic stools, and dark urine
choledocholithiasis
Meckel diverticulum arises from incomplete obliteration of the
omphalomesenteric duct
Conjugates unconjugated bilirubin bound to albumin
UGT 1A1 (uridine diphosphate glucuronosyltransferase)