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Peds > Peds GI uworld > Flashcards

Peds GI uworld Flashcards

1
Q

episodic crying, emesis, bloody stool, lethargy in young child think…

A

intussusception - reducing and recurring

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2
Q

how will abdominal pain manifest in non-verbal child

A

crying and drawing legs to abdomen

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3
Q

currant jelly stool suggests…

A

bowel ischemia

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4
Q

dark and sticky loose stool with streaks of blood think…

A

currant jelly stool

bowel ischemia

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5
Q

diagnosis
treatment
of intussusception

A

ultrasound-guided air contrast enema
(diagnostic and therapeutic… choice)

some places saline enema

if diagnosis less certain, can just ultrasound first

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6
Q 
peds intussusception
path
pres
dx
tx
A

telescoping bowel, periodic, ischemia, infarct

young child episodic crying, emesis, bloody stool (currant jelly), lethargy

ultrasound-guided air contrast enema
(diagnostic and therapeutic)
vs if dx uncertain can US for target sign, sausage sign

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7
Q

why is abdominal CT with contrast not the study of choice for peds intussusception

A

time-consuming (compared to US)
radiation exposure

us guided air contrast enema is diagnostic and therapeutic

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8
Q

anorectal manometry
what does it analyze
common use in peds

A

analyses motility and pressure in distal bowel

for Hirschsprung disease

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9
Q

presentation of Hirschsprung disease

A

neonate with delayed meconium passage or bilious emesis

less commonly enterocolitis in older infant with chronic constipation

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10
Q

risk with enema reduction of telescoped bowel

is the risk high or low

A

low risk of intestinal perforation

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11
Q

why isn’t barium enema preferred to dx and tx intussusception

current preference

A

because if rare case of leak/perf barium can cause peritonitis

so air contrast enema preferred now

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12
Q 
technetium-99m scan
aka...
how does it work...
used to dx...
general presentation of that dx...
A

aka Meckel scan
identifies ectopic gastric tissue
used to dx Meckel diverticulum
which presents with painless rectal bleeding in child typically

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13
Q

tf

intussusception is a pediatric emergency

A

T

rapid dx and tx w ultrasound-guided air contrast enema is critical for avoiding ischemia and peritonitis

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14
Q 
ddx for neonate with delayed passage of meconium
and differentiation according to:
associated disorder
typical level of obstruction
meconium consistency
squirt sign
A

hirschsprung - downs, rectosigmoid obstruction, normal meconium, positive squirt sign

meconium ileus - cystic fibrosis, ileal obstruction, inspissated (thickened/congealed) meconium, negative squirt sign

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15
Q

hirschsprung aka

A

congenital aganglionic megacolon

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16
Q

what percent of healthy, full-term infants pass stool within 48 hours of birth

what to suspect if this is not happening

A

99%

suspect hirschprung or meconium ileus if no stool in 48 hours

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17
Q

how to differentiate hirschsprung from meconium ileus

A

level of obstruction
hirschprung colon, meconium ileus ileum

meconium consistency
hirschsprung normal, meconium ileus inspissated (thickened/congealed)

squirt sign
positive hirschsprung, negative meconium ileus

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18
Q

the earliest life-threatening manifestation of cystic fibrosis

A

meconium ileus

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19
Q

tf

meconium ileus is virtually diagnostic of CF

A

T

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20
Q

basic 1-sentence pathophys of CF

A

mutation in CF transmembrane conductance regulator gene causes abnormal chloride and sodium transport and thick, viscous secretions in multiple organs

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21
Q

pathophys of meconium ileus

A

CF
thick, inspissated meconium difficult to propel
ileal obstruction

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22
Q

upright abdominal xr in meconium ileus

A

multiple dilated loops of small bowel with paucity of air in narrow underdeveloped microcolon

23
Q

baby pt has meconium ileus,
what comorbidity of underlying condition are they most likely to develop?
what likely treatment?

A

chronic rhinosinusitis
(meconium ileus is virtually diagnostic of CF, and nearly all patients with CF develop sinopulmonary disease)
likely to need surgical debridement of sinuses when sx develop

24
Q

what is “squirt sign”

what does it suggest in baby?

A

forceful expulsion of stool after rectal exam

suggests hirschsprungs

25
Q

hirschsprung
underlying dz assoc
comorbiditis to expect

A

alzheimer

hypothyroidism

26
Q

% and pathophys of infertility in CF

A

men - almost all infertile from congenital absence of vas deferens

women - 20% infertile from secondary amenorrhea from malnutrition and thick cervical mucus obstructing sperm entry

27
Q

% and pathophys of sensorineural hearing loss in CF

A

20% sensorineural hearing loss

from frequent treatment with aminoglycosides for gram-negative infections (e.g. pseudomonas aeruginosa)

28
Q

inspissated means

A

thick/congealed

29
Q

manage child who ingested battery

A

get xr

if in esophagus, likely lodged, so immediate endoscopic removal to prevent esophageal erosion

if in stomach, 90% pass uneventfully so observe to confirm excretion and/or follow with radiographs as necessary

30
Q

normal CSF cell count

A

0-5 /mm^3

31
Q

normal CSF glucose

A

40-70 mg/dL

32
Q

normal CSF pressure

A

70-180 mm H2O

33
Q

normal CSF protein

A

v40 mg/dL

34
Q 
normal CSF
cell count
glucose
pressure
protein
A

cell count 0-5 /mm^3
glucose 40-70 mg/dL
pressure 70-180 mm H2O
protein v40 mg/dL

35
Q 
Reye syndrome
etiology
presentation
clinical features (what organs affected)
lab findings
treatment
A

aspirin (salicylates) to kid during influenza or varicella infection

vomiting, abnormal behavior… then seizures, lethargy

acute liver failure
encephalopathy

inc AST ALT PT INR PTT NH3
maybe dec glucose from use and depletion

supportive tx

36
Q

NH3 aka

A

ammoniA

37
Q

is acute liver failure and encephalopathy in Reye syndrome rapid or slow onset?

A

rapid onset

38
Q

major cause of death in Reye syndrome

A

encephalopathy — elevated iCP

39
Q

anticholinergic toxicity
most common drug
presentation

A

diphenhydramine overdose

dry mouth and skin
blurry vision
hyperthermia
urinary retention

40
Q

hep A infection
top 3 presenting symptoms
top 3 labs

A

fever, vomiting, diarrhea

elevated LFTs - AST ALT bilirubin

41
Q

5 risk factors for celiac

A 
first degree FH celiac
down syndrome
autoimmune thyroiditis
type 1 diabetes
selective IgA deficiency
42
Q

celiac dz symptoms

4 GI

3 not GI

A

abdominal pain
flatulence/boating
diarrhea (rarely constipation)
nausea/vomiting

short stature / weight loss
iron deficiency anemia
dermatitis herpetiformis

43
Q

diagnose celiac

A

inc tissue transglutaminase IgA
inc anti-endomyseial antibodies
inc intraepithelial lymphocytes and flattened villi on Duodenal biopsy

44
Q 
celiac disease
path
risk factors
symptoms
diagnosis
A

immune-mediated hypersensitivity to gluten - imparied nutrient absorption in proximal small intestine

first degree FH celiac, down syndrome, autoimmune thyroiditis, type 1 diabetes, selective IgA deficiency

abdominal pain, flatulence/boating, diarrhea (rarely constipation), nausea/vomiting, short stature / weight loss, iron deficiency anemia, dermatitis herpetiformis

inc tissue transglutaminase IgA, anti-endomyseial antibodies, intraepithelial lymphocytes and flattened villi on Duodenal biopsy

45
Q

labs consistent with iron deficiency anemia

A 
microcytic anemia (low Hb, low MCV)
low ferritin
46
Q

how does celiac pt get iron deficiency anemia

A

impaired nutrient absorption from villous atrophy in Proximal Small Intestine aka DUODENUM where iron is absorbed

I’m on faceBook
Do join In
(Iron abdorbed in Duodenum,
B12 absorbed in Ileum?)

47
Q

dermatitis herpetiformis
describe
food allergy association

A

pruritic papular or vesicular rash on knees, elbows, forearms, buttocks

celiac disease

48
Q

fatigue, weight loss, itchy papular/vesicular rash on knees, elbows, forearms, bottocks, iron deficiency anemia…
think…
next step in workup…
and next step if that one is positive…

A

celiac disease
(allergic duodenal inflammation and villous atrophy, poor iron and other nutrient absorption, dermatitis herpetiformis)

anti-tissue transglutaminase antibody assay

followed by endoscopic duodenal biopsy for confirmation

49
Q

in general, what kinds of lab findings might make you consider a bone marrow biopsy

A

abnormal peripheral cell counts

e.g. pancytopenia, leukocytosis

50
Q

confirm suspicion of iron deficiency

A 
microcytic anemia (low Hb low MCV)
low ferritin
51
Q

when to consider hemoglobin electrophoresis for microcytic anemia

A

to exclude thalassemia and other hemoglobinopathies after iron deficiency anemia ruled out with a normal or elevated ferritin

52
Q

what should be followed every 1-2 years in patients with type I diabetes

A

TSH for autoimmune thyroiditis

53
Q

fatigue, anemia, hair loss, brittle nails, constipation in type I diabetic…

think…
1st step in workup…

A

autoimmune hypothyroidism

TSH

Peds (12 decks)

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