גסטרו

Question 1

מה כולל רפלקס ההקאות

Answer 1

ירידת הסרעפת, כיווץ שרירי הבטן והרפיה של הקרדיה של הקיבה

Question 2

VACTERL syndrome clinical presentation?

Answer 2

V- vertebral anomalies 70%
A- anorectal malformaiton 50%
C- CV anomalis 30%
T- trachesophageal fistula 70%
E- esophageal atersia
R- Renal anomalies 50%
Limb defects- 70%

לרוב יהיה עורק אומביליקלי אחד

Question 3

which other congenital lesions is most a/w esopahgeal atresia?

Answer 3

Tracheoesopahgeal fistula

90%

Question 4

Dgx of esophageal atresia?

Answer 4

polyhydrmanoius, no air bubble in stomach

inability to pass zonda to the stomach

Tx- urgent surgery

Question 5

first, second the third line for infant reflux?

Answer 5

fisrt line- no tx. 88% resolve within 1 yr of age
2nd line- PPI
3rd line- surgery

Question 6

which disease is more common vomiting, dysphagia, atopic kids, paon in middle upper abdomen?

Answer 6

Allergic esoinophilic esophagitis

Dgx- biopsy
Tx- הפחתת צריכת מזונות אלרגניים, קו שני סטרואידים

Question 7

Bird beak sign? and dgx?

Answer 7

Acaalesia

dgx- monometria

Question 8

vomiting in infant age 1 wk- 5 month, with lab reasults of unconjugated hyperbili + metabolic alkelosis hypochloremic we should suspect?

Answer 8

pyloric stenosis

Question 9

Olive sign in exmination of infant?

Answer 9

pyloric stenosis

Dgx- US

Question 10

Tx for pyloric stenosis?

Answer 10

hydration + elctrolital repair. surgery

Question 11

most common congenital GI malgormation in kids?>

Answer 11

Meckels diverticulum
50% of bleeding from lower GI in kids < 2 yrs

remenmant of vitelline duct in the ilium

Question 12

position of meckel diverticulum?

Answer 12

50-70 cm from iliocecal valve

Question 13

meckel diverticulum

clinical presentation?
complication?
Dgx?
Tx?

Answer 13

clinical presentation:
painless rectal bleeding and anemia < 2 yrs of age
complication- instetine obstruction, diverticulosis, perforation
Dgx- meckel scan = מיפוי טכניציום - will glow in the stomack and in the divrticulum due to ectopic gastric mucosa
Tx- surgical resection

Question 14

מהי אנקופרזיס ובאיזה מצב נוכל לראות אותה בילדים?

Answer 14

בריחת צואה מעל גיל 4.
במצב של עצירות / עצירות פונקציונאלית - אי נוחות ללכת לשירותים בבית הספר / גמילה מוקדמת מדי

Question 15

טיפול בעצירות

Answer 15

ריכוך צואה ותזונה עשירה בסיבים

Question 16

what is the most common cause of obstruction in lower GI tract (colon)

Answer 16

functional obstraction = Hirshpaung

80% in recto-sigmoid part

Question 17

definitive Dgx of Hirshpung?

Answer 17

biopsy with absence of gnaglions (2 cm above dentate line)

Question 18

most common age of intussuscepttion
(התפשלות מעי)

Answer 18

6m-3 yrs

Question 19

conditions that are a/w intussuseption in kids > 3 yrs

4

Answer 19

• HSP
• lymphoma
• Meckels diverticulum
• polyps- most common

Question 20

10 month old present with abdominal pain.
on exmination a sausage like feeling. in RUQ with bloody jelly stool and latregy within colic episode

what is the most likley dgx?
what is the tx?

Answer 20

intussuseption

Tx- air / barium anema 80-95% success rate

Question 21

reccurence rate of intussuseption after anema and after laprotomia?

Answer 21

anema- 10%
surgery- 2-5%

Question 22

Which vaccine is C/I after intussuseption

Answer 22

Rota virus

Question 23

Volvulus
when is mostly common seen?

Answer 23

85% of cases- first year
50% first month

Question 24

X-ray finding of deodunal atresia?

Answer 24

double bubble sign

Question 25

what is the WHO recommendation for chronic diarrhea?

Answer 25

lactose free diet

Question 26

שלשול אוסמוטי לעומת סקרטורי באיזה מהם נמצא חומרים מחזרים בצואה?

Answer 26

שלשול אוסמוטי

Question 27

most common reason for hypoalbuminemia?

Answer 27

loss trough urine due to kidney disease

Question 28

Which marker can suggest loss of protein trough the GI Tract?

Answer 28

eleveted levels od alpha-1- AT in **stool**

Question 29

Low levels of elastase in stool with loss weight is suggest of?

Answer 29

insufficency of exocrine pancreas think CF- most common

Question 30

Which allele is a/w celiac disease?

Answer 30

HLA-DQ2 /8 95% of pt

Question 31

Extra intestianal menefistation of Celiac in neurologic dermatologic endocrine

Answer 31

neuro- megaloblastic anemia- ataxia, neuropathy and epilepsy endocrine- late puberty derma- dermatitis herpetiformis, apthous somatitis

Question 32

Which Autoimmune diseases are in a/w celiac?

Answer 32

**DM type 1** williams turner addison IgA deffic. Sjoren RA down

Question 33

Dgx of celiac for symptomatic pt? for IgA deff. and non IgA deff.

Answer 33

**Dgx** TTG IgA < 10X of normal value >> dueodenal biopsy **or** TTG IgA > 10X of normal value >> HLA + anti- Endomysial - not need also biopsy **for IgA def** TTG IgG+ and as mention above (biopsy or HLA + anti-EM ## Footnote pass for biopsy if TTG = at least X10 for normal value

Question 34

a-symptomatic pt but high risk dgx of celiac? ## Footnote DM-1, Down, Sick 1st relative

Answer 34

HLA >> anti-TTG **Titer Ab > X3** >> biopsy **Titer Ab < X3** >> anti-EM >> biopsy

Question 35

Which conditions are a/w IgA deficiency?

Answer 35

Celiac or like celiac syndrome + Anaphylaxis for blood transfusion Dgx- serum IgA < 10 mg/dL with normal other Ig.

Question 36

which electrolyte disbalance is a/w acute pancreatitis?

Answer 36

Hypocalcemia

Question 37

Tx for acute pancreatitis?

Answer 37

**nasogastric tube PPI** * imipenem- if necrosis or infection * ERCP- if stones * Trauma / abcesses- surgery | prognosis- healing in 4-5 days

Question 38

which Abs are a/w autoimmune pancreatitis?

Answer 38

IgG4 in kids mainly heart involve with normal levels of IgG4 | Tx- steroids

Question 39

Which gene is involve in Wilson disease?

Answer 39

ATP7B should connect copper to ceuroplasmin in order to excrete trough the bile **if ceuroplasim is not connected to copper its going degradation**

Question 40

Dgx of wilson disease?

Answer 40

low levels of ceuroplasmin in blood + high serum copper leves and 24h of high copper in urine

Question 41

Tx for wilson?

Answer 41

D-phenycylamine - copper cathelathor

Question 42

liver damgage + neurologic signs as tremor, worsening hand writing, decrease school performance with hemolytic anemia and low ceuroplasmin levels which disease?

Answer 42

wilson disease

Question 43

Which autoimmune disease can be in a/w Autoimmune hepatitis?

Answer 43

SLE

Question 44

autoimmune hepatitis (AIH) type 1 and type 2 Abs?

Answer 44

high IgG Type 1- ANA, ASMA type 2- anti- LKM1

Question 45

Which type of cells and necrosis in seen in hepatocytes in AIH

Answer 45

Plasma cells and lympocytes Piecemeal necrosis

Question 46

Tx for AIH?

Answer 46

Steroids and Imuran/ MP6

Question 47

Approch to swollowing foreign object: 1. in stomch 2. in esophagus 3. when we need to sugcally intervention

Answer 47

1. in stomch- supportive. 2. in esophagus-endoscopy 3. surgery intervention- > 1 magnet, lead objects, lithum battery, large battey > 48 hrs in stomach, large and sharp objects.

Question 48

C/I for Gastroscopia?

Answer 48

peritonitis signs