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Peds Boards > GI > Flashcards

GI Flashcards

1
Q

Features of Crohn’s Disease

A 
ThE PUSHPIN
T: transmural ulcers
E: erythema nodosum 
P: perianal fistulas
U: uveitis 
S: skip lesions - top to bottom
H: hepatic disease
P: pyoderma gangrenosum 
I: inflammatory markers (ESR, CRP)
N: noncaseating granulomas
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2
Q

Tests for Celiac disease

A

Stool:

  • split fats
  • reducing substances

Blood:

  • antiendomysial antibodies
  • anti-TTG (more sensitive)
  • anti-DPG (highest specificity)

Gold standard: upper endoscopy with duodenal biopsy showing villous atrophy

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3
Q

Irritable bowel syndrome

A
  1. Noninvasive testing (CBC, ESR, anti-TTG, stool guiac –>
  2. Fiber trial –>
  3. EGD and/or colonoscopy –>

If these fail, you can diagnose IBS

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4
Q

Hirschprung Disease

A

Aganglionic segment of bowel (lack of parasympathetic innervation) that is narrow or contracted that can result in magacolon proximal to that segment.

The affected segment is the narrow segment.

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5
Q

Pyloric stenosis

A
  • Non-bilious projectile vomiting
  • Labs: hypochloremic hypokalemic metabolic alkalosis
  • Pylorus: > 14 mm long or > 4 mm thick
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6
Q

Volvulus

A
  • Bilious emesis
  • Malrotation -> poorly fixed bowel -> bowel wraps around SMA (may cause ischemic bowel) -> bloody stools
  • Double bubble sign on imaging
  • Gold standard study: upper GI series
  • May see “corkscrew” appearance of duodenum
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7
Q

Duodenal Atresia

A
  • Bilious emesis on DOL 1
  • possible jaundice due to increased enterohepatic circulation
  • KUB: double bubble (only if incomplete atresia)
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8
Q

Intussusception

A
  • Often in ileocecal area
  • Currant jelly stools
  • Abdominal pain, bilious emesis, palpable mass
  • Ages: 3 months - 6 years
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9
Q

Meckel’s Diverticulum

A
  • Contains all 3 layers of bowel wall
  • Large volumes of painless rectal bleeding
  • Most present before 2 years of age
  • Found in 2% of population
  • Located 2 ft from ileocecal valve
  • Most are 2 inches in length
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10
Q

What is the inheritance pattern for familial adenomatous polyploid?

A

Autosomal dominant

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11
Q

Presentation for familial adenomatous polyposis

A

Painless rectal bleeding -> polyp found on evaluation in a child less than 10 years of age

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12
Q

When is the colon resected in a child with FAP?

A
  • Yearly screening for polyps after 10 years of age
  • Once large adenomas (>1 cm) are found
  • After age 25 years
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13
Q

What is esophageal perforation associated with?

A
  • Marfan syndrome
  • Ehlers-Danlos
  • Epidermolysis bullosa
  • Ingestion of bases
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14
Q

What is a single umbilical artery associated with?

A

VACTER-L syndrome

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15
Q

What are the five things that can cause rectal prolapse?

A
  • Constipation
  • Diarrhea
  • Polyps
  • Trichuris/Whipworm
  • Shigella
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16
Q

What is congenital hepatic fibrosis associated with?

A

Polycystic kidney disease

Can lead to varices and portal hypertension

17
Q

What is gallbladder hydrops and what is it associated with?

A
  • Right upper quadrant pain from acute swelling or distention without gallstones
  • Associated with fasting, HSP, Kawasaki syndrome, strep pharyngitis, TPN
18
Q

What is primary sclerosing cholangitis and what is it associated with?

A
  • Chronic cholestatic liver disease from autoimmune inflammation -> fibrosis of the intrahepatic and extrahepatic biliary tree
  • ERCP: beading and stenosis of the biliary ducts
  • Associated with ulcerative colitis
19
Q

How do you differentiate hepatocellular jaundice from cholestatic jaundice?

A
  • Hepatocellular jaundice: associated transaminitis

- Cholestatic jaundice: marked elevation in alkaline phosphatase

20
Q

What will be the clinical findings of neonatal cholestasis?

A
  • Jaundice, pale stools, hepatomegaly
  • ⬆️ conjugated bilirubin
  • HIDA scan: uptake without excretion due to obstructive process
21
Q

What causes kernicterus: conjugated or unconjugated bilirubin?

A

Unconjugated bilirubin

22
Q

What are the clinical features of biliary atresia?

A
  • ⬆️ conjugated bilirubin

- Can result in liver failure

23
Q

What are the clinical findings of a choledochal cyst?

A
  • Congenital cystic dilation of biliary tree
  • Sxs: RUQ abdominal pain, abdominal mass, nausea, vomiting, pancreatitis
  • Increased risk of cancer
24
Q

What are the clinical features of alagile syndrome?

A
  • Neonatal jaundice
  • Liver:
    • Paucity of bile ducts
  • Heart:
    • Pulmonary stenosis
    • TOF
  • Features:
    • Small chin -> triangular jaw
    • ⬆️ cholesterol, xanthomas
    • Eye abnormalities
    • Acholic stools
25
Q

What are the features of Gilbert’s Syndrome?

A 
"GUC DRC"
Gilbert's
Unconjugated
Crigler-Najjar
Dublin Johnson
Rotor
Conjugated
  • Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
  • Autosomal recessive
  • Benign
  • Noted at times of illness or stress
26
Q

What are the features of Crigler-Najjar Syndrome?

A 
"GUC DRC"
Gilbert's
Unconjugated
Crigler-Najjar
Dublin Johnson
Rotor
Conjugated
  • Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
  • Type I: NO DIRECT BILIRUBIN; jaundice in first few days of life; lifelong phototherapy
  • Type II: some glucuronyl transferase activity
27
Q

How is Wilson’s disease treated?

A

Penicillamine, a copper chelator

28
Q

How do you screen family members for Wilson’s disease?

A

Obtain a ceruloplasmin level

  • Primary copper carrying protein made in the liver
  • If low, suggests Wilson’s disease
29
Q

What is cholangitis?

A
  • A medical emergency
  • Infection in the biliary tract
  • Charcot’s triad: fever, RUQ pain, leukocytosis
30
Q

What is the most common etiology of nodular gastritis?

A

H. Pylori

Gold standard for Dx: EGD with bx
Can be seen in Crohn’s disease

31
Q

What is Zollinger Ellison syndrome?

A
  • Gastrin tumor of the pancreas -> multiple GI ulcerations
  • Diagnose with high fasting gastric level
  • Associated with MEN I (PPP tumors: Pituitary, Parathyroid, Pancreas
32
Q

What are the clinical features of ulcerative colitis?

A

ULCERS IN ABDomen

Ulcers (mucosal and submucosal)
Large intestine (rectum always involved)
Clubbing of fingers
Extra-intestinal manifestations (e.g. Erythema nodosum)
Remnants of old ulcers (pseudopolyps)
Stools bloody
Inflamed, red granular mucosa/submucosa
Neutrophil invasion
Abscesses in crypts
Biochemical markers of inflammation (⬆️ESR)
Diarrhea (esp. in pancolitis)
33
Q

What are the clinical features of congenital hypothyroidism?

A
  • Constipation
  • Delayed anterior fontanelle closure
  • Hoarse cry
  • Poor growth
  • Umbilical hernia
34
Q

What are some prophylactic medications that may be used in patients with cyclic vomiting?

A

(May be a FHx of migraines or IBS.)

Amitriptyline
Cyproheptadine
Propranolol

(A diagnosis of exclusion, so make sure some sort of work up is done first.)

Peds Boards (24 decks)

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