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Flashcards in BRS- Gastro Deck (144):
1

Percent of diet comprised of carbs? proteins?

carbs: 50%
protein: less than 30% (2.2g/kg in baby, 0.8 in adults)

2

What are micronutrients

vitamins and trace minerals

3

Vitamin deficiency assc with night blindness and dry cornea

vitamin A

4

Vitamin deficiency that leads to low phosphate levels

vitamin D

5

Vitamin deficiency that leads to poor wound healing, immunodeficiency, skin lesions

zinc

6

Vitamin deficiency that leads to dermatitis, diarrhea, dementia

niacin (pellagra)

7

Vitamin deficiency that leads to edema, bleeding gums, poor wound healing

Vitamin C (scurvy)

8

Describe features of Beriberi + what vitamin deficiency causes it?

cardiac failure
peripheral neuropathy
wernickes

B1, thiamine

9

Vitamin deficiency that causes dermatitis, glossitis, microcytic anemia, peripheral neuritis

B6, pyridoxine

10

B12 (aka ____) causes ____ anemia, elevated _____ levels, and ______sx.

cobalamin
macrocytic
methylmalonic acid
neuro

11

Protein deficiency is called ______. Total calorie deficency causes _____.

protein: kawashiorkor
total: marasmus

12

Kwashiorkor distinct symptoms (3)

hair loss
abnormal skin pigmentation
abdominal swelling

13

Three general symptoms of malabsorption

-diarrhea
-FTT
-abdominal distention

14

Test for carbohydrate malabsorption

-clinitest (tests for reducing sugars)
-pH below 5.6 (bacteria turn sugars to acid)

15

Three causes of protein malabsorption

-congenital enterokinase deficiency
-protein losing enteropathy
-inflammatory disorders

16

Test for protein malabsorption

stool levels of a1-antitrypsin
serum levels of albumin

17

Causes of fat malabsorption

-exocrine pancreatic insufficiency (CF, pancreatitis, schwachman diamond syndrome)
-intestinal mucosal atrophy
-bile acid deficiency
-abetalipoproteinemia

18

Cause of fat malabsorption assc with acanthocytes on peripheral smear

abetalipoproteinemia

19

Schawchman Diamond Syndrome:
-inheritance pattern
-labs
-symptoms

-AR
-neutropenia vs pancytopenia
-FTT, fat malabosorption (PI)

20

Frequency of protein intolerance in children + most common source of reactions

8%, cows milk

21

2 possible manifestations of protein intolerance

enteropathy (progressive diarrhea)
enterocolitis (acute diarrhea + rectal bleeding)

22

Protein intolerance prognosis

usually transitory and resolves within 1-2 years
acute symptoms resolve 1-2 weeks after withdrawl of stimulus

23

How common is celiac disease in the US?
Most common age of onset?

1/250
6 months- 2 years

24

Biopsy location + findings in celiac disease

small bowel
(flat villi, deep crypts, vacuolated epi with lymphocytes)

25

Antibodies assc with celiacs

IgA endomysial
serum tissue transglutaminase
antigliadin IgG

26

Celiacs long term consequences

growth failure + delayed sexual maturity

27

Causes of small bowel syndrome

-congential lesions (gastroschisis, volvulus, atresia)
-post op for nec. enterocolitis
-chrons, tumors, radiation

28

If distal small bowel is missing in SBS, ______ are not reabsorbed

B12, bile acids

29

Treatment for SBS

-TPN
-small bowel transplant with life threatening rxn to TPN

30

Complications assc with TPN:

-TPN cholestasis
-gallstones
-renal stones
-baterial overgrowth
-secretory diarrhea

31

Pathophys of GERD (2)

TLESR
Gastric emptying delay

32

When does emesis assc with GERD generally resolve

6-12 months of age

33

How does painful esophagitis present in a baby?

Sandifer syndrome (torticollis, arched back)

34

Symptoms of esophagitis in older kids:

-chest pain
-morning nausea
-hoarseness
-halitosis

35

Respiratory sequelae assc with GERD

-upper + lower airway disease worsened with GERD due to induced bronchopulmonary constriction

36

Describe progression of esophagitis --> cancer

chronic inflammation leads to : squamous cell --> columnar cell (barretts) --> adenocarcinoma of the esophagus

37

Gold standard for diagnosis of GERD

pH probe measurement
(constant measurement of esophageal pH over 18 hours)

38

Conservative management of GERD:

thicken feeds, sit up after feeds
H2 blockers, PPis

39

Pyloric stenosis:
-MC symptom
-MC sex

-nonbilious projectile vomiting in the second or third week of life
-first born males

40

PE findings in pyloric stenosis + acid base status

"olive" to the upper right of the umbilicus
visible abdominal peristaltic waves
hypochloremic hypokalemic alkalosis

41

Gold standard for diagnosing pyloric stenosis

U/S = string sign

42

Treatment of pyloric stenosis

partial pyloromyotomy

43

Midgut volvulus:
gut rotates around _____
more common in what population?

SMA (assc with Laads bands); males

44

Normal rotation of gut in utero

-counterclockwise around SMA at 10 weeks

45

Diagnosis of volvulus

UI contrast imaging shows ligament of treitz right/ jejunum to the right of midline

46

Classic symptom malrotation:

sudden (bilious) vomiting in otherwise healthy baby

47

Treatment of malrotation:

surgery +/- TPN

48

Cause duodenal atresia + assc condition

failure of small bowel to recanalize at 8-10 weeks
downs syndrome

49

Clinical features duodenal atresia

-polyhydramnios in utero
-scaphoid abdomen
-emesis/ FTT
-double bubble sign on imaging

50

Treatment duodenal atresia

surgical

51

Jejunoileal atresia:
cause
symptoms
dx

mesenteric vascular accident
bilious vomiting in first few days of life
radiographs show air fluid levels at lower SI

52

Treatment of jejunoileal atresia

surgical resection and anastomosis

53

Peak incidence of intussusception; MC location

5-9 month old males; ileocolic

54

How commonly is lead point identified in IS

5% of cases (ie Meckels diverticulum)

55

Clinic features of intussusception

-currant jelly stool
-sudden onset colicky pain
-sausage shaped mass

56

Dx and tx of intussusception

-constrast enema to dx, acutally relieves 80-90% cases, surgical treatment of remaining cases

57

Acute abdomen:
-signs of intestinal obstruction
-signs of peritonitis

obstruction: high pitched bowel sounds
peritonitis: diminished or absent bowel sounds, rigidity

58

In an acute abdomen, CONSTANT pain suggests _____.

-strangulation, torsion

59

Labs for acute abdomen:

-CBC
-U/A
-AST/ALT
-amylase/ lipase
-pregnancy, STDs

60

Peak incidence of appendictis occurs at what age?

10-12 years

61

How soon after onset of symptoms does perforation occur in appendicitis?

+ Location McBurneys

36-48 hours

2/3 between umbilicus and ASIS

62

#1 and #2 causes of pancreatitis in kiddos:

-trauma
-idiopathic

63

Two PE "signs" assc with pancreatitis

Gray Turner- blueish flank regions
Cullens- bluish periumbilical region

64

What lab is most specific for pancreatitis?

lipase (elevated longer than amylase as well)

65

Describe pseudocyst assc with pancreatitis

collection of fluid containing pancreatic enzymes, self resolves in most cases

66

MC management of pancreatitis

supportive

67

Two types of cholecystitis

-calculous
-acalculous (salmonella, shigella, e coli)

68

Three conditions predisposing kiddos to chole

SCA
prolonged TPN
CF

69

Describe "sign" assc with chole:

Murphys- pain with inspiration, causes inspiratory effort to stop with palpation of RUQ

70

Define Chronic abdominal pain:

3+ consecutive months pain

71

Function CAP more common in what sex?

females

72

Describe functional CAP symptoms

5+ year old with periumbilical pain that does not interfere with sleep

73

CAP caused by IBS presents how?

-infraumbilical + stool alterations

74

Screening tests for CAP

-CBC, AST/ALT, BMP
-CRP, ESR
-H pylori
-Lactose breath testing

75

Prognosis CAP

25% persists into adulthood

76

MCC encopresis

severe constipation
(liquid stool leaks around a hard mass of retained stool through distended AR canal)

77

Cause of more frequent stools in infant

breast feeding

78

Average # stools in baby, 1 year, kiddo

baby: 4x/day, 2x/day 1 year, 1x/day kiddos

adults= variable (3x/day-->week)

79

MC form of constipation in kiddos

FFR, caused by sentinel event
if organic, MC is hirschsprungs

80

Symptoms of prolonged FFR:

-encopresis
-fecal halitosis
-anorectal distention

81

Define delayed meconium passage

more than 48 hours after birth

82

Some important systemic causes of constipation
(7)

-DM
-hypothyroid
-lead poisoning
-botulism
-CF
-dehydration
-celiacs

83

IBD age of onset

bimodal (15-20, 50+)

84

Males more commonly suffer from which IBD?

CD has 2:1 male: female predominance

85

Location of inflammation: CD/UC

CD: transmural
UC: mucosa

86

Which has skip lesions? UC/CD?

UC: contiguous
CD: skip lesions

87

Complications of UC:

toxic megacolon
risk colon cancer
pyoderma gangrenosum
sclerosing cholangitis

88

Location of intestine affected by UC:

rectum --> colon, can get proctitis vs pancolitis

89

Location of intestine affected by CD:

any part, most commonly terminal ileum

90

Which IBD is assc with abscesses/ fistulas etc?

CD

91

Antibodies assc with UC

ANCA, 80% of cases

92

Antibodies assc with CD

antisaccharomyces cerevisiae, 70% cases

93

Rectal bleeding is more common in which IBD?

UC

94

Medical treatment for mild IBD

sulfasalazine

95

Treatment of perianal involvement in IBD

metronidazole

96

How is intractable colitis cured in UC?

total proctocolectomy

97

Which is surgery not commonly used in CD?

high recurrence rate post bowel resection

98

Melena is suggestive of blood proximal to _____.

Ligament of Treitz

99

GI bleed is confirmed by _____.
Cause of false negative (1).
Cause of false positive (3)

guiac testing
false negative: excess vitamin C
false positive: beets, iron, red meats, etc.

100

Causes of upper GI bleeding: (4)

-swallowed blood
-ulcers
-mechanical (mallory weiss)
-varices

101

How is ongoing bleding of the upper GI tract assessed?

NG tube + inspect nose, oropharynx for sources

102

Labs for diagnosing GI bleed/ stability

CBC, Hb, platelets, coag, AST/ALT, BUN(elevated)

103

Fluid bolus dose for stabilization in acute GI bleed

20 ml/kg normal saline

104

Drugs for treating GI bleed (4)

-octreotide to constrict varices
-abx for H. pylori
-H2i/PPi for gastritis/esophagitis/ ulcers

105

Newborn + rectal bleed always think _____.
Kid + rectal bleed think _____.

Nec enterocolitis
juvenile polyps most common source in kids

106

Causes of lower GI bleeding (6)

-necrotizing/ infectious enterocolitis
-Juvenile polyps
-allergic colitis
-meckels diverticulum
-HUS, HSP
-IBD

107

CBC findings in HUS

-microangiopathic hemolytic anemia
-thrombocytopenia

108

HSP is _____ mediated.
Sx include (4)

-IgA
-rash at buttocks, arthralgias, renal involvement, GI bleeding

109

Tissue + most common location of Meckels diverticulum

-ectopic gastric tissue
-MC in terminal ileum

110

Presentation of Meckels diverticulum

acute painless rectal bleed

111

Three liver enzymes + which is most sensitive/ specific

-AST (senstitive)
-ALT (specific)
-LDH

112

Three biliary enzymes

-alk phos
-gamma glutamyl transpeptidase (GGTP)
-5 nucleotidase (5NT)

113

Enzyme responsible for bilirubin conjugation

UDP glucuronyl transferase

114

How to measure liver fxn

-albumin
-prothrombin time
-lactate
-ammonia

115

Define infant jaundice

-more than 3mg/dl bili after the neonatal period

116

Cholestatic jaundice is retention of _____.
It is defined as ______.

bile in the liver
more than 2mg/dL conjugated bili, or greater than 15% total bili being conjugated.

117

Percentage of neonates with unconjugated jaundice?
Pattern of spread

50%
cranial to caudal

118

Test of choice for suspected cholestasis

HIDA scan

119

Three pathologic causes of decreased UDP glucuronyl transferase

-Gilbert, 50% enzyme reduction, mild, jaundice with stress
-Crigler Najar I, AR, 100% reduction
-Crigler Najar II, AD, 90% reduction

120

Causes of newborn cholestasis (6)
+ which is most common?

-infection
-mechanical obstruction
-a1at deficiency
-TPN assc disease
-metabolic derangements
- idiopathic hepatitis**

121

Neonatal hepatitis:
cause
predominant sex
incidence
diagnosis
prognosis

idiopathic
male
1/5k-10k
exclusion, biopsy
self resolves in 70%

122

How commonly is jaundice seen in neonatal hepatitis during week 1 of life?

50% of cases, 33% asx until FTT/ more liver symptoms later

123

Treatment for neonatal hepatitis

ursodeoxycholic acid
transplant when refractory

124

Biliary atresia:
incidence
most common age of presentation
dx

1/10,000
2/3 present between week 4-6 of life
intraoperative cholangiogram

125

Biliary atresia:
-treatment
-prognosis if left untreated

Kasai portoenterostomy by 50-70 days of life, transplant if failed or repeated cholangitis occurs

complete obilteration and cirrhosis by 4 months if not treated.

126

Alagille Syndrome
-inheritance pattern
-chromosome
-gene

AD, 20, jagged 1 gene

127

List features of Alagille syndrome

-cholestatic liver disease
-debilitating pruritis
-unusual face
-cardiac disease
-renal/eye/MSK abnormalities
-FTT

128

Two major strains of hep viruses affected kids

A, B

129

What virus types are hep ABCDE

A-picorna
B- DNA
C- flavi, RNA
D- delta, RNA
E- hepe, RNA

130

What hep strain causes disease in 50% of adolescents in undeveloped countries? Also causes hepatic failure in 20% preggos.

Hep E

131

Route of infection for:
A,E
B,C

A,E: fecal oral
B,C: vertical, body fluids, parenteral

132

Antigens positive in early Hep B infxn

HbsAg, HbeAg

133

Antibody assc with vaccination AND/ OR live infection, against Hep B

HbsAb

134

Antibody assc with LIVE infection

HbcAb

135

Antibody assc with lade infection of Hep B

HbeAb

136

Early and late antibodies assc with Hep A infection

IgM, persist for 6 months
IgG, life long, late

137

Hep type most responsible for transfusion assc hepatitis

Hep C

138

Hep D requires _____ to replicate

HbsAg

139

Type 1 autoimmune hepatitis antibodies

ANA, ASMA

140

Type 2 autoimmune hepatitis antibodies

antiliverkidney
anti liver cytosol type 1

141

Most common population suffering from autoimmune hepatitis

females, pre-pubertal

142

PResentation of autoimmune hep

50% acute hep, 50% chronic liver disease

143

Nonhepatic signs autoimmune hep

rash, nephritis, vasculitis, arthritis

144

Three labs used to dx autoimmune hep

autoantibodies
elevated liver enzymes
hypergammaglobulinemia