Exam 1 Flashcards
(114 cards)
1
Q
when does physiologic reflux resolve
A
12-18 months
2
Q
signs that reflux is pathological (GERD)
A
failure to thrive, food refusal, pain, GI bleeding, respiratory symptoms, Sandifer syndrome
3
Q
risk factors for GERD in older children
A
CF, developmental delay, asthma, hiatal hernia, repaired tracheoesophageal fistula
4
Q
most common foreign body ingestion
A
coins
5
Q
initial imaging for foreign body ingestion
A
plain radiograph
6
Q
imaging for ingestion of a nonradiopaque object
A
contrast esophagram
7
Q
what foreign body should be removed immediately from esophagus
A
button battery
8
Q
when should esophageal foreign bodies be removed
A
within 24 hours
9
Q
esophageal food impaction raises concern for what
A
eosinophilic esophagitis
10
Q
what to do if button battery has passed into stomach
A
consider endoscopic eval for larger batteries or younger children but otherwise it will likely pass
11
Q
what to do about smooth objects in the stomach
A
may be monitored for several weeks
12
Q
what to do about nails or screws in the stomach
A
will generally pass without incident but endoscopic removal may be considered on a case-by-case basis
13
Q
what objects must be removed from stomach
A
double-sided sharp objects, multiple magnets, large and open safety pins, objects longer than 5 cm
14
Q
how many ingested foreign bodies pass spontaneously
A
80-90%
15
Q
symptoms of ingested foreign body
A
dysphagia, odynophagia, drooling, regurgitation, chest pain, abdominal pain, none, cough (if retained in esophagus > 1 week)
16
Q
what is pyloric stenosis
A
pyloric muscular hypertrophy with gastric outlet obstruction
17
Q
pyloric stenosis is more common in ___
A
boys
18
Q
cause of pyloric stenosis
A
unknown, may be associated with neonatal use of erythromycin
19
Q
pyloric stenosis presentation
A
projectile postprandial vomiting, hunger, postprandial upper abdominal distention, 5-15 mm oval mass in RUQ
20
Q
pyloric stenosis age of onset
A
2-4 weeks (up to 12 weeks)
21
Q
metabolic findings of pyloric stenosis
A
hypochloremic alkalosis with potassium depletion
22
Q
imaging for pyloric stenosis
A
ultrasound
23
Q
ultrasound findings of pyloric stenosis
A
hypoechoic muscle ring > 4mm thickness
24
Q
barium upper GI series findings in pyloric stenosis
A
long, narrow pyloric channel with double track of barium
25
pyloric stenosis tx
manage dehydration and electrolyte abnormalities and then surgical repair (Ramstedt pyloromyotomy)
26
most common causes of gastric or duodenal ulcers
H. Pylori infection, NSAID use, underlying illness
27
most common symptoms of gastric/duodenal ulcers in peds < 6 y/o
vomiting, upper GI bleeding
28
most common symptoms of gastric/duodenal ulcers in older children
epigastric pain
29
diagnosis of gastric/duodenal ulcers
upper GI endoscopy with biopsy
30
triple therapy for H. Pylori
PPI, amoxicillin, clarithromycin for 7-10 days
31
quadruple therapy for H. Pylori
PPI, bismuth, metronidazole, tetracycline (doxycycline if < 8 y/o)
32
imaging for esophagitis
upper GI series and modified barium swallow study/esophagram
33
treatment for candida esophagitis
figure out cause, fluconazole
34
treatment for eosinophilic esophagitis
swallowed corticosteroid, PPI, refer for allergy testing and/or elimination diet
35
classic appearance of H pylori on EGD
nodular gastritis of stomach
36
what medication can be added to PPI for ulcer healing
sucralfate
37
when does hypertophy of muscle begin in pyloric stenosis
postnatally
38
predisposing conditions for mallory-weiss tears
portal hypertension, cirrhosis, severe GERD
39
typical location of mallory-weiss tear
gastroesophageal junction
40
etiology of mallory-weiss tear
longitudinal tears caused by elevated intrabdominal pressure
41
mallory weiss tears are more common in what age group
older children/adolescents, but can present at any age
42
mallory-weiss tear presentation
hematemesis (usually after several bouts of vomiting), melena, symptoms of volume depletion, abdominal pain (due to underlying cause of vomiting)
43
labs for mallory-weiss tear
CBC, coag studies
44
diagnosis of mallory-weiss tear
no specific imaging, generally diagnosed on EGD as one or more linear bleeding lesions at or just proximal gastroesophageal junction
45
when must endoscopy be performed for mallory-weiss tear
within 24 hours of bleeding
46
mallory-weiss tear treatment
determine underlying cause of vomiting, tears typically resolve spontaneously, but severe cases can be treated with systemic vasopressin or surgery (in extreme cases). No special diet is required
47
most common type of cholelithiasis < 10 y/o
black bile stones
48
most common type of cholelithiasis > 10 y/o
cholesterol stones
49
most common cause of cholecystitis in peds
cholelithiasis
50
GERD risk factors
preterm birth, chronic lung disease, cerebral palsy
51
when can gallstones start to form
in utero
52
gallstones ssx
acute/recurrent postprandial RUQ/epigastric pain radiating substernally, back, or right shoulder, N/V, +/- jaundice, fever
53
location of gallstone if jaundice present
common duct or ampulla hepatopancreatica
54
gallstones risk factors
hemolytic disease, females, obesity, rapid weight loss, portal vein thrombosis, "certain ethnic groups (Pima Indians/Hispanics)", Crohns disease, CF, parenteral nutrition
55
labs for gallstones
CBC, gamma-glutamyltransferase (GGT), amylase, CMP
56
diagnostic criteria for acute pancreatitis
at least 2 of the following: upper abdominal pain, amylase/lipase > 3x upper limit, imaging consistent with acute pancreatitis
57
classic presentation of acute pancreatitis
epigastric pain radiating to the back, N/V; tender but not rigid abdomen, diminished bowel sounds, +/- ascites and left pleural effusion
58
most common causes of acute pancreatitis
idiopathic (20%), drugs, viral infections, systemic disease, abdominal trauma, obstruction of pancreatic flow
59
presentation of acute pancreatitis in infants and younger children
abdominal distention with classic symptoms less common
60
indicators of poor prognosis in acute pancreatitis
leukocytosis, hyperglycemia, falling hematocrit, rising BUN, hypoxemia, acidosis
61
initial imaging for acute pancreatitis
ultrasound followed by CT
62
treatment of acute pancreatitis
pain control, decompression of biliary system if obstructed, fluids (LR), enteral feeding, gastric decompression,
63
definition of cyclic vomiting syndrome
recurrent episodes of intense, unremitting nausea and paroxysmal vomiting with return to normal between episodes
64
prognosis of acute pancreatitis
good
65
associated symptoms in cyclic vomiting syndrome
mallory-weiss tear, autonomic symptoms (pallor, sweating, lethargy
66
cyclic vomiting syndrome is associated with what condition
migraines
67
cyclic vomiting syndrome treatment (acute)
avoid triggers, diphenhydramine/lorazepam to induce sleep, antimigraine medications, IV fluids
68
common population affected by cyclic vomiting syndrome
toddlers
69
when does colic occur
2-3 months
70
colic rule of 3s
cries for more than 3 hours per day, more than 3 days per week, for more than 3 weeks
71
causes of swallowing/feeding difficulties
oral-motor dysfunction (due to developmental delay or neuro problem), chronic conditions leading to fatigue, GI pain, emotional/social trauma, enteral/IV nutrition
72
prophylactic cyclic vomiting syndrome treatment
<5 y/o cyproheptadine, >5 y/o amitriptyline
73
dosing consideration for PPI
must take at least 30 minutes before eating
74
major risk factor for celiac disease
type I DM
75
triggers of celiac disease
wheat, rye, barley, some cross-reactivity with oats
76
GI manifestations of celiac (typical)
abdominal pain, diarrhea, vomiting, anorexia, distention, +/- constipation,
77
non-GI manifestations of celiac (atypical)
oral ulcers, dermatitis herpetiformis, growth/pubertal delay, IDA, arthritis, elevated LFTs, behavioral problems, migraines, electrolyte derangements
78
celiac age of onset
6-24 months
79
definition of food intolerance
non-immunologic adverse reaction, inability to digest/metabolize certain foods
80
2 classes of food allergies
immuno-related (IgE-mediated), non immuno-related (not IgE-mediated)
81
definition of adverse food reaction
untoward response to a food
82
valid immunologic tests
serum specific IgE, skin testing
83
valid non-immunologic tests
tTG-IgA/IgG, biopsies, lactose breath test
84
silent celiac disease is characterized by
intestinal damage and positive serology but no symptoms
85
pathophysiology of celiac disease
gluten triggers an inflammatory response leading to damaged microvilli and malabsorption
86
serologic testing for celiac disease
tTG-IgA + total IgA
87
initial testing for celiac disease
serology
88
when to use tTG-IgG + total IgG for celiac disease
if under 4 y/o
89
if celiac disease serology is positive
refer to GI
90
gold standard for celiac disease diagnosis
villous atrophy with intraepithelial lymphocytes on biopsy
91
celiac disease treatment
gluten-free diet, refer to dietician, regular follow up with labs q 4-12 months
92
lactose intolerance pathophys
no lactase to break down lactose into glucose and galactose, so it remains in the gut and gets fermented by bacteria, causing ssx
93
usual age of onset for primary lactose intolerance
around 5
94
causes of secondary lactose intolerance
celiac disease, crohn's disease, prematurity
95
lactose intolerance diagnosis
hydrogen breath test
96
cow's milk protein allergy presentation
healthy infant with slow onset of blood-streaked stools
97
who does cow's milk protein allergy affect
more often males with history of atopy, resolves by 1 y/o
98
cow's milk protein allergy treatment
supervised maternal elimination diet, hydrolyzed/hypoallergenic formula
99
testing to consider for cow's milk protein allergy
abdominal x-ray, hemoglobin/hematocrit
100
most common outgrown IgE-mediated food allergies
milk, egg, soy, wheat
101
most common persistent IgE-mediated food allergies
peanuts, tree nuts
102
diagnosis of food allergies
clinical history, skin prick testing, IgE serum testing
103
cow's milk protein allergy in older children
can be more severe, may cause eosinophilic gastroenteritis with protein-losing enteropathy, IDA, etc
104
diagnostic criteria for IBS
abdominal pain 1 day/week x 2 months with 2 or more criteria: related to defecation, change in stool frequency, change in stool form
105
medications for IBS
anti-diarrheals, laxatives, antispasmodics, antidepressants
106
IBS non-medication treatment
stress relief, peppermint, low-FODMAP diet
107
which SSRI is commonly used for functional GI disorders
citalopram
108
which tricyclic is commonly used for functional GI disorders
amitriptyline
109
what must be done prior to initiation of amitriptyline
get an EKG
110
what beta blocker is commonly used for functional GI disorders
propranolol
111
testing when evaluating for functional GI disorders
CBC w/ diff, UA, celiac panel, stool studies, thyroid, abdominal US, endoscopy
112
what stool study tests for inflammation
calprotectin
113
abdominal migraine presentation
episodic, incapacitating mid-abdominal pain lasting at least 1 hour with weeks-months in between episodes, with other migraine ssx (pallor, photophobia, N/V, HA)
114
functional abdominal pain presentation
episodic or constant abdominal pain not explained by another disorder, associated with stress
