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Gastroenterology Flashcards

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1
Q

Acute Diarrhea

A

Excessive loss of fluid and electrolyte stool

infants - >10 mL/kg/day
older children >200 g/24 hr

<14 days

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2
Q

Chronic or persistent diarrhea

A

> 14 days

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3
Q

Watery diarrhea vomiting

Day care center
Infants and Toddlers

A

Rotavirus

ETEC

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4
Q

Watery diarrhea vomiting

Profuse diarrhea and vomiting

Flecks of mucous on voluminous diarrhea

A

Cholera

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5
Q

Watery diarrhea vomiting

Profuse diarrhea after eating raw oysters or undercooked shellfish

A

Vibrio parahaemolyticus

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6
Q

Watery diarrhea vomiting

Greasy stool after camping gas

A

Giardiasis

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7
Q

Watery diarrhea vomiting

after history of travel

A

ETEC

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8
Q

Bloody diarrhea

Pus and WBC in stool

Trophozoites w/ ingested RBCs

A

Amoebiasis

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9
Q

Bloody diarrhea

Pus and WBC in stool

Abdominal cramps, systemic toxicity after antibiotic use

A

Clostridium difficile

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10
Q

Bloody diarrhea

Pus and WBC in stool

Abdominal cramps, tenesmus, abundant pus and WBC in stool

A

Shigella

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11
Q

Bloody diarrhea

Pus and WBC in stool

High fever, headache, drowsiness, confusion, meningismus, seizures, abdominal distention

History of eating eggs, poultry, unpasteurized milk

A

Salmonella

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12
Q

Bloody diarrhea

Pus and WBC in stool

Diarrhea w/ blood after eating hamburger

A

EHEC

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13
Q

Abdominal cramps
Diarrhea
Sweating
No fever

Ham, potato salad, cream pastries

A

Staphylococcus

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14
Q

Bloody diarrhea

Pus and WBC in stool

Home canned food
Muscle weakness
Diplopia
Blurring of vision

A

Botulism

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15
Q

Shiga-toxin producing E.coli;

bloody diarrhea

A

EHEC

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16
Q

Infantile explosive diarrhea with dehydration; few or no structural changes in the gut mucosa

A

ETEC

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17
Q

Cause colonic lesions like dysentery

A

EIEC

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18
Q

Non-bloody diarrhea with mucus; prolonged

A

EPEC

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19
Q

Significant dehydration; prolonged diarrhea

A

EAEC

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20
Q

Drugs used in Cholera

A

Tetracycline (not for <9 yrs old)

OR

Doxycycline

Alternatives
TMP-SMX
Erythromycin
Furazolidone

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21
Q

Incubation period of enteric fever

A

7-14 days

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22
Q

Signs and symptoms of enteric fever

prolonged fever + weird signs and symptoms (may present w/ UTI, pneumonia, GI symptoms, myocarditis etc)

A

High-grade fever, malaise, myalgia, cough, abdominal pain, hepatosplenomegaly, anorexia, diarrhea / constipation

Maculopapular rashes (ROSE SPOTS) in 25% - visible on day 7-10 of illness on the lower chest or abdomen and lasts 2-3 days

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23
Q

Complications of enteric fever

A

Intestinal hemorrhage
Perforation

If with perforation – RLQ pain, tenderness, vomiting, features of peritonitis

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24
Q

Treatment of enteric fever

UNCOMPLICATED

A

Fully Sensitive - CHLORAMPHENICOL

MDR - AMOXICILLIN, FLUOROQUINOLONE or CEFIXIME, AZITHROMYCIN or CEFTRIAXONE

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25
Treatment of enteric fever | COMPLICATED
Fully Sensitive - FLUOROQUINOLONE MDR - FLUOROQUINOLONE QUINOLONE-RESISTANT - CEFTRIAXONE, CEFOTAXIME
26
S dysenteriae serotype 1 produce a potent protein which inhibit exotoxin causes HUS
SHIGA TOXIN
27
Symptoms of Shigellosis
``` severe abdominal pain high fever emesis anorexia generalized toxicity PAINFUL DEFECATION urgency ```
28
Differential diagnosis for Bloody Diarrhea
CEECSY ``` Campylobacter jejuni EIEC Entamoeba histolytica Clostridium difficile Salmonella Yersinia enterolitica ```
29
Empiric Treatment for Shigellosis
Cefixime Ceftriaxone Azithromycin
30
WHO recommendation for all patients w/ BLOODY DIARRHEA irrespective of age
Ciprofloxacin 30 mg/kg/day in 2 divided doses
31
Improves immune response to Shigella
Zinc 20 mg/day for 14 days
32
Abdominal pain Vomiting +/- Distention Bloody currant stool Sausage shaped RUQ mass (-) bowel sounds RLQ COILED SPRING SIGN
Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment MCC of intestinal obstruction b/w 3 mos-6 y/o Correlation w/ ADENOVIRUS
33
Ultrasound finding in intussusception
Target sign
34
Abdominal pain Vomiting +/- Distention post prandial vomiting, NON BILIOUS Down syndrome olive shaped mass barium studies - SHOULDER SIGN, DOUBLE TRACT SIGN
PYLORIC STENOSIS shoulder sign - elongated pyloric channel, bulge of the pyloric muscle into the antrum double tract sign - streaks of barium in the narrowed channel
35
``` BILIOUS VOMITING (-) abdominal distention usually noted on the 1st day ```
DUODENAL ATRESIA DOUBLE BUBBLE SIGN - d.t. distended and gas filled stomach and proximal duodenum
36
MCC of lower intestinal obstruction in neonates MALES Congenital aganglionic megacolon
HIRSCHPRUNG DISEASE (-) ganglion cells in the bowel wall beginning in the internal anal sphincter RECTOSIGMOID - 80%
37
Gold standard for diagnosis of Hirschsprung disease
RECTAL SUCTION BIOPSY
38
Abdominal pain Vomiting +/- Distention normal history or recurrent obstructive symptoms painless rectal bleeding intermittent pain
MECKEL DIVERTICULUM Scintigraphy scan - detect gastric tissue
39
Abdominal pain Vomiting +/- Distention can't pass NGT severe pain and emesis
VOLVULUS OMEGA SIGN COFFEE BEAN SIGN
40
Meckel Diverticulum Rule of 2
``` 2% of the population is affected 2 yrs old on presentation (usually) 2 times more females are affected 2 inches long 2 feet from the ileocecal valve 2 types of common ectopic tissue (gastric and pancreatic) ``` Does not apply 2 everyone!
41
Prolonged elevation of the serum levels of conjugated bilirubin beyond the 1st 14 days of life
NEONATAL CHOLESTASIS
42
Non-cystic Obliterative Cholangiopathy
BILIARY ATRESIA extrahepatic 2 types: fetal and perinatal
43
Cone shaped fibrotic mass cranial to the bifurcation of the portal vein May be seen in patients w/ biliary atresia
TRIANGULAR CORD SIGN
44
Gold standard for the treatment of biliary atresia
Direct Cholangiography
45
Management of Biliary Atresia
Nutritional Support KASAI HEPATOPORTOENTEROSTOMY * 60 days - golden period * success rate much higher if performed before 8 weeks
46
Definitive management for Biliary Atresia
LIVER TRANSPLANT
47
MCC of viral gastroenteritis in infants
Rotavirus
48
Intussusception has correlation with viral infection
Adenovirus
49
MC intestinal segment affected in Hirschsprung disease
Rectosigmoid colon
50
Stool softeners that should be AVOIDED in children with functional constipation
Senna or Bisacodyl
51
Foreign body ingestion needed URGENT removal
Sharp objects Button batteries FBs with respiratory symptoms
52
Required for ALL symptomatic patients who had CAUSTIC ingestion
UPPER ENDOSCOPY
53
MC pancreatic disorder in children
Acute Pancreatitis sentinel loop cutoff sign blurring of the left psoas margin peripancreatic extraluminal gas bubbles
54
TRUE or FALSE Ranson criteria and APACHE score are appropriate prognostic scores for children with acute pancreatitis
FALSE
55
1st clinical evidence of HBV infection
ALT elevation
56
Most valuable single serologic marker for ACUTE HBV infection
anti-HBcAg
57
1st serologic marker to appear in HBV infections Antigen used in Hep B infection
HBsAg
58
Only serologic marker POSITIVE during the WINDOW period of HBV infection
IgM anti-HBc
59
Serologic markers positive in patients who are immune d.t. natural HBV infection
Anti-Hbc | Anti-Hbs
60
Only serologic marker positive in patients who are immune d.t. Hep B vaccine
Anti-Hbs
61
(+) HBsAg | (+) HbeAg
Incubation period
62
(+) HBsAg (+) IgM (+) HBeAg
Acute Infection
63
(+) IgM anti HBc
Window Period
64
(+) anti-HBs | (+) IgG anti HBc
Complete Recovery
65
(+) HBsAg (+) IgG (-) HBeAg
Chronic Carrier
66
(+) HBsAg (+) IgG (+ HBeAg
Chronic Active
67
(+) anti-HBs
Vaccinated

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