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Flashcards in Gastroenterology 2 Deck (20):
0

Functional fecal retention?

Behavioral pattern of stool withholding that may lead to large amounts of retained feces, encopresis, painful diarrhea,

1

when to suspect Organic versus functional fecal retention?

Organic:
1. delayed meconium passage
2. constipation during infancy
3. history of pelvic surgery
4. encopresis younger than three,
5. inability to toilet train

Constipation after toilet training, sentinel event (abuse, diarrhea, painful stool)

2

Examples of organic causes of constipation?

1. Hirschsprung's disease
2. NeuroEnteric dysfunction
3. Medications (narcotics/sedatives)
4. Low fiber
5. Anatomic
6. Systemic (dehydration, hypothyroid, cystic fibrosis, diabetes)
7. Infant botulism
8. Lead toxicity
9. Anorexia

3

Ulcerative proctitis?

Ulcerative colitis restricted only to the rectum

4

Antibody in UC versus Crohn's disease?

P-ANCA versus Anti-Saccharomyces

5

Pharmacotherapy for IBD? If perianal involvement?

1. Sulfasalazine – mild disease
2. Corticosteroids
3. Immunosuppressive agents – long-term remission
4. Metronidazole if perianal involvement

6

Melena indicates bleed proximal to?

Ligament of Treitz

7

Reasons to get a false positive guaiac test? False negative?

Iron, rare meat, beats, cantaloupe, broccoli, cauliflower

Large dose of vitamin C

8

Patient with upper G.I. bleed – management?

1. IV axis with two large-bore prefer lines
2. Rapid fluid bolus of 20 mL per kilogram
3. Octreotide/vasopressin to constrict varices
4. Antibiotics for H pylori,
5. H2-blockers/PPI's for gastritis/esophagitis
6. Endoscopy if active bleeding or Leapley
7. Arteriographic embolization for serious bleeding from AVMs
8. Surgery if ulcer with active bleeding, perforation, varices

9

Necrotizing enterocolitis – clinical picture? Juvenile polyp? Meckel's diverticulum? Henoch-Schonlein purpura?

1. Rectal bleeding, feeding intolerance, abdominal distension
2. Painless intermittent bleeding
3. Painless, acute rectal bleeding
4. Purpuric rash on buttocks, joint arthralgias, renal involvement, intussusception, bowel perforation

10

Markers with increasing specificity for biliary disease?

5'-nucleotidase >Gamma glutamyl transpeptidase > alkaline phosphatase

11

Cholestatic jaundice?

1. Retention of bile within the liver
2. Direct bilirubin >2 or >15% of total

12

Crigler-Najjar type one versus type two?

1 – 100% percent absence of enzyme activity, Autosomal recessive
2– 90% absence of enzyme, autosomal dominant

13

Neonatal hepatitis – diagnostic criteria? Features? Management?

Idiopathic hepatic inflammation during the neonatal period. diagnosis of exclusion

1. Transient jaundice, and acholic stools in first week of life
2. They progress to liver failure, cirrhosis, portal hypertension

1. Increased nutritional support
2. Ursodeoxycholic acid
3. Liver transplantation

14

Biliary atresia – clinical features? Progression? Associated with?

1. Jaundice, dark urine, acholic stools between 4-6 weeks of life
2. Elevated bilirubin
3. Hepatosplenomegaly, ascites, stearrhea

Rapid progression, with the bile duct obliteration and cirrhosis occurring by four months

Associated with polysplenia syndrome

15

Biliary atresia – diagnosis? Management?

1. Abdominal ultrasound, radionucleotide imaging, liver biopsy in sequence to rule out other causes
2. Intraoperative Cholangiogram with laparotomy to confirm

1. Kasai portoenteroscopy – roux-en-Y intestinal loop attached to porta hepatis (Establishes bile flow)
2. Liver transplantation for late presentations

16

Alagille syndrome? Clinical features? Diagnosis?

Paucity of intrahepatic bile ducts

1. Debilitating Pruritus
2. Unusual facial characteristics – large forehead, wide spaced eyes, saddle nose, pointed chin, large ears
3. Cardiac pulmonary outflow obstruction
4. Renal disease
5. Eye anomalies
6. Musculoskeletal – butterfly vertebra
7. Growth Failure
8. Pancreatic insufficiency

Clinical features make diagnosis

17

Hepatitis A – when is virus shed in stool? Incubation period?

2-3 weeks before symptoms and one week after jaundice

2 to 6 week incubation

18

Type 1 versus type 2 autoimmune hepatitis - markers?

Type one – ANAs, anti-smooth muscle antibody

Type two – anti-liver-kidney-microsome antibody or anti-liver-cytosol antibody

19

Non-hepatic signs of autoimmune hepatitis? Labs?

arthritis, rash, nephritis, vasculitis

Elevated serum transaminases, hypergammaglobulinemia, circulating antibodies