Gastroenterology 2

Question 0

when to suspect Organic versus functional fecal retention?

Answer 0

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)

Question 1

Functional fecal retention?

Answer 1

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

Question 2

Examples of organic causes of constipation?

Answer 2

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

Question 3

Ulcerative proctitis?

Answer 3

Ulcerative colitis restricted only to the rectum

Question 4

Antibody in UC versus Crohn’s disease?

Answer 4

P-ANCA versus Anti-Saccharomyces

Question 5

Pharmacotherapy for IBD? If perianal involvement?

Answer 5

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

Question 6

Melena indicates bleed proximal to?

Answer 6

Ligament of Treitz

Question 7

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

Answer 7

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

Large dose of vitamin C

Question 8

Patient with upper G.I. bleed – management?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Markers with increasing specificity for biliary disease?

Answer 10

5’-nucleotidase >Gamma glutamyl transpeptidase > alkaline phosphatase

Question 11

Cholestatic jaundice?

Answer 11

1. Retention of bile within the liver

2. Direct bilirubin >2 or >15% of total

Question 12

Crigler-Najjar type one versus type two?

Answer 12

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

Question 13

Neonatal hepatitis – diagnostic criteria? Features? Management?

Answer 13

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
3. Increased nutritional support
4. Ursodeoxycholic acid
5. Liver transplantation

Question 14

Biliary atresia – clinical features? Progression? Associated with?

Answer 14

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

Question 15

Biliary atresia – diagnosis? Management?

Answer 15

1. Abdominal ultrasound, radionucleotide imaging, liver biopsy in sequence to rule out other causes
2. Intraoperative Cholangiogram with laparotomy to confirm
3. Kasai portoenteroscopy – roux-en-Y intestinal loop attached to porta hepatis (Establishes bile flow)
4. Liver transplantation for late presentations

Question 16

Alagille syndrome? Clinical features? Diagnosis?

Answer 16

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

Question 17

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

Answer 17

2-3 weeks before symptoms and one week after jaundice

2 to 6 week incubation

Question 18

Type 1 versus type 2 autoimmune hepatitis - markers?

Answer 18

Type one – ANAs, anti-smooth muscle antibody

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

Question 19

Non-hepatic signs of autoimmune hepatitis? Labs?

Answer 19

arthritis, rash, nephritis, vasculitis

Elevated serum transaminases, hypergammaglobulinemia, circulating antibodies