Gastroenterology Flashcards Preview

Royal College Exam > Gastroenterology > Flashcards

Flashcards in Gastroenterology Deck (64)
Loading flashcards...
1

What is "functional constipation"

children without an organic etiology for their constipation. Often the result of holding feces if having a BM is painful.

2

Rome III diagnostic criteria for functional constipation

Must have the following criteria 1x per week for at least two months:

Two of the following in a child with a dev age of 4 yrs:
-Two or fewer defecations in the toilet per week.
-At least one episode of fecal incontinence per week.
-History of retentive posturing or excessive volitional stool retention.
-History of painful or hard bowel movements.
-Presence of a large fecal mass in the rectum.
-History of large diameter stools that may obstruct the toilet.

3

At what transition periods is the developing child prone to constipation?

toilet training and the start of school

4

How do you diagnose fecal impaction?

identifiying a large and hard mass in the abdomen or a dilated rectum filled with stool. You do not need an x-ray!

5

What are the recommended methods of disimpaction?

oral (PEG) or rectal (enemas) medication. Digital disimpaction is not recommended

6

What is the maintenance dose of PEG?

0.4 g/kg/day to 1.0 g/kg/day

7

What is the disimpaction dose of PEG?

1 g/kg/day – 1.5 g/kg/day for 3 days

8

What can you use to treat constipation in infants < 18 months of age?

PEG (0.8 g/kg/day), lactulose, glycerin suppositories

9

How long do you treat for constipation?

Children with constipation should be treated for at least six months, and should have regular bowel movements without difficulty before considering a trial of weaning maintenance therapy.

10

Features of UC

Rectum involved, involves gut continuously, bowel wall may be normal, mucosa is hemorrhagic, strictures/fistulas are rare

11

Features of CD

Segmental involvement / skip lesions, TI is thick/inflammated, transmural inflammation, mucosa looks cobblestone, strictures/fistulas are common

12

What infection mimicks crohn's disease?

yersinia

13

Investigations to do in IBD

CBC (microcytic anemia, thrombocytosis),
ESR, CRP,
albumin,
fecal calprotectin (stool test specific for gut inflammation),

P-ANCA (UC), ASCA (crohn's)

14

Imaging for Crohn's?

MRI-enterography, MR pelvis for peri-anal/fistulas, used to do UGI+small bowel follow-through

15

After how many weeks of life should a jaundiced baby have conjugated and unconjugated bili testing done?

2 weeks

16

Definition of acute liver failure?

INR >= 1.5 with encephalopathy
OR
INR >= 2.0 without encephalopathy

After you have attempted to correct INR with 1 dose of vit K IV

17

What is the only clotting factor made outside of the liver?

factor 8 (made in endothelium)

18

How does alpha-1-antitrypsin present in children?

liver cirrhosis

19

How do you prevent Hep B in at risk newborns?

- vaccine within 12 hours
- immunoglobulin within 7 days

20

When can you return to school if you have Hep A?

7-10 days from first day of jaundice

21

Breast milk protein?

Higher in whey protein (70%) than casein (30%) than bovine sources (18, 82% respectively)

22

contraindications to breastfeeding?

HIV infection, chemotherapy / cytotoxic drugs, radiation therapy, active TB or if the infant has galactosemia

23

who should get 800 IU of vit d per day?

- living north of latitude 55 degrees, October-April
- living in community with high prevalence of vitamin D deficiency
- children with dark skin

24

soy based phytoestrogens are contraindicated in what situation?

congenital hypothyroidism (phytoestrogens can inhibit thyroid peroxidase, potentially lowering free thyroxine concentrations, which could lead to abnormal thyroid function)

25

how do you manage mild dehydration?

replace with ORS 50 mL/kg over 4 hours, replace losses

26

how do you manage moderate dehydration?

rehydrate with ORS 100 mL/kg over 4 hours, replace losses

27

how do you manage protein-losing enteropathy?

hydrolyzed formula

28

how do you test for fat malabsorption

fecal elastase

29

how do you test for carbohydrate malabsorption

stool reducing substances

30

how do you test for protein malabsorption?

stool alpha-1-antitrypsin