Gastroenterology Flashcards
(115 cards)
1
Q
bloody vomit
A
maternal ingestion, esophageal varices, foreign body
2
Q
Bilious vomit
A
URGENT EVAL; obstruction – malrotation w/ or w/o volvulus, congenital intestinal atresia
3
Q
Happy spitter
A
GER; no complications, declines w/ age, growing well, comfortable, healthy (reflux common <6 months)
4
Q
Unhappy spitter
A
GERD; complications; FTT, esophagitis, respiratory complications
fussy, irritable, dystonic neck posturing, feeding refusal; occult blood in stool
consider food protein intolerance
5
Q
Dx for GERD
A
hemoccult
endoscopy, uppter GI, w/ SEVERE SX!
6
Q
Prognosis for GERD
A
usually resolves by 9-12 months- no longer laying down when being fed
7
Q
Tx for GERD
A
1st line- lifestyle; upright positioning for 30 min after feeds; trial of hypoallergenic diet; don’t overfeed, avoid tobacco exposure, thickened feeds (2-3 tsp cereal)
2nd line- used for refractory pts or those w/ complicated disease (CF, esophogitis on endoscopy)
Drugs: short term PPI (omeprazole) vs H2 blocker (ranitidine)
8
Q
PPI
A
omeprazole
9
Q
H2 blocker
A
ranitidine
10
Q
Tx for GER
A
no tx required; educaiton and reasurrance; usually resolves by 6 months
11
Q
Infantile hypertrophic pyloric stenosis etiology
A
genetic predisposition and environmental factors (macrolide abx during first few weeks of life)
M>F (1st more male)
12
Q
Associated w/ hypertrophic pyloric stenosis
A
macrolide use
13
Q
Presentation of pyloric stenosis
A
3-6 weeks olds
foreceful PROJECTILE vomiting after feeding
“hungry vomiter”
FTT and dehydration`
14
Q
PE for pyloric stenosis
A
olive-like mass in RUQ (indicates hypertrophy)
15
Q
Test of choice for pyloric stenosis
A
Ultrasound – elongation and thickening of the pylorus
16
Q
2nd line test for PS
A
Upper GI (UGI) Barium Contrast study – “string sign” (narrowed lumen);
ordered when US is non-diagnostic
17
Q
String sign
A
PS (narrowed lumen) on UGI
18
Q
Tx for PS
A
pyloromyotomy (surgery)
IV fluid
electrolyte resuscitation
GOOD PROGNOSIS
19
Q
Congenital intestinal atresia
A
one or more segments of bowel may be absent and/or obstructed at birth
20
Q
Most common site for atresia
A
duodenum
21
Q
Atresia most common in
A
pts w/ CF and down syndrome
22
Q
Dx of congenital atresia
A
prenatal u/s (usually diagnosed after birth though via symptoms)
- Abdominal Plain Film Xray – duodenal atresia (“double bubble sign”); jujunoileal/colonic atresias (dilated loops of bowel w/ air fluid levels)
- Upper GI and Contrast Enema – used for confirmation or to further identify obstruction
23
Q
Presentation of congenital atresia
A
depends on degree of obstruction (partial vs. complete)
Vomiting (may be bile stained) w/i first 48 hours of life
Abdominal distention
Failure to pass meconium (+/-) – BAD SIGN, think bowel obstruction
24
Q
double bubble
A
congnital atresia
25
strings sign
PS
26
olive like mass
PS
27
Management of congenital atresia
feedings withheld (IV fluid, correct electrolytes)
broad spectrum abx to prevent pos op infection
SURGERY
GOOD PROGNOSIS
28
Volvulus
small bowel twists around superior mesenteric artery; risk of small bowel ischemia!
29
Presentation of midgut malrotation
vomiting (bilious-green or fluorescent yellow)
abdominal pain
hemodynamic INSTABILITY
+/- hematochezia (sign of ischemia)
30
PE for midgut malrotation
abdominal distention and tenderness
31
Dx for malrotation
abdominal x-ray (r/o bowel perforation)
UGI - gold standard! - displaced duodenum, duodenal obstruction; "CORKSCREW APPEARANCE" of duodenum
U/S, barium enema - useful adjunct to UGI, not best for confirming malrotation
32
Tx for malrotation
Ladd Procedure - bowel untwitched and reposition to create adhesions to hold bowel in place
33
Prognosis of malrotation
resolution in 90%
| 1% recurrence
34
Corkscrew on UGI
malrotation
35
Ladd procedure
malrotation
36
most common cause of abdominal emergency in kids < 2 yo
intussuception
37
Who is at risk for intussusception?
kids 6 mo - 36 mo
idiopathic
"lead point" - lesion/variation in intestine; dragged by peristalsis into a distal segment (meckel's diverticulum, tumor, polyp, cyst, chron's, celiac, CF, viral infection)
Rotashield
38
Presentation of intussusception
sudden, intermittent, severe, crampy abdominal pain
unconsolable crying, DRAWS LEGS TO CHEST
vomiting common
Triad: (<15% of pts):
ab. pain
ab. mass
"currant jelly" stools (blood & mucous)
palpable sausage-shaped mass (swollen bowel)
39
olive mass
PS
40
Sausage-shaped mass
intussusception
41
Most common cause of intussusception
meckel's diverticulum
42
Dx of intussusception
U/S - initial test of choice - "target sign" "coiled spring"
Hydrostatic/pneumatic enema: diagnostic and therapeutic (TOC if no perforation)
Surgery if reduction unsuccessful
43
Corkscrew appearance
malrotation
44
Target sign
intussusception
45
coiled spring
intussusception
46
Currant jelly
intussuception
47
Therapeutic TOC for intussusception
hydrostatic/pneumatic enema
48
Most common pediatric surgical emergency
appendicitis
49
Etiology of appendicitis
obstruction of appendiceal lumen leading to inflammation
50
Who is at risk for appendicitis
peaks in 2nd decade of life
| rare before 5 yo
51
Presentation of appendicitis
anorexia
migrating ab. pain (periumbilical to RLQ)
vomiting (after pain)
fever +/-
signs of peritoneal irritation (guarding, rebound tenderness, + Rovsing, obturator or Ileopsoas signs)
52
Tx for appendicitis
if class presentation, proceed to surgery w/o imaging
Imaging:
- U/S (no radiation)
- CT scan
- WBC >10,000 increases liklihood
53
Tx for appendicitis
surgical consult
pre-op managment (fluids, electrolytes, abx)
Surgical resection - appendectomy
NOT (nonoperative treatment) - abx for early appendicitis
54
Diarrhea
>3 loos watery stools/day x 5 days
55
Most common cause of diarrhea
viral (rotavirus, norovirus)
56
Acute diarrhea
abx assocaited (c. diff)
bacterial (salmonella, e.coli, campylobacter, yersinia)
viral (rota, noro, adeno)
Parasitic (giardia lamblia, e. histolytica, cyrpto)
57
C.diff
Dx: stool culture for c.diff toxin
Tx: flagyl
58
Bacterial
Dx: stool culture; blood/mucous - think E.coli O157:H7
Tx: supportive, sometimes abx, no anti-motility
59
Viral
Dx: viral antigen stool test?
Tx: supportive
60
Parasitic
Dx: stool O&P x 3; giardia has stool antigen test
Tx: flagyl
61
Chronic diarrhea causes
celiac
allergic
malabsorption (CF)
toddler's diarrhea
62
Celiac disease
immune mediated inflammatory disease of small intestine caused by gluten sensitivity
63
Dx for celiacs
IgA antibodies to tissue transglutaminase (TTG), small bowel bx
64
S/sx of celiacs
FTT, anemia, possible foul smelling stools
65
Tx for celiac
gluten free diet
66
Allergic chronic diarrhea
food protein allergy (milk,soy)
microscopic blood and mucous in stools, gassy, fussy
Tx: dietary elimination, hydrolyzed or free AA based formula (nutramigen)
67
Toddler's diarrhea
6 mos- 5 yo; self-limited
68
Red flag workup for diarrhea
CBC, CMP, celiac testing, urine Cx, stool testing, imaging
**routine stools are NOT recommended for most cases of diarrhea
69
Tx for acute diarrhea
hydration always
abx sometimes - only if you rule out e.coli
anti-motility rare
70
IBD etiology
interaction of genetic, environmental and immune factors
| peak incidence 15-30 YO
71
2 types of IBD
crohn and ulcerative colitis
72
Smoking and IBD
2x increased risk for CD
| 50% decreased risk for UC
73
Presentation of IBD
diarrhea, ab pain +/- hematochezia
Growth failure, DELAYED PUBERTY (nutrient deficiencies, anemia)
Extraintestinal manifestions:
74
Dx for IBD
CBC, CMP, ESR, CRP, serum Fe, vit D, B12, stool study, c.diff
75
Chrohns Disease
transmural inflammation - mouth to anus (can include all GI tract)
SKIP LESIONS
COBBLESTONE APPEARANCE
perianal fissures, fistulas
76
Dx of Chrohn's
Colonoscopy
| or wireless capsule endoscopy
77
Ulcerative colitis
rectum and large colon;
mucosal layer only
starts at rectum and proceeds proximally to colon
bloody diarrhea common
DIFFUSE/CONTINOUS EDEMA, ERYTHEMA, FRIABILITY, ULCERATION OF COLON
78
Risk w/ UC
colon cancer
79
Tx of IBD
"step up" for most pts
"top-down" for high risk pts
5 components:
- Medications
- Surgery
- Nutritional rehab
- behavioral health support
- colorectal cancer screening in older pts
tx depends on severity of disease
80
Medications for IBD
- Aminosalicylates: 5 ASA (sulfasalazine, mesalamine)
- immunemodulating (mercaptopurine, azathioprine, methotrexate) or biologics (infliximad/remicade)
- steroids (acute flare)
+/- Abx
Surgery- refractory cases
monitor growth, nutrition, infection, psych issues, cancer
81
Aminosalicylates
Sulfasalazine, Mesalamine
82
Immunemodulating agents
Mercaptopurine
Azathioprine
MTX
83
Biologics
infliximad/remicade
84
Meckel's Diverticulum etiology
Vitelline duct leads to formation of diverticulum (outpouching)
Gastric acid produced and cases damage
bleeding occurs from mucosal ulceration
85
Rule of 2's
2% of population
2:1 M:F RATIO
2% develop complication (before 2 yo)
2 feet from ileocecal valve
86
Most common congenital anomaly of GI tract
Meckel's diverticulum
87
Presentation of meckel's diverticulum
Painless rectal bleeding
obstruction (volvulus or intussusception)
Diverticulitis (can mimic appendicitis)
88
Lab/dx for meckel's
Technetium-99 scan (Meckel's scan)
89
Tech 99/meckel's scan
nuclear medicine scan that identifies ectopic gastric mucosa: lights up where there is gastric tissue that shouldn't be there
90
Tx for meckel's
surgical resection -- GOOD PROGNOSIS
91
Constipation
regular passage of firm or hard stools or infrequent passage of stool -- if impacted, ecnopresis can occur (incontinence of stool)
92
cause of constipation
multifactorial
r/o anatomic or biochemical cause
95% functions, 5% organic
93
Functional constipation
psych
| diet
94
Organic constipation
```
anal stenosis
hypothyroidism
celiacs
hirshsprung's
hypercalcemia
CF
```
95
Functional constipation
voluntary withholding of stoop (avoid due to negative experience)
Stool incontinence: encopresis
96
Periods kids are most likely to develop constipation
intro to solid foods or cow's milk
toilet training
start of school (5-6)
97
Other functional causes
lack of fiber
dairy excess
poor water intake
98
Fiber intake kids >2 YO
Age + 5-10 g/day
99
Fiber for infants <2YO
5g/day
100
Findings suggestive of organic cause of diarrhea
```
failure to pass meconium
FTT
abdominal distention or obstructive sx
lumbosacral problems, neuro abnormalities
anterior placed anus/other alterations
occult blood in stool
```
101
Sx of constipation
+/- fecal leakage
abdominal discomofort (generalized or LLQ)
hypoactive BS if impacted
anal fissures
102
Red flags for constipation
```
wt loss, poor weight gain/growth
anorexia, fever, hematochezia
hx of delayed passing of meconium (CF)
acute onset
failure to respond to conservative tx
```
103
Labs for constipation
xray to r/o impaction
| CBC, CMP, TSH, celiac, chloride sweat test
104
Managment of constipation
```
fluids
gradual increase of daily fiber
decrease dairy (<16 oz/day)
juice - apple, prune or pear
If encopresis, relieve impaction if present (polyethylene glycol/Miralax)
```
105
Meds for constipation
Miralax, lactulose, enemas, suppositories
106
Hirchsprung disease aka
congenital aganglionic megacolon
107
What is hirchsprung
absence of ganglion cells in mucosal and muscular lays of the colon -- leads to spasm and abnormal motility -- colon fails to relax and may lead to obstruction
108
Epidemiology of hrichsprung
M>F
80% present <6 wks old
patients w/ Down Syndrome have higher risk
109
Presentation of hirschprung
failure to pass meconium in first 48 hours
Bilious voming!
Abdominal distention
late presentation rare: pass meconium but develop sx later -- chronic constipation and FTT
later dx = less severe disease
110
Bilious vomiting
Malrotation
| Hirschprung
111
Nonbilious projectile vomiting
PS
112
PE for hirschprung
ab distention
Tight anal sphincter
"squirt sign"
113
Labs/dx for hirschprung
Contrast enema - unprepped to localize "transition zone" - change from narrowed aganglionic segment to the dilated proximal colon
Rectal bx -- GOLD STANDARD - confirms absence of ganglion cells
114
Tx for hirschprung
surgical resection of aganglionic segment of colon
115
Prognosis for hirschsprung
good; may have some abnromal bowel function
| fecal incontinence, constipation
