GI Flashcards
(123 cards)
0
Q
most common cause of peptic ulcer disease in kids
A
H pylori»_space;> NSAID/ASA/alcohol
1
Q
most common site of peptic ulcers in kids
A
duodenal for primary
gastric for secondary
2
Q
dx and treatment of hpylori?
A
endoscopy/bx or urea test or H.pylori stool Ag test (for response to tx monitoring, not initial dx)
Tx: PPI, amox, clarithro
3
Q
Dx in triad of jaundice, abd mass, intermitt abd pain
Most common type
complication
A
choledochal cyst: congenital cystic dilation of hepatic biliary tree
Most common type 1: dilation of common bile duct
complications: cholangitis or pancreatitis
4
Q
Dx of pancreatitis?
Classic sign
A
AMylase and lipase have to be 3x ULN
classic pain radiating to back
5
Q
Turner vs Cullen sign?
What are they and what is the dx
A
pancreatitis
Turner: flank ecchymosis
Cullen: blue umbilicus
6
Q
metabolic issues causing pancreatitis (2)
A
hypercalcemia
hyperlipidemia
7
Q
colicky abd pain (l>R), n/v, palpable renal mass, microscopic hematuria?
A
UPJ obstruction
8
Q
type of gallstone seen in sickle cell disease?
A
Pigmented stone
9
Q
meds that can precipitate gallstones (3)
A
ceftriaxone, furosemide, OCPs
10
Q
transmission of acute intermittent porphyria
A
autosomal dominant, but variable penetrance
11
Q
Dx in pt w/ severe intermittent abd pain, n/v, weakness, confusion, seizures
A
acute intermittent porphyria
12
Q
triggers for acute intermittent porphyria and how to dx?
A
low carb intake, meds(sulfa, barbiturate), hormonal changes
Dx: urine porphyrin screen (porphobiligen and ALA during acute attack only) - due to decr RBC porphobilinogen deaminase or DNA testing
13
Q
When to give immunoglobulin for Hep A? vs Vaccination?
A
IG: before travel, lasts < 12 wks or after exposure within 14 days (day care/intimate contact)
Also two vaccines which require booster 6-18 mos later for post-exposure prophylaxis too. Used for travelers, hi risk populations, now everyone!
14
Q
type of virus for hep A
A
RNA
15
Q
type of virus for Hep b
A
DNA
16
Q
biggest concern for pediatric hep B?
A
vertical trm from mom - 90% if mom is HBsAg +, and 1/2 may be chronic carriers
17
Q
when do Hep B core antibodies appear?
A
IgM then IgG, 1-4 wks after HBsAg (not Ab), and may persist for yrs
18
Q
symptomatic vs convalescent phase of Hep B infx w/ regard to HBcAb and HBsAb after acute infx
A
in symptomatic phase: higher HBc and rising HBs
HBs > HBc in convalescent phase
19
Q
lifetime risk of hepatocellular carcinoma if hep B carrier (HBsAg +)
A
25%
20
Q
how to prevent vertical transmission of Hep B in positive mother?
A
vaccinate AT BIRTH with HBIG (synergistic)
21
Q
Think of correlating what with consideration of alpha interferon therapy for Hep B?
A
ALT!! If its high, better response and expect it to fall. Also may have loss of HBsAg
22
Q
hep C type of virus
A
RNA
23
Q
type of virus Hep E?
A
RNA
24
Hep E treatment / prevention?
no vaccine yet. There is pooled immunoglobulin
25
most common form of viral hepatitis in children in US?
Hepatitis A
26
mean incubation period of Hep B?
120 days
27
marker of carrier state in Hep B
surface antigen
28
is there a chronic carrier state in Hep C?
no.
29
ASCA vs P-ANCA in UC vs crohn's
ASCA more in Crohns
| P anca more in UC
30
UGI/Small bowel follow throw in crohns
T1 nodularity, narrowing separation of bowel loops
31
when is peak neonatal bili and jaundice and what levels
peak bili 8-12 usually, max 15 for physiologic
| occurs at day 4-6, with jaundice by day 2-3
32
Crigler Najjar defect?
Presentation
Tx?
UDP glucuronyl absence
presents w/ severe hyperbili, grey stool, lt urine in neonate
Tx: PB in type two, or trp
33
classic hyperbili/jaundice with stress / fasting
| Transmission
Gilberts
| autosomal dominant, incomplete penetrance or AR
34
most common cause of cholestatic hyperbili in newborn?
A1AT
35
Dx in baby with jaundice at 2 wks, acholic stool, and HSM
Extrahepatic biliary atresia
36
two forms of biliary atresia in baby?
embryonic: jaundice at birth and other anomalies
perinatal: most w/ obliteration of previously formed bile ducts
37
What is Alagille's syndrome
presentation
genetics
liver failure from paucity of intrahepatic bile ducts and cardiac (pulm stenosis and tetralogy) and other anomalies incl butterfly vertebrae, renal, delay, triangle face
JAGGED 1 autosomal dominant with incomplete penetration
38
most common cause of acute liver failure in newborn
| The lab finding?
neonatal hemochromatosis
| Normal AST/ALT or absent b/c liver is shot.
39
most common place for foreign body to lodge? then?
esophaus: 60-70% below cricopharyngeal
20% at level of aortic arch
10-15% above LES
40
foreign bodies which might not pass all the way through if its gotten to the stomach?
longer than 5cm or wider than 2cm, may not
41
dx for dysphagia, droolilng, hoarseness
| may have wheezing or vomiting
foreign body ingestion
42
foreign body in esophagus looks like what on XR? (vs trachea)
AP: face of coin
lateral film shows edge
This indicates Esophagus!
43
removal of foreign body/coin in esophagus for sx patient?
emergent endoscopy or foley balloon catheter extraction by radiologist
44
management of foreign body in lower 2/3 of esophagus in asx pt?
repeat xR in 12-24 hours, but if its still there... go get it b/c corrosive (zinc penny) so can't stay there (ok in stomach, not esoph)
45
What foreign objects should be removed?
pointed or sharp objects
coins/blunt objects in stomach for up to 4-6 wks
long/large objects
condoms/balloons need surgery / not endoscopy
46
food or meat stuck in esophagus
| who is at risk and what is the treatment
No barium study
should not stay in esoph > 12 hrs (meat enzymes eat esoph)
happens in people with esoph anomalies/motility d/os
47
how long can battery stay in?
hardly at all:
esoph out by 12 h
stomach out by 48, then 5 days total to get it out
48
alkali ingestion
| causes what? damages what?
liquefaction necrosis, less bitter/colorless/odorless
| Damages upper/lower esophagus
49
Acid ingestion causes what?
coagulation necrosis which limits penetration of acid, bitter tasting *swimming pool stuff, toilet bowl cleaner*
stomach/pylorus damage
50
Presence or absences of oral burns predicts what?
NOTHING. doesn't tell you about likelihood of esophageal burns (50/50)
51
How do you manage caustic ingestions?
fluids, may need EGD within 12-24 hrs/ ENT/ Pulm consult
| NO neutralizing agent or induced vomiting
52
long term risk after lye ingestion?
squamous cell carcinoma of esophagus 4 decades later
53
management of Grade 1-2A esophageal burns *not circumferential
clears, ok to d/c when taking POs, no long-term sequellae
54
Management of grade 2B or 3 esoph burns
high risk >70% chance of esophageal stricture
NGT feeds
steroids / Abx
55
genetic susceptibility for celiac?
HLA DQ2 and 8
56
what grain generally okay in celiac?
oat
57
dermatitis herpatiformis
celiac
58
% w/ DS who have celiac
7% *same as in DM1
59
fibrosing colonopathy from what?
in cf w/ too much lipase > 20,000
60
mec ileus in what % cf?
10-20%
61
diet rec for CF?
120% RDA calories, 40% long chain FA, 100% protein, 5-10x fat, lipase enzyme supp
62
average rate of cell turn over in intestine?
| recovery after viral infx?
3-5 days, but two wks to recover
63
Dx of lactose intol?
| How to prep for test?
breath test: 50mg lactose then look for rise in breath H2 over 20 PPM is diagnostic. Must fast 6 hrs first, No Abx 10 days first
64
most common presentation of eos esoph?
| Work up?
dysphagia, also GERD, esophagitis
| EGD, skin testing IgE RAST
65
endoscopic findings of EE?
furrows, vertical lines, rings, white plaques, crepe paper mucosa, strictures
66
Treatment of EE?
oral steroids, inhaled steroid Fluticasone, Singlulair/Montelukast, (Ketotifen, Mepolizumab)
67
goat milk doesnt have what?
folic acid
68
strict vegetarian diet leads to what def? (really a vegan thing)
B12
69
what should you give vegan mothers who are breast feeding and why?
B12 to prevent methylmalonic acidemia
70
B12 def most likely to occur in child s/p what surgery? (where its absorbed)
terminal ileum
71
KAsai procedure for what? Timing when?
for extrahepatic biliary atresia, should have been done by 8 wks latest
72
anemia,hemolysis, spinocerebellar degeneration, decr DTRs, wide gait
What vit Def?
Vit E Def
73
what three groups get fat soluble vitamin malabs?
CF
biliary atresia
short gut
74
prolonged TPN, excessive ileostomy output, cardiomyopathy
| What is missing, what is the def?
Selenium def (forgot minerals)
75
infant who initially did well and then suddenly develops bilious emesis in first few days/months of life?
midgut volvulus distal to ampulla of Vater
76
in newborn with very distended abdomen whose mother had diabetes
small left colon / hypoplastic left colon syndrome
77
painless large maroon / burnt tarry stool, and patient with anemia?
The Rule?
Dx w/ what?
Meckel diverticulum bleed: painless rectal bleeding
Rule of 2s: 2yo, Males 2x, 2% population, w/in 2ft of ICV
Dx Meckel's scan and H2 blocker first
78
treatment rec for toddler's diarrhea and clue about the dx?
no diarrhea at night
increase fat intake to slow transit, decr carbs/total fluid
*death by sippy cup!
79
most common cause of rectal prolapse?
chronic constipation
80
how does ibuprofen cause gastric ulcers?
inhibits prostaglandin synthesis
81
GI med that can cause gynecomastia
reglan
82
chronic watery diarrhea after camping trip or bad water or daycare
Dx?
Test of Dx?
Giardia
| Entero test ELISA, string test
83
best oral rehydration solutions contain what % gluc and what % NaCL?
2% gluc
| 90 mEQ NACL
84
what is used to find WBC in stool?
methylene blue - neutrophils
85
options for prophylaxis of travelers diarrhea?
bismuth subsalicylate or bactrim. Usu not needed
86
fever, HA, Abd pain, muscle aches, rose spots
diarrhea NON bloody?
Dx / Bug?
Tx
Salmonella --> typhoid fever
| Tx: None for just diarrhea. For typhoid systemic disease: CTX and cefotax if bactrim resistance
87
seizures and diarrhea watery --> bloody
| Tx
shigella
| Bactrim
88
Tx of campylobacter
erythro / azithromycin
89
Tx for cdiff < 6 mos kid
NONE, normal carriers unless sx
90
bug that looks like appendicitis and tx?
Yersinia
| None if limited to GI
91
2 Tests for sugar malabsortion causing chronic diarrhea?
1. clinitest for reducing substances (all except sucrose) in stool
2. Hydrogen breath test: normal gut should ferment the sugar and release H
92
Tests for fat malabsorption
1. fecal fat 3 day
| 2. serum carotene and prothrombin time: indirect for Vit A and Vit K
93
link between neuroblastoma and diarrhea?
vasoactive intest peptide
94
steatorrhea and acanthocytosis (spiny RBCs), retinal damage and neuro findings
Dx?
abetalipoproteinemia
95
protein losing enteropathy with hypoproteinemia, hypogammaglobulinemia, steatorrhea, lymphedema, lymphopenia
intestinal lymphangiectasia
96
polyhydramnios and nonbilious vomiting in LBW newborn
| Imaging study will show radiolucent filling defect in prepyloric region
Antral web
97
Risk fact for Pyloric stenosis
mother w/ PS
98
numbers to remember for pyloric length and thickness in ultrasound dx of pyloric stenosis
length > 14mm
| thickness > 4mm
99
bilious vomiting, rt sided abd distension, Ladd bands constricting large/small bowel, gastric and duodenal dilation, decr intestingal air, corkscrew appearance of duodenum
Volvulus!
100
zofran mech of action
serotonin receptor antagonist
101
large cyst on floor of mouth and tx
ranula
| excision
102
swelling of parotid gland, dry mouth, poor tears
| Dx?
Mikulicz's disease (large gland in head/neck syndrome)
| Large bottles of milk replacing ducts / parotids
103
cause of parotitis with high fever and marked tenderness
s aureus
104
too few teeth or underdeveloped teeth
Dx and test
genetics
The main DDX
Ectodermal hypoplasia, x-linked, skin bx shows no sweat pores
DDX: Hallermann Streiff syndrome w/ underdeveloped small teeth but no sweat gland issues
105
dx with too many teeth
Gardner's syndrome
106
prostaglandin analogue used in peptic ulcer disease?
misoprostol
107
Dx steps for H pylori
| Tx
Serologic testing for H pylori IgG - SCREEN ONLY
Test w/ fecal Ag or Urea breath test
Confirmatory but invasive endoscopic bx
Tx: PPI, 2Abx (Amox/Flagyl OR Clarith/AMox) x 14 d
108
How to dx Zollinger Ellison
fasting gastrin level
109
pancreatic insuff with skeletal and bone marrow issues?
Shwachman Diamond syndrome
110
risk of Colon cancer in UC?
20%/10 yrs after first 10 yrs of disease
111
concern when child > 6 gets intussussception
lymphosarcoma - lead point
112
normal time to pass a stool in newborn
99% in 1st 24h, 1%in 48. If not think CF or hirsh
113
polyps that are and aren't assoc w incr malignancy/
GArdners: yes
| juvenile polyp: NO
114
geographic location for entamoeba histolytica
dx test
tx
south, indian reservation
positive serology to confirm the dx
flagyl for colitis / liver abscess
iodoquinol if asx
115
diagnostic test for cholestatic jaundice?
hepatobiliary scintigraphy
116
Diagnostic test series for suspected biliary atresia?
US --> HIDA scan --> Bx
117
Treatment of Wilson's and its s/e
penicillamine
| s/e: aplastic anemia
118
besides wilson, dz causing increased copper
chronic active hepatitis
119
"Diagnostic test" for pancreatitis?
| more specific lab test?
US
| lipase: specific
120
How to dx Hep A
| Common group involved?
IgM Ab for recent disease x 6 mos. IgG persist for life / gives immunity
Alaskans and Native Americans NOT Asians
121
hep B + Hep D causes what
can create a severe acute hepatitis and resultant cirrhosis
122
hepatitis in Asia, Africa, Mexico?
Hep E
