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GI Flashcards

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1
Q

treatment appendicitis

A

appendectomy
-give 3rd gen cephalosporin pre-op (remember ONE/TEN/ME for cephs) and if appendix is perf, continue it post-op

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2
Q

what is colic

A

severe and paroxysmal crying, usually in the evening

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3
Q

when does colic peak

A

2-3 months, ends around 4 months

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4
Q

rule of 3’s for colic

A

cry > 3 hrs/day, 3 d/wk, for 3 weeks

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5
Q

childhood constipation is almost always {what type of constipation}

A

functional

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6
Q

what diagnostic criteria is used to dx constipation

what imaging might you get

A

Rome III criteria

may have to get abdominal XR

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7
Q

Rome III criteria for constipation

A

At least two of the following in a child with a developmental age younger than four years

Two or fewer bowel movements per week
At least one episode of incontinence per week after the acquisition of toileting skills
History of excessive stool retention
History of painful or hard bowel movements
The presence of a large fecal mass in the rectum
History of large-diameter stools that may obstruct the toilet
At least two of the following in a child with a developmental age of four years or older with insufficient criteria for irritable bowel syndrome

Two or fewer bowel movements in the toilet per week
At least one episode of fecal incontinence per week
History of retentive posturing or excessive voluntary stool retention
History of painful or hard bowel movements
The presence of a large fecal mass in the rectum
History of large-diameter stools that may obstruct the toilet

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8
Q

MC triggers for constipation

A

transitioning to solid foods from breastmilk and formula, potty training, and starting school

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9
Q

tx constipation

A

increase fiber 11-24 g/day
decrease cow’s milk
mineral oil
polyethylene glycol
lactulose
bathroom training

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10
Q

what are the most accurate signs in dehydration

A

prolonged capillary refill, poor skin turgor, and abnormal breathing

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11
Q

what is duodenal atresia

A

complete absence or closure of a portion of the duodenum leading to a gastric outlet obstruction

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12
Q

what other issues is duodenal atresia associated with

A

down syndrome
polyhydramnios (be more suspicious of duodenal atresia if polyhydramnios is present)

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13
Q

sx duodenal atresia

A

bilious emesis within 24 hours after birth
abdominal distention
emesis worse with feeding
failure to pass meconium

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14
Q

dx duodenal atresia

A

abdominal XR - double bubble sign - distended air-filled stomach + smaller distended duodenum separated by the pyloric valve

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15
Q

tx duodenal atresia

A

non-emergent surgical correction

NG decompression

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16
Q

fecal incontinence is also called

A

encopresis

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17
Q

how old do you have to be to be dx with encopresis

A

4 or older

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18
Q

encopresis is almost always associated with

A

severe constipation

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19
Q

what diagnostic imaging should be obtained for encopresis

A

KUB, rectal exam

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20
Q

Traveler’s diarrhea

A

e coli

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21
Q

Diarrhea after a picnic and egg salad

A

staph aureus

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22
Q

Diarrhea from shellfish

A

vibrio cholera

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23
Q

Diarrhea from poultry or pork

A

salmonella

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24
Q

Diarrhea in a patient post-antibiotics

A

c diff

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25
Diarrhea in poorly canned home foods
C. perfringens
26
Diarrhea breakout in a daycare center
Rotavirus
27
Diarrhea on a cruise ship
norovirus
28
Diarrhea after drinking (not so) fresh mountain stream water
Giardia lamblia – incubates for 1-3 weeks, causes foul-smelling bulky stool, and may wax and wane over weeks before resolving
29
what is frequently associated with GERD
hiatal hernia
30
what is a significant risk factor for GERD
obesity
31
pathophys of GERD
hypotensive LES or transient LES relaxations
32
sx GERD
heartburn (pyrosis) and regurgitation heartburn - burning sensation in retrosternal area after eating, worse when supine; relieved with antacids (usually) regurgitation - sour/acidic taste in mouth
33
criteria standard dx for GERD and what should you do if alarm features
pH monitoring - < 4 = diagnostic upper endoscopy if alarm features
34
tx GERD
diet modifications H2RAs (sx < once weekly) - famotidine for example PPI (2 or more episodes per week) - omeprazole for example
35
what is the MC cause of cholestasis in newborn
neonatal hepatitis
36
Hirschsprung disease is also called
congenital aganglionic megacolon
37
what is the cause of Hirschsprung disease
absence of ganglion cells in the mucosal and muscular layers of the colon leading to a functional obstruction (failure of colonic muscles to relax)
38
what organs are MC affected in Hirschsprung disease
rectum and part of the sigmoid colon
39
who is more likely to get Hirschsprung disease, M or F?
M 4:1
40
sx Hirschsprung disease
neonatal large bowel obstruction --> meconium ileus within first 48 hours of life bilious vomiting progressive abdominal distention poor feeding --> failure to thrive
41
PE for Hirschsprung disease
no stool in rectal value bc of the tight anal sphincter abdominal distention
42
tx Hirschsprung disease
surgical resection
43
how to remember the location of indirect vs direct inguinal hernia
MDs LIe Medial (to the inferior epigastric artery) = direct Lateral (to the inferior epigastric artery) = indirect
44
what is hesselbach's triangle composed of (inguinal hernia anatomy)
RIP - rectus abdominis (medial border), inferior epigastric vessels (lateral border), poupart's (inguinal) ligament (inferior border)
45
what is the MC type of hernia in both sexes, young children, and adults
indirect hernia
46
indirect hernia is due to
persistent patent processes vaginalis
47
sx indirect hernia
asx may develop scrotal swelling incarcerated - painful, enlargement of irreducible hernia strangulated - irreducible hernia with compromised blood supply + toxicity
48
sx direct hernia
asx, swelling at hernia site incarcerated - painful, irreducible strangulated - irreducible + compromised blood supply + toxicity
49
dx inguinal hernia
clinical groin US initial CT if unsure or possibility of strangulation
50
tx inguinal hernia
surgical repair with mesh strangulated = medical emergency
51
what is intussusception and what place is MC involved?
telescoping (invagination of an intestinal segment into the adjoining distal intestinal lumen leading to bowel obstruction Ileocolic junction MC (ileum + cecum)
52
what is the most common cause of bowel obstruction in infants and young kids
intussusception
53
MCC of intussusception
idiopathic (75%)
54
sx intussusception
triad - vomiting + abdominal pain + passage of blood per rectum -- currant jelly stools (stool mixed with blood and mucus) abdominal pain is usually severe, crampy, and progressive vomiting may be bilious
55
PE for intussusception
sausage-shaped mass may be palpation in mid-right upper abdomen + emptiness in right lower quadrant (Dance's sign) may have positive guaiac if currant jelly stool
56
Dx for intussusception Make sure to remember what type of contrast
US - best initial; donut, target, or bull's eye sign - concentric alternative echogenic and hypo echoic bands air or contrast enema - diagnostic and therapeutic; air enema MC >> water-soluble contrast >> barium
57
Tx intussusception
initial - fluid and electrolyte replacement pneumatic (air) decompression enema surgery if air enema fails
58
when is hyperbilirubinemia considered pathologic in a newborn
within the first 24 hours of life
59
what type of hyperbilirubinemia in dubin-johnson syndrome
direct (conjungated) = dubin-johnson
60
sx dubin-johnson syndrome
usually asx generalized constitutional sx mild icterus
61
dx dubin-johnson syndrome
mild, isolated conjugated hyperbilirubinemia - can increase w illness, pregnancy, contraception bx - grossly black liver and dark granular pigment in hepatocytes
62
tx dubin-johnson syndrome
no treatment
63
inheritance for crigler-najjar syndrome
autosomal recessive
64
what type of hyperbilirubinemia in crigler-najjar syndrome
unconjugated = crigler-najjar
65
what is the cause/pathophysiology of crigler-najjar syndrome
decreased glucuronosultransferase (UGT) enzyme which converts indirect bilirubin to direct
66
different types of crigler-najjar syndrome
type 1 - no UGT activity type 2 - markedly reduced UGT activity
67
sx crigler-najjar syndrome
type 1 - neonatal jaundice w severe progression --> kernicterus type 2 - asx
68
dx Crigler-najjar syndrome
isolated indirect (unconjugated) hyperbilirubinemia molecular testing for mutations in the bilirubin-UGT1 A1 gene normal hepatic bx
69
tx crigler-najjar syndrome
type 1 - chronic daily phototherapy type 2 - no tx usually - can use phenobarbital
70
what type of hyperbilirubinemia of Gilbert's syndrome
mild isolated unconjugated (indirect) = Gilbert's
71
what is the cause/pathophysiology of Gilbert's syndrome
reduced uridine diphosphoglucuronate-glucuronosyltransferase 1A1 (UGT1A1)
72
sx Gilbert's syndrome
transient episodes of jaundice triggered by stress, fasting, alcohol, illness, dehydration, menstruation, overextension
73
dx Gilbert's syndrome
slight increase in indirect (unconjugated) bilirubin
74
tx Gilbert's
no tx
75
lactose intolerance is due to
low levels of lactase enzyme in SMALL INTESTINE
76
test of choice for lactose intolerance
mainly a clinical dx hydrogen breath test -hydrogen produced when colonic bacteria ferment undigested lactose
77
B3 is also called
niacin
78
niacin is also called
B3
79
what is the MCC of B3 deficiency
alcohol use
80
what is the clinical name for B3/niacin deficiency
pellagra
81
sx of pellagra
dermatitis - photosensitive hyper pigmented dermatitis (pigmentation and scaling similar to sunburn, esp on sun-exposed areas diarrhea - due to malabsorption and proctitis dementia - irritability, anxiety, insomnia, disorientation, delusions, dementia, encephalopathy
82
what is another dermatologic manifestation of pellagra
casal's necklace - ring dermatitis around the neck
83
tx pellagra
oral supplementation w 100-200 mg of nicotinamide or nicotinic acid 3x daily for 5 days
84
what is pyloric stenosis
hypertrophy and hyperplasia of the pyloric muscles causing a functional gastric outlet obstruction leading to non bilious vomiting, dehydration, and ALKALOSIS in infants < 12 weeks
85
when is pyloric stenosis MC
3-12 weeks of life
86
what sex is more likely to get pyloric stenosis
M : F 4 : 1
87
what abx are a huge risk factor for pyloric stenosis
macrolides - esp erythromycin and azithromycin when given < 2 weeks of age
88
sx pyloric stenosis
non bilious, forceful vomiting esp AFTER feeding strong!!! appetite --- "hungry vomiter"
89
what is the nickname for an infant who has pyloric stenosis
"hungry vomiter"
90
PE for pyloric stenosis
olive sign - palpable pylorus; olive-shaped NONTENDER, mobile hard 1-2 cm mass RUQ esp after emesis have have dehydration
91
Dx for pyloric stenosis
US - elongated, thickened pylorus - also called a target sign on transverse view upper GI series - string sign - narrowed elongated pyloric channel
92
lab studies for pyloric stenosis
hypochloremic hypokalemic metabolic alkalosis from vomiting
93
tx pyloric stenosis
surgical pylorotomy after fluid and electrolyte correction
94
when does umbilical hernia usually resolve
by 2 years
95
when should surgery be performed for umbilical hernia
5 years or older or incarcerated/strangulated
96
sx vitamin A deficiency
night blindness xerophthalmia (dry eyes) bitot's spots - white spots on conjunctiva due to squamous metaplasia of the corneal epithelium
97
dx vitamin A deficiency
clinical; decreased serum retinol levels
98
what is the syndrome of vitamin C deficiency called
Scurvy
99
sx scurvy
hyperkeratosis - hyperkeratotic follicular papules (keratosis pilaris?) surrounded by hemorrhage hemorrhage - vascular fragility w recurrent hemorrhages into the gums, skin, joints; impaired wound healing hematologic - anemia, glossitis, malaise, weakness, increased bleeding time
100
dx scurvy
clinical serum ascorbic acid levels leukocyte ascorbic levels more accurate
101
vitamin C is also called
ascorbic acid
102
ascorbic acid is also called
vitamin C
103
vitamin D deficiency can cause what 2 clinical syndromes
osteomalacia (adults MC but also kids) rickets (kids)
104
sx osteomalacia
diffuse bone pain + tenderness proximal muscular weakness bowing of long bones (waddling)
105
dx osteomalacia
decreased calcium decreased phosphate decreased 25-hydroxyvitamin D increased PTH radiographs - looser lines (femoral neck, shaft, and trochanter)
106
definition of osteomalacia
decreased bone mineralization
107
definition of rickets
decreased cartilage at the growth plates
108
sx rickets
delayed fontanel closure craniotabes (soft skull bones) growth dleays genu varum (lateral bowing of the femur and tibia)
109
dx rickets
same levels as for osteomalacia radiographs - widening of epiphyseal plate, costochondral junction enlargement (rachitic rosary), & long bones have a fuzzy appearance

Peds EOR (9 decks)

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