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Flashcards in GI Deck (41)
1

Difficulty swallowing
Feeding refusal
Vomiting

What should this raise concern for?

Foreign body ingestion

Coins = #1

Flex endoscopy = dx and tx

Observe only if pt is NOT symptomatic

2

Intussusception
- what is it
- age group
- triggers
- sx
- dx
- tx

Telescoping of one bowel into another

Usually between 6-24 mo age

Triggers:
- preceeding viral infections --> Peyer patches hyperplasia
- Meckel's diverticulum
- Polyps and hematomas (HENOCH-SCHONLEIN purpura!)

If kid is older and getting intussusception, should think about pathologic lead point like Meckel's diverticulum

Sx:
- periodic pain (crampy, colicky)
- emesis before ab pain
- currant jelly stools (late finding)
- sausage shaped mass in RUQ (invagination of ileum into colon causes obstructive mass to be found in RUQ)

Dx
- Ultrasound will discover target sign
--> 100% sen and specific during period of pain
- Barium enema will see coil spring sign

Tx
- air enemas
- water soluble contrast enema

3

Cleft lip cause

Medial nasal and maxillary processes fail to join

4

Cleft palate cause

Failure of palatal shelves to fuse

5

Black hairy tongue

result of elongation of filform papillae

6

Secretory Diarrhea

Binds receptor on epithelium to induce diarrhea

Watery
Large volume

Normal osmolarity - electrolyte loss

Persists even w/o PO intake

Causes:
- cholera
- toxigenic E coli
- neorblastoma
- C diff
- cryptosporidosis

7

Osmotic diarrhea

2/2 ingestion of poorly absorbed solute or one not absorbed due to defect (eg lactase deficiency)

Lesser volume

Dec diarrhea w/ fasting

Increased osmolarity - free fatty acids released from CHO fermentation

8

Motility disorders

Loose to normal appearing stool

Ex:
- IBS
- thyrotoxicosis
- infection

9

Mucosal inflammation

Decreased mucosal surface area and colonc reabsorption, increased motility

- Blood and WBC in stool (dysentery)

Ex:
- Celiac
- salmonella
- shigella
- amebiasis
- rotavirus

10

Obstipation

Absence of bowel mvmts

11

What should you consider in neonate w/ constipation?

HIrschsprung until proven otherwise!

12

Dx hirschsprung

Bx of rectosigmoid region
- no ganglion cell

Barium enema - megacolon

13

Encopresis

voluntary or involuntary fecal soiling in children who have usually already been toilet trained

14

Anal tone in Hirschsprung

Normal

No rectal stool present

15

Duodenal atresia

Obstruction 2/2 failure of recanalization of duodenal lumen

20-30% pts w/ duodenal atresia have trisomy 21

1/10,000 live births

16

Duodenal atresia
- presentation
- dx
- tx

Usually present on 1st day life
- bilious vomiting
- no ab distension
- +/- hx polyhydramnios

Double bubble on xray

Tx w/ surgery

17

Gastroesophageal reflux + opsithotonus

What do you think of?

Sandifer syndrome

18

Standard for dx GERD

pH probe

19

Incidence hypertrophic pyloric stenosis

Risk factors

3/1000

Boys > girls (esp 1st born boy)
- Erythromycin
- formula feeding

20

Hypertrophic pyloric stenosis
- presentation
- dx
- tx

Nonbilious projectile vomiting > 3 wks old

Olive in abdomen palpated
+/- jaundice, wt loss, dehydration

Dx
- Ab US - thickened pylorus
- barium swallow
- hypokalemic hypochloremic metabolic alkalosis

Tx
- fluid rehydration
- correct electrolytes
- surgery

21

Crohns disease
- presentation
- dx
- tx
- complications

Usually more extraintestinal manifestations than UC

Arthritis
Wt loss
Ab pain - crampy
Diarrhea +/- blood
Perianal disease (fistula)

Can occur anywhere along GI tract

Dx
- String sign w/ upper GI studies
- skip lesions
- fistulas
- increased ESR
- colonoscopy + bx to dx

Tx
- steroids
- aminosalicylates
- azathioprine + metronidazole for fistulas
- cyclosporine
- tacrolimus
- TNF alpha

Complications
- malabsorb
- FTT
- wt loss

22

Ulcerative colitis
- presentation
- dx
- tx
- complications

Usually only in colon
Blood diarrhea + mucus
Ab pain + tenesmus

Moderate = > 6 stools/day, fever, anemia, hypoalbuminemia

Severe = anemia, fever, leukocytosis, tachy

Pyoderma gangrenosum

Dx
- dx of exclusion
- sx present 3-4 weeks
- anemia
- endoscopy
--> mucosa friable + bleeds easily
- NO skip lesions

Tx
- aminosalicylates
- sulfasalazine
- steroids
- surgery - total colectomy

Complications
- higher risk colon cancer

23

Meckel Diverticulum - what is it?

#1 congenital anomaly of GI tract

Vestigial remnant of omphalomesenteric duct

24

Meckel diverticulum risk factors/etiology

2% infants
2 yo - peak incidence
2 types of tissue - ectopic gastric mucosa
2 cm size
2 ft from ileocecal valve

25

Meckel
- presentation
- dx
- tx

Painless rectal bleeding

Dx - technetium scan

Tx - surgery

26

Prune Belly (Eagle Barrett Syndrome)

2/2 congenital absence of anterior ab wall muscles

Triad:
- urinary anomalies (hypoplastic kidneys, hydronephrosis, hydroureter)
- no ab wall muscles
- undescended testes

95% are males

27

Umbilical polyp

persistence of omphalomesenteric duct or urchus.

Tissue is firm, red, with mucoid secretion.

Tx is surgery

28

Breastfeeding failure jaundice

Seen in breastfed only kids (no formula) not getting enough breast milk

Feeding insufficiency --> insufficient caloric intake --> prolongs intestinal transit time --> increased absorption of unconj bilirubin through enterohepatic circulation

Occurs in 1st wk of life

Lose > 10% BW
Decreased wet diapers
Decreased stools

Tx:
- promote and support successful breastfeeding
- increase feedings

29

Normal diapers and wt loss/gain in first week for babies

15-20 min / breast, 8x/day

4-6 wet diapers / day

8-12 stools/day

lose 10% of birth weight in first week

30

Breast milk jaundice

Factor in human milk increases bilirubin enterohepatic circulation

UNCONJUGATED (indirect) hyperbilirubinemia into 3rd and later weeks of life

Tx:
- temporary stop of breastfeeding if bilirubin very high
- otherwise, no tx

31

Extensive fatty vacuolization of liver without inflammation

Hepatomegaly

No icterus

What is this?

Reye syndrome = fatty live + encephalopathy

Seen in kids < 15 yo

Diffuse mt injury --> N/V, HA, excitability, delirium, liver failure progressive CNS damage

Labs:
Increased AST, ALT
Increased ammonia
PT increased
Hypoglycemia
Metabolic acidosis

Tx:
- glucose
- FFP
- mannitol (for cerebral edema)

32

Balloon degeneration w/ polymorphic cellular infiltrates in liver

Acute alcoholic hepatitis

33

Panlobular mononuclear infiltration w/ hepatic cell necrosis

Acute viral hepatitis

Kupffer (macrophages) phagocytose hepatocellular debris

34

Neonatal jaundice with conjugated hyperbilirubinemia is suggestive of...

noenatal cholestasis

35

Indications to evaluate neonatal jaundice

Conjugated hyperbilirubinemia (even if baby is otherwise nl)

Jaundice in 1st 24-36 htss life

Serum bilirubin rising rate > 5mg/dL /24hr

Serum bilirubin > 12mg/dL in full term or 10-14 mg/dL in preterm

Jaundice persisting after 10-14d life

Presence of signs or sx

36

Is the abdomen distended in duodenal atresia

No!
Air cannot pass the duodenum

37

Best way to avoid necrotizing enterocolitis

premies and LBW higher risk!

Decreased rates of NEC in breastfed premies

38

Hischsprung highly assoc w/ what genetic condition?

Down sydnrome

39

Meconium ileus vs hirschsprung

Meconium ileus
- ileum obstruction
- plugs are super thick and won't propel so won't have "squirt sign" = expulsion of feces w/ rectal
- meconium is inspissated
- assoc w/ CF

Hischsprung
- assoc w/ down
- + squirt sign
- meconium consistency is normal

40

Jejunal atresia

Vascular accident in utero

Triple bubble sign and gasless colon on Ab Xray

P/w bilious vomiting + ab distension

Risk factors:
- exposure to cocaine and other vasoconstrictive drugs

41

Midgut volvulus onset

After 4-5 days after birth