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Flashcards in GI Deck (269)
1

Squamous cell cancer of esophagus

Smoking, etOH, hot liquids, pickled foods, Nitrates, deficiency of B1, carotene, selenium

2

Adenocarcinoma of esophagus

Constant GERD, Barrett's, weight loss, high calorie/fat, hiatal hernia --> GERD

3

Drugs that cause esophagitis

K, iron, tetracyclines, NSAIDS, alendronate, quinidine

4

Zenker diverticulum pathogenesis

Motor dysfxn - sphincter contraction/dysmotility --> excision & cricopharyngeal myotomy

5

Progressive dysphagia, CP, regurg, No LES relaxation

Achalasia - myenteric plexus, T. cruzi

6

Progressive dysphagia, nighttime cough, regurgitation, weight loss, heart burn

Achalasia --> Barium +/- manometry --> Endoscopy w/ balloon dilation or myomectomy

7

Crushing pain w/ swallowing, dysphagia for liquids, regurg

Achalasia --> Barium +/- manometry --> Endoscopy w/ balloon dilation or myomectomy

8

Dysphagia for solids --> softs --> liquids, weight loss, smoking or longstanding GERD

SCC (smoking) or Adenocarcinoma (GERD) --> Barium --> endo + bx --> CT for operability

9

Dysphagia of both solids and liquids, chronic GERD 1st step

Barium esophogram --> endocsopy

10

Prolonged forceful vomiting + bright red blood

Mallory-weiss tear --> endocscopy --> laser

11

Prolonged forceful vomiting --> sternal pain, fever, leukocytosis

Boerhave syndrome --> Gastrografin swallow --> repair

12

#1 cause of esophageal perforation

Instrument --> emphysema in neck --> contrast esophagram

13

CP, epigastric pain, burning + CXR widened mediastinum, mediastinal air

Esophageal rupture = instrument, KCl, vomiting, Barrett, candida/HIV, caustic ingestion

14

Food stuck in throat/muscle that initiates swallowing

Cricopharyngeal

15

Severe odynophagia, CD4 <50, round ulcers in esophagus cause

HSV - CMV (deep linear ulcers)

16

Drug causes of esophagitis

KCl, tetracyclines, bisphosphonates, NSAIDs

17

Intermittent CP, dysphagia, simultaneous high amplitude contractions

Dissuse esophageal spasm

18

Fibrosis, atrophy, no distal esophagus movement, loss of LES tone

Scleroderma

19

Stuck chicken bone, unable to open mouth fully, limited nexk extension, fever

Retropharyngeal abscess --> CT + Abx to avoid --> mediastinum

20

Tx for variceal bleeding

2 Ivs or central line --> octreotide or somatostatin

21

Tx for non-bleeding varicees

BB (propanolol) --> sclerotherapy --> TIPS if refractory to all other tx

22

#1 esophageal atresia

Proximal pouch, distal TE fistula

23

Overweight, burning pain worse laying down, bending over, tight clothes, antacids help, long standing

GERD --> PPI --> endoscopy + Bx

24

Nocturnal wheezing, morning hoarsness, inflamed pharynx next step?

GERD --> PPI

25

GERD <50, no alarm sx, or cancer risk next step

H.pylori test or PPI 1x daily --> switch PPI or 2x daily ---> endoscopy

26

GERD >50, smoker, melena, hematemesis, weight loss next step

Endoscopy

27

GERD refractory to meds + ulcers, stenosis, dysplastic changes

Nissen fundoplication --> resection w/ severe dysplasia

28

When is early endoscopy considered for dyspepsia?

New-onset >55, weight loss, progressive dysphagia, bleeding, Hx CA, odynophagia

29

H. pylori dx

Stool antigen or IgG serology if on PPIs but gold standard = endocsopy + Bx

30

Dyspepsia <55 w/ no alarm sx tx

Test-and treat = PPI, H. pylori Ag --> Omeprazole + bismuth + metronidazole + tetracycline

31

Colonoscopy indication w/ PUD

>50 w/ blood in stool or anemia even w/ found ulcer to R/O colon CA

32

Old + anorexia + weight loss + epigastric distress, early satiety

Gastric adenocarcinoma --> endoscopy --> CT --> surgery

33

Gastric adenocarcinoma dx, next step?

CT = extent/mets of CA

34

etOH + aspirin, hematemesis cause?

Acute erosive gastritis

35

Early satiety, post-prandial pain, vomiting, abdominal succussion splash, acid or beozar ingestion

Pyloric stricture

36

S/P gastrectomy, abd cramps, weakness, lightheaded, post-prandial pain

Dumping (post-gastrectomy syndrome) --> diet modification --> octreotide

37

Upper abd pain better or worse w/ food, N, early satiety, NSAIDs for chronic arthritis, dark stool

Peptic ulcer

38

Ulcer work-up

CBC, D/C NSAIDs, upper endoscopy, H. pylori, PPI

39

Most common ulcer type

Duodenal

40

Ulcer type w/ NSAID use, usually pain immediately after eating

Gastric

41

Awoken w/ severe abd pain, pain w/ eating, drinking heavily, FREE AIR under R hemidiaphragm Dx?

Perforated peptic ulcer (viscous) --> urgent laparotomy

42

Vomiting blood or blood in NG tube

Upper GI bleed --> endoscopy

43

Black tarry stool (melena) work-up

Upper GI bleed --> endoscopy

44

BRBPR

Anywhere --> NG tube+ = upper; NG white w/o blood = endoscopy; NG tube only bile = lower

45

BRBPR from lower GI source work-up

Hemorrhoids; >2ml/min/1unit/4hrs --> angiogram & embolization; <0.5ml/min or stopped = colonoscopy

46

Blood per rectum work-up not actively bleeding

Young = upper; Old = both

47

Blood per rectum in kid

Meckels

48

Massive upper GI bleed post-op, multiple trauma, stress

Ulcer --> endoscopy, embolization

49

BRBPR, NG tube (-) blood, (-) colonoscopy but continues to bleed next step

Labeled erythrocyte scintography --> angio or repeat colonoscopy

50

Abd pain >3d/mo, change in frequency & form, relief w/ BM, mucous, bloating, incomplete emytping

IBS = NORMAL mucosa

51

Diarrhea and bloody stools, Crypt abscess, abd pain, weight loss, mucosal inflammation

UC - continuous, "lead-pipe," megacolon, colorectal CA

52

Surgical indications in UC

>20yrs (--> malignant), malnutrition, many hospitalizations, toxic megacolon

53

Frequency of colonoscopy with UC

After 8 years of UC ---> Every year - high colorectal CA rates

54

Non-caesating granulomas, cobblestone, diarrhea, "string sign," fistulas

Crohns

55

Chronic diarrhea, weight loss, pain, auto-immune (B-27), reactive thrombocytosis picture

Crohn's Disease

56

Anal fissure, ulcer fails to heal or worse w/ surgery

Crohns Disease --> NO surgery but Remicade

57

Abd pain, aphthous ulcers showing granulomatous inflammation assoc?

Crohn's Disease

58

Extraintestinal complications of UC - don't require surveillance

PSC, uveitis, erythema nodosum, spondyloarthropathy

59

Diarrhea, weight loss, anemia, high ESR, + SOBT, neutrophilic cryptitis

IBD

60

Weight loss, bloating, flatus w/ certain foods

Celiac = intestinal villous atrophy

61

Anti-tissue transglutaminase & endomysial abs

Celiac

62

Chronic steatorrhea, celiac --> ? Disruption in Ca levels

Dec VitD --> dec Ca --> Inc PTH & dec Phos

63

Chronic steatorrhea, DEC D-XYLOSE IN URINE

Celiac (proximal SI malabs)

64

Mucosal subepithelial collagen deposition

Microscopic/collagenous colitis

65

Blunting of colonic villi, lymphocytes, plasma cells, eosinophils, - O&P, travel

Tropical sprue

66

Hx diarrhea, non-deforming migratory arthritis, fever, PAS + MO in small intestine, villous atrophy

Whipple's

67

Alopecia, dec taste, bullous lesions around mouth/face, TPN

Zinc deficiency (jejunum)

68

Early satiety, intractable vomiting, hypoK, hypoCl, alkalosis, peptic ulcers

Gastric outlet obstruction --> NG stomach decompression, NaCl, KCl

69

Periodic, shifting abd pain, vomiting, fever, leukocytosis, obstipation, tenderness, distension

SBO --> NPO, NG, IVFs --> surgery 1 day total to 3 days partial

70

Colicky abd pain, vomiting, abd distention, obstipation, high-pitched BS, XR distended bowel

SBO --> NPO, NG, IVFs --> surgery 1 day total to 3 days partial

71

Colicky abd pain, vomiting, abd distention, obstipation + fever, leukocytosis, peritonitis

Strangulation --> emergency surgery

72

Colicky abd pain, vomiting, abd distention, obstipation + irreducible hernia

Incarcerated hernia

73

DM, early satiety, vomiting, bloating, hypoglycemia after meals/insulin

Gastroparesis --> metaclopramide (EPS), small meals, Erythromycin, cisapride

74

Tx cancer related anorexia

Progsterone analogs - megestrol acetate, medroxyprogesterone or mertazipine (TCA)

75

Diarrhea, flushing of face, wheezing, JVD

Carcinoid syndrome --> high urine 5-HIAA

76

Right sided colon mass presentation

Anemia

77

Work-up for colon mass

Colonoscopy + Bx --> CT --> hemicolectomy

78

Left sided colon mass presentation

Obstruction, pencil stools, bloody BM

79

Probability of malignancy in polyps

Familial polyposis > familial inflammatory > villous adenoma > adenomatous

80

Emergency colectomy w/ C. diff

Tx unresponsive, WBC >50K, lactate >5

81

Post-op hypotension, CAD, "thumb printing," bloody diarrhea - bleed location?

Splenic flexure - 2nd = rectosigmoid

82

Worsening post-prandial pain --> food avoidance

Occlusion/atherosclerosis of mesenteric arteries

83

LLQ pain, N/V, constipation, wall thickening, soft tissue masses or fat inflammation

Diverticulitis --> CT scan + NPO, IVFs, Abx

84

LLq pain, fever, leukocytosis, wall thickening + stranding, >3cm perisigmoid fluid collection

Complicated diverticulitis --> CT guided percutaneous drainage --> surgery at d5

85

#1 cause of lower GI bleed

Diverticulosis

86

Old, abd pain, severe distension, XR --> air-fluid, huge air loop in RUQ w/ tapering "Parrot's beak"

Sigmoid volvulus _> proctosigmoidoscopy and leave rectal tube in

87

Fever, tachy, anemia, leukocytosis

Toxic megacolon = ABD X-ray

88

Diarrhea w/ dark brown colon and shiny patched lymph follicles

Factious diarrhea (laxative abuse)

89

Watery diarrhea, cramping after dairy ingestion next step?

Hydrogen breath test

90

Bloating, watery diarrhea, excess flatus + DM, scleroderma, surgery, AIDS, ESRD or cirrhosis

Bacterial overgrowth --> endoscopy, hydrogen breath --> high-fat diet, metaclop, augmentin

91

Sepsis tx w/ Cipro --> new diarrhea, WBC inc to 14K, confusion

C. diff = PO metronidazole 15K PO Vanco + IV metro

92

Flushing, diarrhea and wheezing, hypotension, tachy

Carcinoid syndrome --> surgery, octreotide

93

Abrupt painless watery diarrhea, severe dehydration

Cholera

94

Acute abd pain, bloody diarrhea, anemia, thrombocytopenia, renal insufficiency, jaundice

E. coli --> HUS --> plasmaphoresis

95

Recent diarrhea + abx --> renal failure, thrombocytopenia, schistiocytes, inc retic, inc LDH

Microangiopathic hemolytic anemia from HUS

96

Abd pain, bloody diarrhea, low H&H, low platelets, inc Cr, Inc bili

HUS --> renal failure/damage #1

97

Cirrhosis, ascities, fever, lethargy, confusion, inc WBC, inc liver enzymes, asterixis next step?

Dx paracentesis for SBP ---> 3rd gen cephalosporin

98

Dx criteria for SBP

>250 PMNs and + culture

99

Hx cirrhosis, abd pain, fever, paracentesis >250 PMN

SBP

100

Ascities d/t portal HTN criteria

Serum-ascities albumin gradient >1.1

101

Colonic perforation vs. SBP on CXR

Subdiaphragmatic free air w/ perforation

102

Sudden onset, constant, very severe, won't move, free air on XR

Perforation (peptic ulcer #1) --> emergency surgery

103

Sudden onset, colicky, radiation, moving to find comfort

Obstruction

104

Gradual onset, constant, general --> specific, fever, leukocytosis

Inflammation

105

Mild generalized acute abd w/ ascities, fever leukocytosis, 1 organism

Primary peritonitis --> Abx

106

Work-up for generalized acute abd

EKG, trops, CXR (PNA), PE, amylase, lipase, CT abd (stones) --> otherwise exp laparotomy

107

Abd pain worsened w/ eating

Mesenteric ischemia/angina

108

Acute abd + AFIB or MI, blood in bowel, acidosis, sepsis

Mesenteric ischemia --> ateriogram + embolectomy

109

1wk RLQ abd pain --> back, fever, anorexia, fever, leukocytosis, pain w/ R hip extension and IR

Appendix rupture w/ abscess --> Abx, bowel rest --> appendectomy in 6-8wks

110

Trauma with vertebral fx, retroperitoneal hemorrhage + dilated bowels on XR

Paralytic ileus

111

Internal hemorrhoid presentation

Bleed --> rubber band ligation

112

Young woman, exquisite pain w/ defecation, blood streaks --> constipated

Anal fissure (post. Midline) --> CCB ointment 2% TID 6wks

113

Can't sit down, no BMs d/t pain, fever, redness, swelling lateral to anus

Ischiorectal/perirectal abscess --> I&D

114

Hx ischiorectal abscess --> fecal soiling, perineal discomfort, cord-like tract felt

Fistula-in-ano --> r/o tumor and fistulotomy

115

HIV, fungating anal mass, inguinal LNs palpable

SCC of anus --> Bx + NIGRO chemradiation --> surgery if residual

116

Pain and swelling over coccyx/superior gluteal cleft

Pilonidal cyst --> I&D

117

Nagging abd pain --> back, N/V, tender in epigastrum

Acute pancreatitis --> NPO, NG, IVFs, Opioids, bowel rest

118

Acute onset constant epigastric pain --> back, N,V

Acute pancreatitis --> NPO, NG, IVFs, Opioids, bowel rest

119

Acute pancreatitis + elevated Hct

Edematous pancreatitis (hemorrhagic has lower Hct)

120

Pancreatitis 1st steps?

CT or RUQ US w/ pain

121

Tx acute pancreatitis

IVFs, fentanyl, NPO --> cholecystectomy

122

Complications of acute pancreatitis

PLUERAL effusion, ARDS, ileus, renal failure

123

1-2 wks s/p acute pancreatitis, fever, leukocytosis, shock

Infected pancreatic necrosis--> surgical debridement

124

Pancreatitis day 10 --> fever, leukocytosis

Abscess/suppurative pancreatitis --> wait >4wks for debridment

125

4wks s/p acute pancreatitis, palpable mass, inc amylase, no fever, early satiety

Pseudocyst --> US --> drainage only if >6wks or 5cm or infected

126

Chronic epigastric pain w/ pain free intervals, Malabs, DMII, Weight loss

Chronic pancreatitis --> CT or X-ray --> MRCP/ERCP --> small meals, enzyme replacement

127

Pancreatic cancer risks

Chronic pancreatitis, DM, smoking, high fat diet

128

Causes of chronic pancreatitis

etOH, CF, Auto-immune

129

Inc risk for severe pancreatitis

>75, high CRP, obesity, etOH, inc BUN --> CT --> inc vascular permeability --> MODS

130

Painless jaundice >50 y/o

Pancreatic malignancy --> compressing bile ducts

131

Jaundice, w/ non-palpable GB, pain, steatorrhea, inc bili, alk phos, anemia

Pancreatic CA --> US --> CT

132

Non-tender GB, RUQ pain, elevated direct bili, elevated alk phos

Pancreatic CA --> CT scan

133

Multiple ulcers, jejunal ulcer, impaired fat abs, resistant to H.pylori therapy, watery diarrhea

Zollinger-Ellison syndrome (gastrinoma) --> pancreatic enzyme inactivation

134

Somatostain supression test --> inc gastrin, somatostatin receptive scintography

ZE --> CT + resect

135

Repeated dec BG, HIGH C-peptide w/ high insulin

Insulinoma --> CT + resect

136

DM, migratory necrolytic dermatitis

Glucagonoma (DO NOT do glucose supression) --> glucagon assay, CT, resection or somatostain

137

Fasted --> large meal, epigastric pain, vomiting --> resolves, NO fever or leukocytosis

Biliary colic (stone in cystic duct) --> US for cholelithasis

138

Colicky RUQ pain --> R shoulder, belt like radiation to back

Biliary colic (stone in cystic duct) --> US for cholelithasis

139

Bloating and dyspepsia after fatty meals

Cholelithiasis --> US

140

RUQ pain, N/V, fever, air fluid levels in GB, US showing curvilinear shadowing

Emphysematous cholecystitis

141

Biliary colic --> constant pain, fever, leukocytosis + stones, thick wall

Acute cholecystitis --> NG, NPO, IVFs, Abx and "cool down" ?chole w/in 72hrs

142

Cause of acute cholecystitis

Impaction of STONE in CYSTIC duct --> inc alk phos

143

High fever, jaundice, RUQ pain, MARKEDLY HIGH ALK PHOS, WBC

Acute cholangitis (common duct blockage) --> Abx, ERCP or percutaneous drainage

144

Obstructive jaundice, severe icterus, very high alk phos cause

Common bile duct stone

145

Gallstone pathogenesis

Excess cholesterol --> insoluble crystals

146

Risk factors for cholesterol gallstones

White, obsese or rapid loss, Female, OCPs, glucose intolerance, hypomotility (preg, old)

147

Types of gallstones

Cholesterol >> mixed >> pigmented calcium bilirubinate

148

Risk factors for pigmented gallstones

Hemolysis (sickle cell), biliary infection, parasite, old age

149

Anti-mitochondrial Abs, very high alk phos

Primary biliary cirrhosis

150

Gallstone path in small bowel resection or TPN pt

Stasis

151

Gallstone path w/ OCPs & pregnancy

Estrogen --> inc Cholesterol secretion

152

Alternative tx for gallstones

UDCA --> dec cholesterol in bile by red hepatic secretion and inc intestinal abs

153

Burns, severe trauma, TPN, vent or fasting --> RUQ pain, thick GB w/o stones + fluid around, bowel distention

Acalculous cholecystitis --> gangrene, perf, emphysematous --> sepsis --> death

154

S/P cholecystectomy, intermittent RUQ pain, dilated common bile duct

Postcholcystectomy syndrome (PCS) --> ERCP

155

Anti-mitochondrial Abs

PBC

156

Pruritis, jaundice, steatorrhea, inc Alk phos, bilirubin, anti-mitochondrial abs eye finding?

PBC = xanthelasma

157

Hx of UC/IBD, fatigue, inc alk phos, bilirubin, atypical perinuclear antineutrophil cytoplasmic Ab

PSC

158

ERCP shows hepatic duct dilation "beading," periductular "onion skinning," w/ lymphocytic infiltrate

PSC

159

SW Native, mexican, gall stones, old, salmonella carrier, procelin GB at risk?

GB CA = surgery curative

160

Elevated conjugated bilirubin, Alk Phos, painless jaundice, fatigue, weight loss

Malignant obstruction --> US or CT

161

Red bile salt abs

Ileal resection

162

How to evaluate injury/hepatic function d/t chronic hepatitis

Liver Bx

163

High iron, transferritin sat, ferritin, high liver enzymes

Hemochromatosis = susceptible to Listeria, Yersinia, Vibrio (iron-loving)

164

Inc risk of infections w/ what organisms w/ hemochromatosis?

Yersinia, Vibrio, Listeria

165

Young, new resting temor, rigidity, clumsy gait, slurred speech, steatosis, mallory bodies in liver

Wilson's disease

166

PAS + and diastase resistant liver bx

Alpha-1 anti-trypsin deficiency

167

Fever, leukocytosis, tender liver, hx ascending cholangiitis

Pyogenic liver abscess --> US/CT --> percutaneous drainage

168

1-2 wks fever, RUQ pain from endemic area, dysentery, jaundice, liver mass, anchovy paste

Amebic liver abscess ---> serology + METRONIDAZOLE

169

Travel to Mexico, RUQ pain, single thin walled, uniform liver cyst, bloody diarrhea

Amebic liver abscess (E. histolytica)

170

Fever, abd pain, jaundice, N/V, AST>ALT

Alcoholic hepatitis ---> Prednisone

171

Slightly elevated liver enzymes, - hepatitis, no extrahepatic sx, TB tx, fatty change, necrosis

INH hepatitis

172

Slightly elevated liver enzymes, NO necrosis or fatty liver changes, OCPs

OCP hepatitis

173

RUQ pain, inc AST, ALT, DM, no etOH, hyperechoic liver

Non-alcoholic fatty liver (NAFLD) - insulin resistance --> inc lipolysis, TGs synthesis

174

Ascites, jaundice, telangiectasias, palmar erythema, testicular atrophy, gynecomastia, inc GGT

etOH hepatitis

175

EGG SHELL calcification of hepatic cyst, budding daughter cysts

Hydatid cyst - Echinococcus --> surgery + albendazole

176

IVDU w/ + HBV infection treated, now AST/ALT decline, PT increases = ?

Fulminant hepatitis

177

AFP level high, one lesion w/ poorly defined borders, central necrosis possible

HCC

178

Vague RUQ pain, weight loss, AFP high

HCC --> CT + resection

179

Solitary right lobe mass, young, middle aged women, RUQ pain, jaundice,

Hepatic adenoma (OCPs) --> CT --> resection to prevent rupture and bleeding

180

Enlarged hepatocytes containing glycogen and lipid deposits

Hepatic adenoma --> CT --> resection to prevent rupture and bleeding

181

Liver mass w/ sinusoids in kupffer cells, hyperplastic response to hyperperfusion

Focal Nodular Hyperplasia

182

Liver cirrhosis tx change pH from acidotic --> alkalotic, inc Na, dec K, inc BUN, Cr,

Loop diuretic therapy

183

Elevated conjugated bilirubin

Hepatobiliary disease (cirrhosis, hepatitis, gallstone), Dubin-Johnson, Rotor

184

Inc in DIRECT bili causes

Obstructive (cyst), sepsis, INFECTION, CF, metabolic

185

Elevated unconjugated bilirubin

Hemolysis, Thalassemia or Gilbert's

186

Pre-hepatic jaundice

RBC hemolysis --> unconjugated bili

187

Post-hepatic jaundice

Bile duct stone, strictures, tumor --> conjugated bili

188

Hepatic conjugated hyperbilirubinemia jaundice

Viruses, etOH

189

Conjugated bilirubin, elevated ALT, AST

Viral, etOH, ischemic, autoimmune, toxin HEPATITIS, Hemochromatosis

190

Conjugated bilirubin, elevated alk phos

Cholelithiasis, PSC, PBC, Malignancy, Cholangiocarcinoma --> US

191

Bili 6-8, inc INDIRECT only

Hemolytic jaundice

192

Elevated both conjugated, unconjugated + very high LFTs, modest alk phos

Hepatocellular jaundice - Hepatitis

193

Elevated both conjugated, unconjugated + modest LFTs, very high alk phos

Obstructive jaundice --> US

194

High alk phos, dilated ducts on US next step?

ERCP --> chole

195

Obstructive jaundice + anemia + blood in stool

Ampullary CA --> endoscopy

196

Gilbert's path

AR dec in glucuronidation --> unconjgated bili (2-4md/dl)

197

Infant w/ kernicterus, indirect bili 20-25

CNJ-1

198

Dark granular liver on bx

Dubin-Johnson (not Rotor - inc both labs)

199

Jewish, conjugated bili, weak, fatigue, icteric w/ illness

Dubin-Johnson

200

Elevated coproporphyrin I

Dubin-Johnson

201

Conjugated bilirubin, Normal ALT, AST, Alk phos

Dubin-Johnson, Rotor

202

Dark urine + bilirubin + dipstick = conjugated, jaundice cause?

Rotor

203

Always pathologic jaundice

Direct >15%, 1st 24hrs

204

1st week, poor intake, poor weight gain, dec stool, dec wet diapers, jaundice

BreastFEEDING failure jaundice - relative dehydration

205

>1wk, inc B-glucuronidase & lipase jaundice, UNconjugated bili

Breast milk

206

When to evaluate jaundice

5-8 in 24hrs, inc >0.5mg/dl (hemolysis)

207

Asian, 2-day old, jaundice, high un-conjugated bili

Physiologic = dec UGT enzyme

208

Exchange transfusion indication

Bilirubin >20-25

209

Inc conjugated bilirubin

Galactosemia

210

Ab pain, dark urine, mass RUQ, cystic extra hepatic mass

Choledochal cyst --> US --> CT or MRI & can --> cholangiocarcinoma

211

Congenital intrahepatic dilation of bile ducts

Caroli's syndrome

212

Marked obstructive jaundice, substantial conjugated, acholic stools

Biliary atresia

213

6-8 weeks, persistent jaundice

Biliary atresia --> HIDA 1 week after phenobarbital injection (pools = dx) --> resect

214

Anti HBsAg (+), Anti-HAV Abs (-), Anti-HCV Abs (+) next step?

HAV vaccine to prevent acute hepatic failure - Has Hep C infection

215

Diarrhea, Abd pain, jaundice 1mo after travel to C. America, tender hepatomegaly, low fever

Hep A - contaminated water/oysters --> supportive care + vaccine or Ig to close contacts

216

Test to confirm HepA

Anti-Hep A IgM

217

Risk of developing chronic HBV infection

90%infants --> 80% of HCC worldwide

218

HBsAg >6 months

Chronic HBV

219

Anti-HBcAg IgM

Acute infection

220

HBV tx

Interferon + lamivudine

221

Waxing and waining LFTs, chronic arthralgias, +RF, ANA, cryoglobulin, PCT, GN, type of hepatitis?

Chronic Hep C --> Hep A & B vaccines, safe in pregnancy

222

#1 chronic liver disease and #1 cause for transplant

HCV - 60-80% --> chronic infection = avoid etOH use, get HepA, B vaccination

223

Unintentional weight gain, jaundice, ascites, RUQ tenderness, edema, faded tatoos

Chronic Hep C (HCV RNA + Anti-HCV Ab)

224

HCV tx

Interferon + ribavirin

225

How does HDV infect

Viral envelope of HBV

226

HbsAg

1st, before AST, ALT rises, suggests infectivity

227

Anti-Hbs

Vaccination or cleared = immunity

228

Anti-HBc

After HbsAg dissapears - most specific for acute infection, present in "window" period

229

HbeAg

Infectivity, >3mo = chronic

230

Central abd herniation + covering

Omphalocele - tetrology, trisomy, ASB, Beckwith

231

Right paraumbilical hernia, no covering, no other malform

Gastroschisis --> Silo, moist --> twist bowel in each day, TPN

232

1st step in managing gastrochisis

Immediately wrap w/ sterile dressing, plastic --> OG, Abx --> surgery

233

#1 intestinal obstruction

Atresia

234

Distention, tenderness, bloody stool & air in bowel wall

Necrotizing enterocolitis - d/t asphyxia --> bowel ischemia

235

PRE-ME, abd distention, vomiting, hypothermia, enteral feedings --> bloody BM w/ 1st feed, DEC platelets

Necrotizing enterocolitis --> breast milk dec

236

<1.5kg, congenital heart disease, hypotension, bloody stool, lethargy, RDS

Necrotizing enterocolitis --> NPO, Abx, IVF, TPN --> US brain to r/o IVH

237

Small left colon, ab distention, no meconium cause

DM mom

238

Reye syndrome liver pathology

Fatty vacuolization (fatty liver) w/o inflammation, mitochondrial injury

239

Inc LFTs, prolonged PT, hypoglycemia, acidosis, vomiting, ASA

Reye syndrome --> FFP, glucose, mannitol

240

Cryptorchidism risks

Pre-me, LBW, DES --> orchipexy b4 1 y/o

241

Cryptorchidism complications

Subfertility > torsion, cancer, hernia

242

Mom migraine HA, recurrent self-limiting episodes of vomiting

Cyclical vomiting

243

1st born boy, 3-5wks, Erythromycin use, formula, non-bili vomit, small stool, hungry

Pyloric stenosis (hypoCl, K metabolic alkalosis) --> US donut sign --> IVFs, electrolytes, surgery

244

Difficulty swallowing, refusal to feed, vomiting

Foreign body - #1 are COINS --> flexible endoscopy

245

Foreign body - no Sx tx; not radioopaque tx?

Observe if not sharp; CT scan

246

Concave abd, barrel chest, R sided heart, No Left lung sounds, RDS

Diaphragmatic hernia = posterolateral LEFT --> intubation, delay repair 3-4d

247

Scaphoid abd, resp insufficient

Diaphragmatic hernia = posterolateral LEFT --> intubation

248

Bilious vomiting, CTFR gene, no air in rectum - "ground glass" loops of bowel

Meconium ileus --> Gastrographin enema

249

Soap-bubbles on XR, microcolon contrast enema

Meconium ileus

250

3d old, inspissated/viscous meconium

Meconium ileus = CF

251

Meconium normal consistency when irrigated, rectosigmoid obstruction, explosive w/ DRE

Hirschsprungs --> bx & surgery

252

2 y/o male painless (vs. intussusception) hematochezia

Meckels --> techneicum-99 --> surgery

253

Recurrent intussussception cause

Meckels diverticulum

254

Hx gastroenteritis, colicky abd pain, drawing legs to abd, vomiting, "empty RLQ"

Intussussception --> US or KUB (sausage shape) --> air enema

255

Triple bubble sign, bilious vomiting, no meconium, cocaine use, no chr abn

Jejunal atresia

256

Meconium aspiration syndrome

D/t stress, hypoxemia, Inc >42wks

257

Regurg each feeding, burps --> better, no gagging, cough, ok weight/size

Normal GERD --> upright 20-30min and reassurance, small frequent feeds

258

Regurg, vomiting, bloody stool, eczema

Milk protein allergy

259

Fam hx eczema, breast feeding, bloody stool, regurg

Milk protein allergy --> mom eliminate all dairy and soy, continue breastfeed

260

Regurg, FTT, sign irritability, Sandifer syndrome

GERD --> thicker, antacid, pH probe, EGD

261

Coughing, choking spells, gurgling, NG tube coils

Esophageal atresia --> surgery

262

Upside-down baby gram large distance imperforate anus

Colostomy now & fix b4 toilt training

263

Epispadias assoc w/

Bladder extrophy

264

"Wet w/ urine," "red and shining," "no bowel is seen"

Bladder extrophy --> emergent intervention first 1-2d of life

265

Dysuria from birth, 0 urine output day 1, inc Cr, +/- oligohydramnios

Posterior urethral valves --> cath + residuals --> VCUG --> leave cath in, resect & re-implant

266

1st drinking binge (high flow) --> colicky abd pain that sponatenously resolved

Uretero pelvic junction --> IVP --> stent ot surgery

267

GIRLS normal voiding + CONSTANT LEAK, ureter --> urethra

Low implantation of ureter --> IVP --> re-implantation b4 toilet training

268

Frequent UTIs OR any pyelonephritis

Vesiculoureteral reflux --> IVP --> surgical OR ppx abx and wait to outgrow

269

Unless hematuria occurs w/ HUGE trauma, kids don't pee blood

US --> IVP --> NO CT scans unless it may be cancer