GI Flashcards
(269 cards)
1
Q
Squamous cell cancer of esophagus
A
Smoking, etOH, hot liquids, pickled foods, Nitrates, deficiency of B1, carotene, selenium
2
Q
Adenocarcinoma of esophagus
A
Constant GERD, Barrett’s, weight loss, high calorie/fat, hiatal hernia –> GERD
3
Q
Drugs that cause esophagitis
A
K, iron, tetracyclines, NSAIDS, alendronate, quinidine
4
Q
Zenker diverticulum pathogenesis
A
Motor dysfxn - sphincter contraction/dysmotility –> excision & cricopharyngeal myotomy
5
Q
Progressive dysphagia, CP, regurg, No LES relaxation
A
Achalasia - myenteric plexus, T. cruzi
6
Q
Progressive dysphagia, nighttime cough, regurgitation, weight loss, heart burn
A
Achalasia –> Barium +/- manometry –> Endoscopy w/ balloon dilation or myomectomy
7
Q
Crushing pain w/ swallowing, dysphagia for liquids, regurg
A
Achalasia –> Barium +/- manometry –> Endoscopy w/ balloon dilation or myomectomy
8
Q
Dysphagia for solids –> softs –> liquids, weight loss, smoking or longstanding GERD
A
SCC (smoking) or Adenocarcinoma (GERD) –> Barium –> endo + bx –> CT for operability
9
Q
Dysphagia of both solids and liquids, chronic GERD 1st step
A
Barium esophogram –> endocsopy
10
Q
Prolonged forceful vomiting + bright red blood
A
Mallory-weiss tear –> endocscopy –> laser
11
Q
Prolonged forceful vomiting –> sternal pain, fever, leukocytosis
A
Boerhave syndrome –> Gastrografin swallow –> repair
12
Q
1 cause of esophageal perforation
A
Instrument –> emphysema in neck –> contrast esophagram
13
Q
CP, epigastric pain, burning + CXR widened mediastinum, mediastinal air
A
Esophageal rupture = instrument, KCl, vomiting, Barrett, candida/HIV, caustic ingestion
14
Q
Food stuck in throat/muscle that initiates swallowing
A
Cricopharyngeal
15
Q
Severe odynophagia, CD4 <50, round ulcers in esophagus cause
A
HSV - CMV (deep linear ulcers)
16
Q
Drug causes of esophagitis
A
KCl, tetracyclines, bisphosphonates, NSAIDs
17
Q
Intermittent CP, dysphagia, simultaneous high amplitude contractions
A
Dissuse esophageal spasm
18
Q
Fibrosis, atrophy, no distal esophagus movement, loss of LES tone
A
Scleroderma
19
Q
Stuck chicken bone, unable to open mouth fully, limited nexk extension, fever
A
Retropharyngeal abscess –> CT + Abx to avoid –> mediastinum
20
Q
Tx for variceal bleeding
A
2 Ivs or central line –> octreotide or somatostatin
21
Q
Tx for non-bleeding varicees
A
BB (propanolol) –> sclerotherapy –> TIPS if refractory to all other tx
22
Q
1 esophageal atresia
A
Proximal pouch, distal TE fistula
23
Q
Overweight, burning pain worse laying down, bending over, tight clothes, antacids help, long standing
A
GERD –> PPI –> endoscopy + Bx
24
Q
Nocturnal wheezing, morning hoarsness, inflamed pharynx next step?
A
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
