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Flashcards in GI Deck (70)
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1

What is GERD

post prandial regurgitation
• 85% resolves by 12 m, mostly benign and self limiting

2

What are 5 disorders of the esophagus?

Gastroesophageal Reflux
Eosinophilic Esophagitis
Achalasia of the Esophagus
Caustic Burns of the Esophagus
Foreign Bodies of the Alimentary Tract

3

What are some complications of GERD?

apnea, aspiration, irritability, neck contortions
o sandifer syndrome→ severe form of reflux when they arch their back and turn their head to the side
o RED FLAG: bilious vomitus→ could be malrotation with volvulus, insussuception

4

4 Ways to diagnose GERD?

• Antacid trial→ diagnostic & therapeutic
• UGI: r/o anatomic probs, non specific
• pH probe
• Esophagoscopy: evaluate the esophagitis

5

Treatment for GERD?

• Smaller more frequent meals, thickened foods, H2 antagonists, hydroxylated formulas, fundoplication

6

Eosinophilic Esophagitis

• MC in boys
• Sx similar to gerd, with dysphagia→ don’t respond to antacids
• Endoscopy→ white exudate w/eosinophils, hypertrophied mucosal ring
• Skin testing may show allerfins to foods

7

3 treatments for Eosinophilic Esophagitis?

o Exclusion/elimination diet
o Inhailed steroids
o Esophageal dilation for strictures

8

Achalasia of the Esophagus

• MC in kids over 5
• SX→ dysphagia, posprandial vomiting, retrosternal pain, early satiety, weight loss, solid food impaction,

9

Caustic Burns of the Esophagus symptoms?

pH12= larger volume of ingestion=liquefaction necrosis
• Sx→hoarseness, stridor, drooling, food refusal, dyspnea

10

Caustic Burns of the Esophagus is caused by?

• Caused by→ gels/powders (dishwashing detergent)

11

Caustic Burns of the Esophagus Dx and complications

• Dx→ endoscopy72 hrs could be perfed
• Complications→ full thickness necrosis , can lead to stricture

12

Caustic Burns of the Esophagus

• Tx→ repeated esophageal dilation, colonic interposition/gastric tube for strictures resistant to dilation

13

Foreign Bodies in GI Tract:

• 80-90% pass, MC are coins, things with heavier blunt ends pass w/out problem
• Removal: button batteries, open safety pins, more than one magnet, objects > 5cm. wooden tooth picks

14

3 disorders of the stomach and duodenum

Pyloric stenosis
Gastric & duodenal ulcer
Congenital duodenal obstruction

15

Pyloric Stenosis

MC males, 13% fam hx,
• Sx→2-12 weeks of posprandial nonbilious projectile vomiting, ravenous appetitie after vomiting

16

What are 3 findings on PE for pyloric stenosis?

o Dehydration, hypochloremic lkalosis
o RUQ/epigastric “olive”
o Gastric wave=pathognmomonic

17

Work up for pyloric stenosis

o UGI→ long narrow pyloric channel (dbl track sign), tightened pyloris
o U/S→ hypoechoic mass, thickness, pyloric lenghth over 15mm

18

Treatment for pyloric stenosis?

o Pyloromyotomy

19

Gastric & Duodenal Ulcer

Local erosion of gastric/duodenal mucosa, any age, MC males, often “stressed”/ICU babies
• SX→ pain, bleeding, obstructions, anemia, perforation

20

MC causes of gastric & duodenal ulcer

o Underlying severe illness: CAN, burns, sepsis, cirrhosis, RA
o H.pylori
o NSAIDS, ASA, alcohol
o Toxins

21

Diagnosis of gastric & duodenal ulcer

preferably endoscopy
o UGI may show ulcer, but non specific
o Breath test after PO radioactive-labeled urea→ for H.pylori

22

Treatment for gastric & duodenal ulcer

o H2 receptor agonist & proton pump inhibitors
o 7-14 day course of sucralfate
o Limit caffeine, ASA, alcohol (what the fuck?), NSAIDS
o Amoxicillim, metronidazole, clarithromycin, bismuth subsalicylate for 10-14 days (for h.pylori)
o Amox for 14 days + omeprazole for 6 wka
o Clairthro for 7 days w/PPI for 6 wks

23

what is Congential Diaphragmatic Hernia

→ abd contents herniate through posterolateral defect, diaphragm doesn’t fuse=lung hypoplasia (80% are L.diaphragm)

24

How is Congenital diaphragmatic hernia usually diagnosed?

• When newborn→ resuscitate, intubate, cant use bag+mask (bowel will inflate)
• Can be found on CXR by accident
• Kids w/it often have GERD

25

Intestinal Atresia & Stenosis:

• Usually dx’d prenatally with U/S
• Sx→ bilious vomiting & distension soon after birth
o Associated with: atresias, cardiac & renal anomalies, downs syndrome

26

how to diagnose and treat Intestinal Atresia & Stenosis:

• X-ray→ double bubble w/gasless bowel
• Tx→ duodenoduodenostomy→ bypasses the stenosis/atresia

27

Intestinal Malrotation:

most present in 1-3 weeks with bilious vomiting leading to obstructions, malabsorption, diarrhea

28

How to diagnose Intestinal Malrotation:

o Plain film→ will see dbl bubble, distal gas
o UGI→ gold standard, 96% sensitivity
o Barium enema for confirmation

29

How to treat Intestinal Malrotation:

o Ladd procedure→ duodenum mobilized, mesenteric root extended, bowel fixed in more normal layout

30

What is short bowel syndrome?

when 50% of bowel is removed
• Cant grow in length to compensate, with nutrition enterocytes proliferate and villi lengthen and intestine will elongate in height