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Flashcards in GI Deck (70)
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What is GERD

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


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


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 Ways to diagnose GERD?

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


Treatment for GERD?

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


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


3 treatments for Eosinophilic Esophagitis?

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


Achalasia of the Esophagus

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


Caustic Burns of the Esophagus symptoms?

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


Caustic Burns of the Esophagus is caused by?

• Caused by→ gels/powders (dishwashing detergent)


Caustic Burns of the Esophagus Dx and complications

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


Caustic Burns of the Esophagus

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


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


3 disorders of the stomach and duodenum

Pyloric stenosis
Gastric & duodenal ulcer
Congenital duodenal obstruction


Pyloric Stenosis

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


What are 3 findings on PE for pyloric stenosis?

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


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


Treatment for pyloric stenosis?

o Pyloromyotomy


Gastric & Duodenal Ulcer

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


MC causes of gastric & duodenal ulcer

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


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


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


what is Congential Diaphragmatic Hernia

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


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


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


how to diagnose and treat Intestinal Atresia & Stenosis:

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


Intestinal Malrotation:

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


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


How to treat Intestinal Malrotation:

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


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