GI Flashcards
1
Q
6 year old with periumbilical pain yesterday, now presents with RUQ tenderness and guarding, but no rebound tenderness…best diagnostic test to determine if surgery is necessary?
A
CT with contrast, because best way to rule out appendicitis is via CT with contrast
-Don’t be tricked into steering way from thinking appy just because there is no rebound tenderness and going after ruling out something like Yersinia, mesenteric adenitis, or Crohn’s
2
Q
Name 10 causes of acute abdominal pain.
A
- Appendicitis
- Pain from pneumonia
- Post-Op Intestinal Obstruction
- Constipation (Cyst-ovarian)
- Mesenteric adenitis
- Mono
- Pancreatitis
- Hepatitis
- Infection (UTI)
- Trauma
3
Q
What needs to be considered in any child presenting with an acute abdomen?
A
Appendicitis
4
Q
What is the usual age in which appendicitis presents?
A
More common in kids over 2, but can present in infants too
5
Q
What is the diagnostic spot for pain in appendicitis?
A
McBurney’s point
6
Q
Where is McBurney’s point?
A
1/3 the way between the ASIS and umbilicus
7
Q
Name some symptoms associated with appendicitis.
A
Pain in the RLQ, nausea, vomiting, anorexia, low-grade fever
8
Q
What is the psoas sign associated with?
A
Appendicitis
9
Q
What is the psoas sign?
A
Pain when straightening out the leg
10
Q
Name 2 XR findings in appendicitis.
A
- Sentinel loop
2. Absence of air in the RLQ
11
Q
What is a hardened mass (usually of stool) seen on XR in appendicitis?
A
Fecalith
12
Q
What is the most common finding on XR for appendicitis?
A
NEGATIVE…don’t be fooled into thinking it isn’t an appy just because the XR is negative
13
Q
True or False: A child who wishes to eat is unlikely to have an appendicitis?
A
True
14
Q
Is severe vomiting associated with appendicitis?
A
Not always
15
Q
Does a normal WBC count rule out appendicitis?
A
No
16
Q
Acute abdominal pain with a history of cough and other respiratory signs…what test do you use to diagnose the problem?
A
Pneumonia…CXR
17
Q
Post-op patient with acute abdominal pain?
A
Obstruction
18
Q
What is seen on XR with post op intestinal obstruction?
A
Obstructive gas pattern
19
Q
What is the first thing you do with post-op intestinal obstruction?
A
Bowel decompression
20
Q
Causes of acute abdominal pain?
A
"CAMP HIT" Constipation (Cyst-Ovarian) Adenitis (Mesenteric) Mono Pancreatitis Hepatitis Infection (UTI) Trauma
21
Q
What includes all children who have abdominal pain for which a specific cause cannot be identified?
A
Recurrent or chronic abdominal pain
Some kids will have an etiology (like celiac) while some kids will continue with pain for which no cause can be found.
22
Q
- Recurrent pain in the upper abdomen or periumbilical pain.
- Pain isn’t relieved with defecation or changes in stool pattern.
- No organic cause of explanation for symptoms
A
Functional dyspepsia
23
Q
How long do the symptoms of functional dyspepsia have to be present before a diagnosis can be made?
A
At least once per week for at least 2 months
24
Q
What do you think if they describe a kid with recurrent pain in the upper abdomen or periumbilical pain, pain isn’t relieved with defecation or changes in stool pattern, and no organic cause of explanation for symptoms who has a recent history of acute viral gastroenteritis?
A
Gastroparesis (this will be described after the viral illness has resolved)
Not functional dyspepsia
25
True or False: If the test for H. Pylori is poitive in the context of recurrent abdominal pain, does that mean there is a causal relationship?
False (so routine testing for H. Pylori in a question involving a patients with functional dyspepsia will likely be wrong)
26
What is H. Pylori associated with?
1. Low socioeconomic status (especially those living in crowed housing)
2. Immigrants from developing countries
27
If routine testing for H. Pylori indicated in someone with functional dyspepsia?
No... can consider if patient is an immigrant from a developing country or is of low socioeconomic status
28
Name some red flags and systemic findings that point away from functional dyspepsia.
Pain radiating to back, bilious vomiting, bloody emesis, difficulty swallowing, melena, weight loss, fever, night sweats, anemia
29
What is treatment for functional dyspepsia (non-pharmacological)?
1. Eliminating items that can exacerbate symptoms: NSAIDs, spicy foods, soda (caffeine)
2. Small more frequent meals
30
What are some pharmacological treatment options for functional dyspepsia?
H2 antagonists or gastric PPIs
*Can also consider a low dose antidepressant (works in adults, not proven in kids)
31
How long/frequent must there be symptoms for irritable bowel syndrome?
Once a week for at least 2 months
32
Name symptoms and findings consistent with irritable bowel syndrome.
1. Abdominal discomfort improved with defecation
2. Change in stool frequency
3. Change in stool consistency
4. No organic explanation for symptoms
5. Straining or bowel urgency
6. Feeling of incomplete evacuation
7. Passage of mucus
8. Bloating
9. Abdominal distention
33
What are some red flags in the clinical description that point away from IBS?
1. Pain limited to night time
2. Unexplained weight loss
3. Oral ulcers
4. Rash
5. Pallor
6. Bloody stools
34
What is the more likely diagnosis if they are describing GI issues in a kid with additional systemic signs like anemia, fever, arthritis, delayed puberty, short stature, or family history?
IBD
35
What are 2 non-pharmacological ways to manage IBD?
1. Dietary changes
| 2. Addressing psychological issues
36
What are some dietary changes that can help with IBD?
Reducing sorbitol (stuff in sugar free candy), fructose, and gas-forming foods (like brussel sprouts, broccoli, beans, kim chee)
37
What is a controversial pharmacologic to help with IBD?
Tricyclic antidepressants
38
How long must symptoms be present to diagnose childhood functional abdominal pain?
At least once a week for past 2 months
39
What is described by episodic or continuous abdominal pain that doesn't meet the diagnostic criteria for other GI disorders? In addition, there must be evidence of loss of daily activity and additional symptoms like headache, limb pain, or sleep disruption?
Childhood functional abdominal pain
40
What is the typical clinical presentation of an abdominal migraine?
Acute, incapacitating, periumbilical abdominal pain that lasts for more than 1 hour
41
What are some additional findings seen in abdominal migraine?
Pallor, anorexia, nausea, vomiting, headache, or photophobia
42
What is required to diagnose abdominal migraines (deals with when symptoms occur)?
There must be symptom free period lasting weeks to months between episodes.
In addition, family history of migraine headaches could be included
43
What are two non-pharmacological ways to treat abdominal migraine?
1. Remove triggers like caffeine or nitrate-containing foods (smoked meats)
2. Reduce psychological stress
44
True or False: Pharmacological treatment for abdominal migraines and regular migraines is the same?
True
45
What should you consider in a patient who presents with recurrent abdominal pain and urinary retention, tachycardia, blurred vision, and dry mouth?
Anti-cholinergic medication... this kid may have been inappropriately prescribed anticholinergics to treat recurrent abdominal pain...anticholinergics should NOT be given to kids with acute or chronic diarrhea
46
When would you order labs or imaging for a kid with suspected functional abdominal pain?
You wouldn't...watch for signs or indications of psychological stressors
47
When do you use antidirrheal medications in children?
NEVER
If you are presented with a kid in GI distress who got anti-diarrheals, these medication are cause of symptoms
48
Where is watery diarrhea derived from?
Small intestine
49
How is watery diarrhea described (2)?
1. High volume
| 2. Not bloody
50
True or False: No specific tests are needed when presented with a patient with water diarrhea?
TRUE
51
What are the 2 exceptions to testing for watery diarrhea?
Concern for C. Diff or diarrhea due to cholera
*Picture watery diarrhea with a "C" (sea) to remind you of C. Diff and Cholera needing specific studies
52
How is inflammatory diarrhea described?
Small and frequently contains blood, mucous, and WBCs. More toxic picture will be described.
53
True or False: Children who have diarrhea should continue to be fed age-appropriate diets?
True
54
What is the optimal mixture of oral rehydration solution in a child who is moderately to severely dehydrated?
2% glucose and 90mEq NaCl
55
True or False: Pedialyte is considered a rehydration solution
FALSE
56
True or False: The AAP recommends fatty foods and foods high in simple sugars (sweetened tea, juice, soft drinks) to help the diarrhea resolve faster
FALSE
57
What is the AAP view on the BRAT diet?
Contains well-tolerated foods, but too limited and doesn't supply optimal nutrition. "Bowel rest" is considered to be unnecessary starvation.
58
Why is anything that reduces intestinal motility dangerous?
Results in pooling of fluids with dehydration going unnoticed
59
True or False: Oral rehydration fluids reduce ongoing stool losses?
False
60
Is tea part of the BRAT diet?
NO
61
What is more indicative of diarrhea secondary to bacteria than occult blood?
Neutrophils in the stool
62
What can be used to find WBCs in stool?
Methylene blue
63
How does viral diarrhea present (like rotavirus)?
Low grade fever, vomiting, and large loose watery stools
64
What is the leading and 2nd lead cause of diarrhea in infants worldwide?
Rotavirus, then adenovirus
65
How does bacterial diarrhea often present?
High fever, small frequent stools, mucous or blood
66
How does enteropathogenic E. Coli (EPEC) diarrhea present?
Acute and chronic diarrhea in neonates and children under 2. Stool non-bloody, but fever and vomiting commonly seen.
67
Where is EPEC more common?
Areas with poor sanitation
68
How does enterotoxigenic E. Coli (ETEC) diarrhea present?
Severe diarrhea and cramping that is self-limited
69
What is another name for ETEC?
Traveler's diarrhea (Mexico)
"Entero-TACO-genetic" (enterotoxigenic) E. Coli causes traveler's diarrhea
70
Is prophylaxis against ETEC (traveler's diarrhea) indicated in otherwise healthy children?
Not typically
71
What can you use for prophylaxis against ETEC?
Bismuth subsalicylate or antibiotic (Bactrim)
72
When would you consider antimicrobial therapy for ETEC?
If diarrhea doesn't improve after several days of supportive care and assays for Shiga toxin are negative
73
What are some treatment options for ETEC?
Bactrim, azithromycin, ciprofloxacin (depending on age of patient)
74
What are some other names for Shiga toxin producing E. Coli (STEC)?
O157:H7 serotype, enterohemorrhagic E. Coli (EHEC), verotoxin-producing E. Coli
*Important to remember that this is a Shiga-toxin producing bacterial... problems happen with this
75
How does Shiga toxin producing E. Coli present?
Stools usually start as watery diarrhea and become bloody after 3 or 4 days. Several abdominal pain and cramping are typical, but fever is rare.
76
What 2 complications can Shiga toxin producing E. Coli cause?
1. Hemorrhagic Colitis
| 2. HUS
77
Why are antibiotics contraindicated in enterohemorrhagic E. Coli diarrhea?
1. Can result in release of shiga toxins
| 2. Increase risk of HUS in kids
78
What organisms cause prolonged watery diarrhea and are common in people of all ages in industrialized as well as developing countries?
Enteroaggregative E. Coli (EAEC)
79
How does enteroaggregative E. Coli act (how did it get its name)?
Bacteria stack up on each other... bacteria aggregate and colonize intestinal mucosa, releasing enterotoxinc and cytotoxins that destroy cells lining the intestines
80
How does enteroinvasive E. Coli diarrhea present?
Clinical picture similar to dysentery (Shigella)... stools may be blood- and mucous-tinged, and tenesmus may be present
81
True or False: Patients with enteroinvasive E. Coli are usually afebrile
TRUE
82
What is protracted diarrhea defined as?
Diarrhea beyond 2 weeks that can't be attributed to an acute gastroenteritis
83
What would you think for a newborn with protracted diarrhea?
Anatomical causes (short gut)
84
What would you think for an infant with protracted diarrhea?
Viral infection or protein intolerance
85
What would you think for a toddler or older kid with protracted diarrhea?
Lactose intolerance
86
What is a test for sugar malabsorption?
Clinitest (Quick Screen)... tests for reducing substances (dietary sugars except sucrose). Presence of these reducing substances in stool would correlate with sugar malabsorption.
87
What is a test for sugar malabsorption?
Hydrogen breath test. Normal gut flora ferments sugar, resulting in hydrogen production, which is absorbed in blood and excreted in lungs.
88
What is a test for fat malabsorption?
Fecal fat measurement. A single stool specimen for fat isn't valid verification...need 3-day fecal fat determination.
89
What is a test for fat malabsorption?
Serum carotene and prothrombin time... indirect tests (correlate with vitamin A and vitamin K absorption.
90
What is a test for protein malabsorption?
Albumin level and total protein. This typically occurs along with fat malabsorption. When it occurs as an isolated clinical finding, edema and other clinical findings will be noted.
91
Does the description of loose stools suggest/confirm chronic diarrhea?
No.. a kid with steatorrhea might have a couple large, firm, stool daily, but still be suffering from chronic malabsorption
92
How can a neuroblastoma cause diarrhea?
Can produce vasoactive intestinal peptides
93
When does transient lactase deficiency occur and how long to return to normal?
After an acute gastoenteritis, can take up to 3-6 months to return to normal
94
What is the most common cause of chronic diarrhea in children up to age 3?
Toddler's diarrhea (chronic non-specific diarrhea)
95
What is toddler's diarrhea often due to?
Excessive fruit juice intake
96
How does toddler's diarrhea present?
Typically in a toddler with formed stool in the AM, which becomes progressively loose as the day progresses
97
True or False: By definition, growth an development are normal in Toddler's diarrhea?
True... Poor growth, fever, and melena are not seen
98
What is treatment for Toddler's diarrhea?
Limiting carbohydrates in diet and increasing intake of high fiber foods (fruits and veggies)
99
What are 3 predisposing factors diarrhea can be seen with?
1. Malnutrition
2. Chronic infection
3. Systemic disease
4. Immunodeficiency
100
What is a common cause of vomiting in early infancy... description similar to that of a septic infant?
Inborn errors of metabolism
101
What should you look for if you are given an infant with a septic picture and labs as clues to point to inborn errors of metabolism?
1. Metabolic acidosis with elevated anion gap
2. Hypoglycemia
3. Hyperammonemia
4. No fever
102
How does duodenal atresia present?
Bilious vomiting during the first day of life
103
What is seen on XR for duodenal atresia?
Double Bubble sign
104
Why are infants with duodenal atresia frequently icteric?
Diminished enterohepatic circulation
105
When will you see no air distal to the site of atresia in duodenal atresia?
If there is complete atresia
106
What do you do for any newborn who presents with bilious vomiting?
Abdominal film
107
True or False: Malrotation is a surgical emergency that requires immediate intervention
TRUE
108
What causes malrotation?
Cecum's failure to descend while being handcuffed to the posterior right abdominal wall... this compresses the duodenum, causing duodenal obstruction
109
How does malrotation typically present?
Bilious vomiting, abdominal tenderness, abdominal distention, crampy abdominal pain, blood via rectum
110
What presents similarly to malrotation?
NEC
Typically seen in preemie, but can occur in full-term infant
111
What presents in infancy as bilious vomiting and right-sided abdominal distention?
Volvulus
112
Which condition is associated with Ladd Bands, and what is the result of this?
Volvulus
| Constrict the large and small bowel
113
What are the XR findings for volvulus?
Gastric and duodenal dilation, decreased intestinal air and corkscrew appearance of duodenum.
114
How can GE reflux present?
Severe emesis (sometimes out of the nose), abdominal pain, arching with feeds. Effortless regurgitation (spitting up) in infant who is well otherwise.
115
Which condition (in a severe case) can result in apnea and failure to gain weight?
GE reflux
116
True or False: Infant with daily episodes of spitting up at 4 months of age can be normal?
True
117
Which 3 things seen with suspected GERD require further workup or treatment?
1. Esophagitis (posturing)
2. Failure to thrive
3. Apnea
118
Which test for GERD assesses for malrotation and hiatal herna?
UGI series
119
Which test for GERD assesses extend and duration of reflux over a 24 hour pediod?
pH probe study (esophageal impedence)
120
Which test for GERD looks for gastroparesis?
Gastric emptying scan
121
Which test for GERD measures peristalsis and esophageal sphincter pressure?
Esophageal motility evaluation
122
If they mention amount baby is being fed along with signs of reflux, what should you consider?
Reducing amount of feedings (overfeeding can cause GERD)
123
True or False: Regurgitation is often a normal finding in infants
True... reassurance is often correct answer
124
At what age do infants who have physiologic reflux outgrow it?
1
125
What are signs indicating higher risks for complications of GERD?
1. Prematurity
2. Underlying neurological impairment
3. Family history severe GERD
126
What are 3 non-pharmacologic treatments for GERD?
1. Upright when feeding
2. Smaller more frequent feeding
3. Thickened feeds (rarely)
127
Which 2 groups of patients is pharmacologic treatment of reflux indicated for?
1. Symptomatic disease
| 2. Neurological impairment
128
What are 2 classes of medications for GERD?
1. Antacids (ranitidine)
| 2. PPI (Omeprazole and lansoprazole)
129
True or False: Medications treat reflux
FALSE: Decrease pain from heartburn, not actual reflux
| Boards want you to choose reflux precautions and reassurance
130
What should you think of with GE reflux and dystonic movements of the head and neck?
Sandifer Syndrome (Sandpiper blowing sand out of pipe...reflux plus twisted pipes/twisted movements)
131
What is the MOA for Zofran?
Serotonin receptor antagonist
132
When is surgery indicated for GERD?
Severe consequences (failure to grow or respiratory compromise) and medication failure
133
Does pyloric stenosis occur more frequently in males or females?
Males
134
Does a paternal or maternal history of pyloric stenosis increase the risk of developing pyloric stenosis more?
Maternal... (since it is rarer in females)
135
How is pyloric stenosis diagnosed?
US
136
How is pyloric stenosis treated?
Surgically (AFTER electrolyte imbalance is corrected)
137
What will be the description for pyloric stenosis?
Progressive non-bilious vomiting
| They will not likely give projectile vomiting with a palpable olive
138
When does pyloric stenosis typically occur?
Second month of life (could be anywhere from 2-5 months however)
139
What is the metabolic problem with pyloric stenosis?
Hypochloremic metabolic alkalosis with severe hypokalemia
| Vomiting HCl...acid and chloride
140
When would a pre-term infant present with pyloric stenosis?
Later than the 2-5 month age range... but the equivalent postnatal age
141
What other lab abnormality can be seen in pyloric stenosis in up to 2.5% of cases?
Elevated indirect bilirubin
142
What are the diagnostic criteria for pyloric stenosis?
Ultrasound:
1. Pyloric length greater than 14mm
2. Pyloric muscle thickness greater than 4mm
143
What must be done before surgery with pyloric stenosis?
Correction of electrolyte imbalances
144
2 month old, Down Syndrome, projectile non-bilious vomiting with hypochloremic metabolic alkalosis....imaging study results?
Pyloric muscle measures over 6mm in thickness or pyloric channel 18mm in length or thickening and elongation of pyloric muscle.
-Don't get thrown by Down Syndrome and pick double bubble...duodenal atresia presents in first day of life, not at 2 months.
145
What endocrinology problem can present as vomiting?
DKA
146
What cause of vomiting can have emotional overtones with a precipitating event?
Cyclic vomiting
147
What 2 things are children with cyclic vomiting at risk for?
1. Migraines
| 2. Irritable bowel syndrome
148
What age is typical for cyclic vomiting?
Early school age
149
True or False: Cyclic vomiting episodes are separated by asymptomatic periods
TRUE
150
What type of diagnosis is cyclic vomiting?
Diagnosis of exclusion
151
Patient with intense periods of vomiting that lasts up to 48 hours. Feels well between episodes.
Cyclic vomiting
152
What conditions can present with severe episodic vomiting?
1. Pancreatitis
2. Metabolic defects
3. Migraine variant cyclic vomiting
153
5 year old, vomiting episodes lasting 48 hours, end suddenly after nap, Mom with history of severe headaches, uncle going to bathroom multiple times during visit?
Cyclic vomiting (family history of migraine and IBS, symptoms last around 48 hours)
154
What are long-term pharmacological treatment options for cyclic vomiting?
1. Cyproheptadine
2. Propranolol
3. TCAs
(Similar to migraine)
155
What would be best initial treatment for kid presenting with cyclic vomiting?
IV hydration
156
What is rumination?
Frequent regurgitation of ingested food into the mouth that is re-chewed and swallowed or spit out. Appear calm during episodes.
157
What 2 groups will you typically see rumination in?
1. Infants of severely disturbed caregivers
| 2. Older kids who are themselves disturbed or developmentally delayed
158
What disorder might be seen with kids who induce vomiting to seek attention in environments where there is a failure in reciprocal interaction between the infant and caregiver?
Rumination
159
What is the treatment for rumination?
Resolve the emotional trigger
160
What are some disorders with a presentation similar to rumination?
1. Achalasia
2. Gastric outlet obstruction
3. GERD
161
True or False: Rumination is associated with forceful emesis
FALSE
162
What is associated with forceful vomiting, weight loss, dysphagia, and failure to thrive?
Achalasia
163
What is associated with similar symptoms to achalasia, but also abdominal pain and distention?
Gastric outlet obstruction
164
What kids present with nothing other than emesis, but often results in irritability (not calming)?
GERD (as opposed to rumination)
165
Cyst on floor of mouth described as mucocele?
Ranula
166
Midline mass on floor of mouth?
Ectopic thyroid
167
What is done for an ectopic thyroid?
Nothing... do not remove it
168
What is the treatment of a ranula?
Excision
169
What can present with underdeveloped or absent teeth?
Ectodermal hypoplasia (think empty dental)
170
How is ectodermal hypoplasia diagnosed?
Skin biopsy
171
What does skin biopsy show in ectodermal hypoplasia?
Lack of sweat pores
172
How is ectodermal hypoplasia inherited?
X-linked (picture small X's sitting on gums)
173
What syndrome presents with underdeveloped small teeth?
Hallermann Streiff Syndrome
Picture large man hollering under stress...large teeth come out of mouth and only small ones left
174
How do you differentiate between ectodermal hypoplasia and Hallermann Streiff Syndrome?
Both have absent/underdeveloped teeth, but ectodermal hypoplasia has other signs of endocrine underfunction such as absence of sweat glands
175
Don't mistake ectodermal hypoplasia or Hallermann Streiff Syndrome with what?
Physical abuse
176
What leads to portal hypertension?
Liver disease
177
Liver disease + bright red bloody stools, hematemesis, or tarry stools, what is the answer?
Esophageal varices
178
True or False: Esophageal varices can cause tarry stools
TRUE
179
What is the most common type of TE fistula?
TE fistula with a blind upper esophageal pouch
180
How does a TE fistula often present?
Coughing and vomiting with feeding in the newborn period
181
What film finding can you see with TE fistula?
Feeding tube coiled up in blind-ending esophagus
182
How is TE fistula initially managed prior to surgical correction?
NPO and draining the blind-ending esophagus
183
Name 4 descriptions associated with TE fistula
1. Copious oral secretions
2. Polyhydramnios
3. Coughing and cyanosis with initial feeding
4. Inability to pass feeding tube
184
The non-common types of TE fistulas present how?
Older children as respiratory symptoms (cough) associated with eating and/or drinking
185
If you have a kid with a TE fistula and are asked for further studies, what should you think?
Ruling out other associated findings common with VACTERL
186
What is a chronic autoimmune condition that presents as GERD unresponsive to PPI?
Eosinophilic esophagitis (EE)
187
How is eosinophilic esophagitis diagnosed?
History along with biopsy
188
What does biopsy in EE show?
Eosinophil-predominant inflammation in esophageal wall
189
True or False: EE can have an allergic component
TRUE
190
How is EE treated?
1. PPI
2. Diet changes
3. Corticosteroid therapy
191
What is described by vomiting after eating (postprandial emesis) and epigastric pain severe enough to wake the child up at night?
Peptic ulcer disease
192
Can you see guaiac positive stools with PUD?
YES... clincher in description
193
True or False: Plain KUB is helpful when PID is suspected
FALSE: Plain KUB important first study when evaluating kid with abdominal pain, but not helpful when PUD suspected
194
What are 4 primary meds used to treat PUD in kids?
1. H2 blockers
2. Sucralfate
3. Prostaglandins
4. PPIs
195
Which medication blocks gastric acid secretion?
H2 blockers
196
Which medication coats damaged gastric mucosa and protects it from further damage?
Sucralfate
197
What enhances bicarb production and to some extent decreases gastric acid production as well?
Prostaglandin analogues
198
What medication inhibits the gastric acid pump?
PPI
199
What is a prostaglandin that is used for PUD, but shouldn't be given to pregnant teens?
Misoprostol
200
What is the best diagnostic study for PUD?
Upper GI endoscopy
201
What should be done during UGI endoscopy with concern for PUD?
Biopsy... want to see histology and do culture for H. Pylori (can also rule out mild esophagitis)
202
What are 2 social risk factors for H. Pylori disease?
1. Lower socioeconomic status
| 2. Immigration from developing country
203
Why do NSAIDs cause GI symptoms?
Interferes with prostaglandin synthesis
204
True or False: Gastric ulcers are treated with diet
FALSE
205
What do NSAID induced ulcers respond well to?
H2 antagonists
206
True or False: There is no correlation between dyspeptic symptoms and extent of ulcer
TRUE
207
Uncomplicated dyspepsia due to what can be managed with antacids and food?
NSAIDs
208
12 year old with chronic periumbilical pain positive for H. Pylori on serological testin... best next step?
Another study like fecal antigen or urea breath tests... positive serology not enough reason to treat. You need another study is screen is positive.
209
True or False: Positive serology is sufficient to make diagnosis of H. Pylori
FALSE... Serologic testing for H. Pylori IgG has high sensitivity with lots of false positives
210
If you prove that H. Pylori is present, does that mean it is causing a patients chronic abdominal pain?
NO
211
What is gold standard for H. Pylori diagnosis?
Endoscopic biopsy
212
Who do you limit H. Pylori testing to?
At risk (not general screening)... so don't do an endoscopic biopsy on everyone even though it's gold standard
213
Treatment for H. Pylori?
1. PPI (omeprazole or lansoprazole)
| 2. 2 Abx (clarithromycin & amoxicillin or clarithromycin & metronidazole
214
How long do you treat with H. Pylori?
7 days is acceptable, 14 has better eradication rate
215
Abdominal distention, anorexia, diarrhea, failure to thrive, weight loss, proximal muscle wasting, non-resolving iron-deficiency anemia?
Celiac disease
216
What is gluten found in?
Foods that contain wheat or rye
217
Can patient with celiac eat oatmeal?
It's fine in some patients and can be tested initially
218
True or False: Patient with celiac disease need vitamin supplementation
TRUE
219
What is the best way to screen for celiac disease
1. Elevated levels of IgA antibodies against tissue transglutaminase (anti-tTG)
2. IgA antibodies to endomysium
220
What does a patient have to have to screen for celiac with labs?
Normal IgA levels (testing IgA antibody levels)
221
What is diagnosis of celiac disease confirmed by?
Biopsy
222
Small bowel resection (infant with NEC for instance) and CBC in question... what do you check?
B12 deficiency... look for macrocytic anemia in CBC
223
Why does bowel resection cause B12 deficiency?
B12 absorbed at terminal ileum (with help of intrinsic factor) and resection of this part of bowel can cause B12 deficiency (AKA pernicious anemia)
224
What are 2 obstacles for B12 absorption besides bowel resection?
1. Parasites
| 2. Inflammatory bowel disease
225
Which intestinal disorder has a high emotional component?
IBS
226
Diarrhea worse in morning, no association of pain with any particular foods...?
IBS
227
What is the best treatment for IBS?
High fiber diet and close attention to emotional factors contributing to problem
228
What medication can be used for IBS?
Amitryptyline
229
History of chronic diarrhea, steatorrhea, and low sodium along with fat-soluble vitamin deficiency?
Cystic Fibrosis
230
Why does CF cause low sodium?
It's lost through sweat
231
Fat-soluble vitamins?
ADEK
232
What cause fat-soluble vitamin deficiency in CF?
Malabsorption
233
What are 4 things that can be associated with rectal prolapse?
1. CF
2. Pertussis
3. Tenesmus
4. Chronic constipation
5. Meningomyelocele
6. Parasites (recent travel, new immigrant)
(anything causing increased intra-abdominal pressure)
234
Extra teeth, pre-malignant polyps in large and small intestines, osteomas...?
Gardner's Syndrome
235
How is Gardner's syndrome inherited?
Autosomal Dominant
236
How is Gardner's syndrome treated?
Surgical
237
What has mucosal pigmentation of the lips and gums associated with hundreds of colonic polyps which may become malignant?
Peutz-Jeghers Syndrome
238
What is treatment for Peutz-Jeghers Syndrome?
Routine colonoscopies removing any worrisome polyps
239
What typically presents in a teenager with a history of chronic crampy lower abdominal pain, with or without a history of bloody stools?
Ulcerative Colitis
240
Severe colitis can present with what 3 signs?
1. Fevers
2. Hypoalbuminemia
3. Anemia
241
Which ethnicity is at particular risk for UC?
Ashkenazi (European) Jews
242
True or False: Severe cases of UC require initial hospitalization for rehydration and/or blood transfusion
TRUE
243
What 3 things are required when UC is actually a medical emergency?
1. Fluids
2. Blood transfusions
3. Steroids
244
What is given when infection is suspected with UC?
Metronidazole
245
What is first-line medical treatment for UC?
5-ASA
246
What are 3 types of second-line medical treatment for UC?
1. Corticosteroids
2. 6-mercaptopurine or azathioprine or methotrexate
3. Cyclosporine or tacrolimus
247
Which 2 GI conditions are associated with HLA-B27 and ankylosing spondylitis?
Crohn's and UC
248
What eliminates the risk for cancer in kids with UC?
Colectomy
249
What is the cancer rate per decade after first 10 years of disease with UC?
20%
250
Name 3 extracolonic manifestations of UC
1. Arthritis
2. Mucocutaneous lesions
3. Liver disease
251
True or False: Colectomy doesn't stop the progression of ankylosing spondylitis
TRUE
252
What does drug therapy help prevent in UC?
Relapses
253
Why is a surgical consult needed for UC?
Risk for perforation
254
What test should never be done with acute UC and why?
Barium enema, risk of perforation
255
Why should pain meds be avoided with UC?
Can make it difficult to track clinical status
256
What can Crohn's disease present as even before overt GI symptoms?
Weight Loss
257
What lab may be the only clue you get for Crohn's?
ESR
258
What lab should you get in a kid presenting with short statue to consider Crohn's?
ESR
259
What can be seen on XR for Crohn's?
Skip lesions
260
What can be seen on endoscopy for Crohn's?
Cobblestone appearance, transmural lesions, noncaseating granulomas
261
What can be mistaken for Crohn's disease because it can result in nodularity and mucosal thickening of the terminal ileum?
TB
262
Medical management of Crohn's (5 things)?
1. Corticosteroids
2. Aminosalicylates
3. Immunomodulators
4. Antibiotics (metronidazole)
5. Nutritional support
263
What is used instead of azulfidine (sulfapyridine) for UC and Crohn's?
5-ASA
264
Name 7 extra-intestinal manifestations of Crohn's disease.
1. Pyoderma gangrenosum of foot
2. Erythema nodosum (red tender nodules over shin)
3. Ankylosing spondylitis/sacroilitis
4. Arthritis
5. Eyes (uveitis)
6. Liver disease
7. Renal stones
265
Lesions are continuous (no skipped lesions), surgical excision is curative, toxic megacolon can occur, growth retardation and pubertal delay.... UC or Crohn's?
UC
266
Lesions aren't continuous (yes skipped lesions), surgical excision isn't curative, toxic megacolon can occur, growth retardation and pubertal delay...UC or Crohn's?
Crohn's (growth retardation and pubertal delay is more common in Crohn's than UC)
267
How can Crohn's initially present?
As an acute abdomen (it can mimic appendicitis)
268
What can oral aphthous ulcers and perianal fistulae be presenting signs of?
Crohn's
269
How do meds affect the long-term course of Crohn's?
They don't change the long-term course... they just decrease morbidity
270
Is crohn's managed inpatient or outpatient?
Mild symptoms are treated as outpatients, more severe symptoms (massive weight loss, significant systemic symptoms) are hospitalized
271
For crohn's, steroids induce remissions in what % of patients with small bowel involvement?
70%
272
True or False: There is a high relapse rate after steroids are weaned in crohn's
TRUE
273
Classic presentation for intussusception?
Healthy child 3 months to 6 years who has sudden onset of abdominal pain with drawing up his legs and vomiting, then has a period of being perfectly fine, then pain recurs.
274
What may relieve pain with intussusception?
Passing of a stool
275
What ultimately happens to a child with intussusception?
They become lethargic
276
What is the classic description of stool in intussusception?
Currant jelly
277
Bloody stool with palpation of a sausage-like mass in right abdomen?
Intussusception
278
Recurrent crampy abdominal pain in a febrile child... not as severe as in intussusception or appendicitis...?
Campylobacer jejuni or Yersinia infection
279
In later stages, how can intussusception be described?
Bilious vomiting with shock-like symptoms
280
Kid around 2, afebrile, symptoms mimicking sepsis, no GI symptoms...?
Think of intussuception (high on list in an afebrile kid that loos toxic, especially with unexplained lethargy or pallor)
281
How is intussusception diagnosed and treated?
Air enema resulting in hydrostatic reduction
282
What needs to be ruled out when a child over than 6 gets intussusception?
Lymphosarcoma (this could be lead point causing intussusception)
283
20 month old, colicky abdominal pain and RLQ mass. Intermittent severe pain and lethargy between episodes. Best diagnostic study?
Air contrast enema (diagnostic and therapeutic)... don't choose US or CT (don't be fooled by "mass")
284
Left lower quadrant pain with palpable mass...?
Fecal overflow incontinence/Encopresis
285
Previously stool-continent school aged child with daily soiled pants who doesn't have weight loss, fever, or other systemic manifestations?
Fecal overflow incontinence/Encopresis
286
3 phases of treatment for Encopresis?
1. Education
2. Emptying the colon
3. Maintenance program
287
Are soiling episodes with encopresis in the child's control?
No... educate parents that episodes are out of child's control and not purposeful behavior... punishment and blame should be avoided
288
How do you cleanout for encopresis?
Clean out with enema, then oral cathartics and stool softeners (enemas and suppositories may traumatize child... don't use unless there is encopresis)
289
What are goals of maintenance program with encopresis?
Adjust doses of medications until colon regains tone and one soft stool daily is obtained
290
What is congenital aganglionic megacolon?
Hirschprung's Disease
291
What causes hirschprung's disease?
Absence of parasympathetic innervation of internal anal sphincter... affected recto-sigmoid segment is contracted, region proximal to aganglionic segment becomes distended with stool
292
What is classic presentation for Hirschprung's Disease?
No passage of meconium in first 48 hours
293
What should you think of for any significant defecation problem in newborn, especially male/
Hirschprung
294
What else can infants with Hirschprung's present with besides failure to pass first stool in hospital or constipation?
Bilious vomiting
Poor PO intake
Abdominal distention
295
What genetic condition is Hirschprung associated with?
Down syndrome
296
How is Hirschprung diagnosed?
Rectal biopsy
297
What is treatment for Hirschprung?
Surgical excision of aganglionic segment followed by colostomy and ultimately end-to-end anastomosis
298
Rarely has delayed passage of meconium in newborn period, rarely has signs of obstruction, yes to soiling, no failure to thrive, present after age 2, difficulty with toilet training, and stool in rectal ampulla on PE... Functional constipation v. Hirschsprung's?
Functional consipation
299
Delayed passage of meconium in newborn period, signs of obstruction, rare soiling, failure to thrive, not present after age 2, no difficulty with toilet training, and no stool in rectal ampulla on PE...Functional constipation v. Hirschsprung's?
Hirschsprung's
300
What is seen with anal stenosis?
Infant strains to pass small liquid stools and there is a tight band narrowing on anus
301
True or False: Anal stenosis is self limited
TRUE
302
When does anal stenosis remit by?
Age 1
303
Who is functional constipation typically seen in?
Infants fed cereal at an early age (delayed passing of meconium will NOT be described in vignette
304
Constipation, poor growth, hoarse cry, umbilical hernia, delayed closure of anterior fontanelle?
Congenital Hypothyroidism
305
What % of healthy newborns deliver their first stool within their first 24 hours?
99% (other 1% deliver within 48 hours)
306
What should 2 considerations should there be when there is no stool production in the first 48 hours?
1. Hirschprung disease
| 2. Cystic Fibrosis
307
Why doesn't Hirschprung's usually present after age 2?
It is usually treated before age 2
308
What is the first thing you should do to distinguish upper from lower GI bleeding?
NG lavage
309
When presented with a GI bleed, what is the first consideration?
Immediate fluid resuscitation (if there are signs of hypovolemia)
310
What is the vomiting of bright red or coffee-ground appearing blood?
Hemetemesis
311
What reflects bleeding proximal to the Ligament of Treitz?
Hemetemesis
312
What presents as painless effortless regurgitation of bright red blood in a newborn with no evidence of volume depletion?
Swallowed maternal blood
313
If you are suspicious for swallowed maternal blood in an infant, what should you check?
Mom's breasts for cracks that would lead to blood ingested by the infant
314
What test helps to determine if swallowed blood is Mom's or infants?
Apt test
315
What does a negative Apt test mean?
Blood is of maternal origin
316
In children, what is GI bleeding classified by?
Source of UGI bleed
317
What are common causes of bleeding from esophagus?
Esophagitis (acid reflux or pill-ingestion) and Mallory-Weiss tears
318
What are common causes of bleeding from the stomach?
Gastritis due to NSAIDs or stress/acid/infection
319
What are common causes of bleeding from the intestine?
Crohn's disease
320
What can cause false-positive guaic testing?
Recent meat ingestion, horseradish, and ferrous sulfate administration
321
What can cause false-negative guaic testing?
Vitamin C ingestion, outdated cards, improper specimen storage
322
What is the most common cause of upper GI bleeding in all age groups?
Peptic or acid irritation
323
What are 3 causes of GI lower GI bleeding in infants?
1. Hirschprung's disease
2. Malrotation with an associated volvulus
3. NEC
324
Preemie infant with lower GI bleeding?
NEC
325
What can present with bilious vomiting and melena that can cause a lower GI bleed?
Malrotation with associated volvulus
326
What can present as lower GI bleeding in an infant with associated colitis?
Hirschsprung's disease
327
What has increased risk of Hirschprung disease, duodenal atresia, Meckel diverticulum, and pyloric stenosis?
Down Syndrome
328
Name two causes of lower GI bleeding in toddlers?
1. Anal fissures
| 2. Intussusception
329
What is the most common cause of lower GI bleed in toddlers?
Anal fissures
330
True or False: Anal fissures are benign
TRUE
331
What are anal fissures usually secondary to?
Constipation
332
What cause of lower GI bleeding in toddlers typically presents in a child 9 months of age or older?
Intussusception
333
What is the passage of bright red or maroon stools?
Hematochezia
334
What does hematochezia suggest?
Distal bleeding or massive proximal bleeding
335
What diagnosis to consider with hematochezia?
1. Allergic
2. Infectious
3. Intussusception
4. Meckel's
5. Rectal fissures/tears
6. Ingestions
7. Bleeding disorders
336
What is described as dark, tarry stools?
Melena
337
What usually causes melena?
Upper GI bleed
338
What can Melena be associated with?
Meckel's diverticulum (consider this if melena is described instead of painless bleeding)
339
What % of newborns is Meckel Diverticulum present in?
2-3%
340
What manifests as painless rectal bleeding during the first 2 years of life?
Meckel Diverticulum
341
What is done to diagnose Meckel Diverticulum?
Technetium 99m pertechnetate scintigraphic study (ectopic gastric mucosa takes up the material and lights up)
342
What is a very common cause of lower GI bleeding?
Meckel Diverticulum
343
What is treatment for Meckel Diverticulum?
Surgical
344
What is the rule of 2 with Meckel Diverticulum (Meckel's DiverTWOculum)?
1. Presents around age of 2
2. 2 types of tissue (gastric and intestinal)
3. Found 2 feet from ileocecal valve
4. 2 inches in length
5. 2% of population
345
What are causes of lower GI bleeding in school age children?
1. Juvenile polyp
2. Crohn's and UC
3. Infectious diseases
346
What is typically described as painless rectal bleeding in an otherwise healthy preschool child?
Juvenile polyp
347
True or False: Juvenile polyps are associated with an increased risk for malignany
FALSE
348
What presents as painless rectal bleeding in a school age child?
Juvenile polyposis
349
What 2 GI conditions can present in school age children with blood in stools?
1. Crohn's
| 2. UC
350
What can present in school age children as fever, crampy abdominal pain, and bloody stools?
Infectious diseases
351
What presents with elevated direct bilirubin?
Cholestatic jaundice
352
What causes cholestatic jaundice?
Liver/parenchymal disease or anatomical/obstructive disease
353
Why is intervention required with cholestatic jaundice
To prevent severe liver disease
354
What is a good first step when evaluating cholestatic jaundice?
Hepatobiliary scintigraphy
355
What happens in hepatobiliary scintigraphy with liver disease?
Isotope is taken up and makes its way to the biliary system
356
What happens in hepatobiliary scintigraphy with obstruction?
Isotope has uptake in liver, but no excretion down biliary tree
357
If you choose phototherapy for an infant with jaundice, what should not be present?
Direct hyperbilirubinemia
358
What happens if you do phototherapy on a cholestatic baby?
Yellow babies turn into bronze babies (more green-blue and stay this color for months)
359
What causes increased direct bilirubin, pale stools, and hepatomegaly?
Cholestatic jaundice
360
When does neonatal hepatitis present?
Later (like months after birth)
361
When does obstructive jaundice present?
At birth or within weeks (not months) later
362
What is hyperalimentation induced cholestasis due to?
Protein intake
363
What should protein intake be limited to with hyperalimentation cholestasis?
2g/kg/day
364
What can be used to stimulate bile secretion and decrease serum bili levels in hyperalimentation cholestasis when limiting protein doesn't work?
Phenobarbital
365
What is seen with elevated direct bilirubin and acholic (clay-colored) stools in a child over 1 month of age?
Biliary atresia
366
That can be done for biliary atresia if the infant is younger than 2 months?
Kasai procedure (joins liver to intestine)
367
What is the order of tests to do when biliary atresia is suspected?
US, then HIDA, then ultimately biopsy
368
What is the most common cause of cholestatic jaundice in a newborn?
TPN (especially if it's a preemie)
369
What 2 things help distinguish cholestatic jaundice from hepatocellular-caused jaundice?
1. Cholestatic disease has a very high alkaline phosphatase
| 2. Hepatocellular has very high SGPT/SGPOT
370
What is a cause of extrahepatic biliary obstruction that presents similarly to biliary atresia?
Choledochal cyst
371
What is used to diagnose choledochal cyst?
Abdominal US
372
What presents as neonatal jaundice, fever, acholic stools, RUQ pain, and a palpable mass?
Choledochal cyst
373
What is Gilbert syndrome due to?
Glucuronyl transferase deficiency
374
True or False: Gilbert syndrome is a harmless familial condition
TRUE
375
What results in intermittently elevated unconjugated serum bilirubin, particularly with illness or other stressors?
Gilbert syndrome
376
What will be one hint about symptoms with Gilbert syndrome?
Similar history in other family members
377
When is Gilbert syndrome normally recognized?
After puberty
378
What should be considered if they present you with a teenager who gets jaundiced when he has an upper respiratory infection or is fasting?
Gilbert Syndrome
379
What labs are abnormal with Gilbert syndrome?
Elevated indirect bilirubin, other LFTs normal
380
What is done to treat Gilbert Sydrome?
Nothing...no treatment is necessary
381
Recent influenza-like disease or varicella during which aspirin was given?
Reye Syndrome
382
How do kids with Reye's Syndrom present?
Comatose with elevated LTFs and serum ammonia levels
383
If you are presented with a second episode of a kid being comatose with elevated LFTs and serum ammonia levels what should you think?
Inborn error of metabolism (Reye's Syndrome is not the right answer)
384
What is Wilson's Disease also called?
Hepatolenticular degeneration
385
What is the inheritance of Wilson's Disease?
Autosomal Recessive (you "rec"eive a copper penny)
386
What is Wilson's Disease a disorder of?
Copper metabolism
387
Where does copper get deposited in Wilson's Disease?
1. Eyes (Kayser Fleisher Rings)
2. Liver
3. Brain
4. Kidney
388
What is the result of copper depositing in the kidney in Wilson's disease?
Renal tubular acidosis
389
How does Wilson disease present in children and teenagers?
Liver disease
390
How does Wilson disease present in adults?
Neuropsychiatric disease
391
How is Wilson disease diagnosed?
Clinically along with significantly elevated hepatic copper and decreased ceruloplasmin
392
What happens to serum copper levels in Wilson's disease?
They are low because most of the copper is accumulated in the tissues
393
What is the copper level in the urine for Wilson's disease?
Increased copper in urine
394
What is treatment for Wilson disease?
D-penicillamine to chelate copper along with low copper diet (remember "copper penny")
395
True or False: Wilson's disease is fatal if not treated
TRUE
396
What can penicillamine result in?
Aplastic anemia (picture copper pennies clogging up the bone marrow)
397
What condition besides Wilsons can you see excess copper in?
Chronic active hepatitis
398
What is a very common presentation of A1AT deficiency?
Persistent jaundice in newborn period
399
What 3 organ systems does A1AT deficiency affect?
1. Lung
2. Liver
3. Skin
400
What does A1AT do to the lungs?
COPD
401
What does A1AT do to the liver?
Neonatal hepatitis with cholestasis
402
What does A1AT do to the skin?
Necrotizing panniculitis and psoriasis in adults
403
Recent studies suggest that A1AT may be as prevalent as what other chronic disease?
CF
404
What are the 2 most important findings in a child with impending liver failure?
1. Elevated serum ammonia level
| 2. Change in mental status
405
If you are presented with a patient with chronic tremor and anxiety and lab findings consistent with liver disease what do you want to rule out?
Wilson's Disease (measure a serum ceruloplasmin level)
406
What is characterized by mid-epigastric pain radiating to the back with guarding and rebound, coupled with diminished bowel sounds and vomiting?
Acute pancreatitis
407
What is the range of descriptions of the child you could get with acute pancreatitis?
Child comfortable lying on his side with knees to chest or signs of volume depletion (decreased urine output, pulmonary edema, pulmonary effusions)
Pancreatitis with Pulmonary edema and Pleural effusion
408
What is the most specific test in diagnosing pancreatitis?
Abdominal US (NOT serum amylase)
409
What test is used to follow recurrent pancreatitis, not to diagnose acute pancreatitis?
ERCP
410
True or False: Normal amylase doesn't rule out pancreatitis
TRUE
411
Which lab test is more specific for pancreatic disease...amylase or lipase?
Lipase
412
What is seen with glucose, calcium, BUN/Cr, blood counts, and coags with pancreatitis?
1. Hyperglycemia
2. Hypocalcemia
3. Elevated BUN/Cr
4. Anemia
5. Coagulopathy
413
Familial dyslipidemia is an important cause for recurrent what in children?
Pancreatitis
414
What would hinting at a family member dying of premature atherosclerosis in a kid with abdominal pain be?
Familial dyslipidemia causing pancreatitis
415
With recurrent pancreatitis in a kid with a family history of someone dying of premature atherosclerosis what is the test to order?
Serum lipid levels (don't pick imaging or cardiac studies offered)
416
What metabolic problem is another known cause of acute or recurrent pancreatitis?
Hypercalcemia
417
What should you consider if you are presented with a kid who has hyperparathyroidism or kidney stones who presents with acute or recurrent abdominal pain?
Hypercalcemia causing pancreatitis
418
Is acute sporadic or recurrent chronic pancreatitis more common?
Acute sporadic
419
What is acute sporadic pancreatitis usually due to?
Blunt abdominal trauma or idiopathic
420
What usually causes chronic, relapsing pancreatitis?
Infection, autoimmune disease, inherited conditions, or medications
421
What is the most common cause of recurrent pancreatitis?
Hereditary pancreatitis
422
What is a presenting sign in over 1/4 of kids with cholecystitis that is often not seen in adults?
Jaundice
423
Child who is jaundiced with fatty food intolerance and has fever, pain radiating to right scapula, and palpable mass in RUQ?
Cholecystitis
424
Abdominal pain that radiates to the shoulder is likely to be what?
Gallbladder pain
425
What causes shoulder pain with gallbladder issues?
Diaphragm irritation (diaphragm and shoulder share common pain pathways)
426
Name 5 conditions that leave children predisposed to cholecystitis.
1. Hemolytic disease
2. Prolonged use of TPN
3. Small intestinal disease
4. Obesity
5. Pregnancy
427
15 year old male presents with right shoulder pain, nausea, vomiting, lethargy.... diagnosis, how to diagnose, treatment?
1. Cholecystitis
2. Abdominal US
3. Surgery
428
What refers to stones in the gallbladder?
Cholelithiasis
429
What refers to stones within the hepatic or common bile duct?
Choledocholithiasis
430
What 3 things can choledocholithiasis result in?
1. Cholangitis
2. Obstructive jaundice
3. Pancreatitis
431
Name 4 risk factors for gallstones.
1. Cystic Fibrosis
2. Ileal resection
3. Treatment with ceftriaxone
4. TPN
432
15 year old icteric female presents with abdominal pain and hepatosplenomegaly...diagnosis and test?
Cholelithiasis, abdominal US (NOT hepatitis)
433
How are cholelithiasis and cholecystitis diagnosed?
US
434
What are common symptoms between cholecystitis and cholelithiasis?
1. Abdominal pain
2. Nausea
3. Vomiting
* Both diagnosed by US*
435
What are symptoms unique to cholecystitis (not cholelithiasis)?
1. Shoulder pain
| 2. Lethargy
436
What are symptoms unique to cholelithiasis (not cholecystitis)?
1. Hepatosplenomegaly
| 2. Icteric
437
When is IgM-specific antibody positive?
Only acutely (then it resolves)
IgM is iMMediate
438
When is IgG antibody positive?
For life (once it turns positive, it is always positive)
IgG is for Good
439
What is the presentation for HAV?
Flu-like symptoms, elevated LFTs, recent trip to place where Hep A is endemic
440
How is Hepatitis A transmitted?
Fecal-Oral
441
Where is Hep A prevalent?
Where there is poor hygiene and poor sanitation
442
How is Hep A contracted?
From household contacts and daycare centers by drinking contaminated water or by ingesting contaminated foods (raw or undercooked shellfish from contaminated waters)
443
What % of kids younger than 5 have asymptomatic infection with Hep A and won't be jaundiced?
90% (most kids with hepatitis A infection will be asymptomatic)
444
Which ethnic groups is Hepatitis A prevalent among?
1. Native American
| 2. Alaskan Natives (Eskimo)
445
Which ethnic group is Hep A not commonly seen in?
Asians
446
Which groups of children and adults with HAV should be excluded from work and for how long?
People who work in food service or child care centers, one week after onset of symptoms
447
How is Hep A diagnosed acutely?
IgM for hepatitis A
448
How long can an IgM level remain elevated in Hep A?
6 months
449
What does elevated IgG confirm with regard to Hepatitis A infection?
Previous infection and immunity against the disease
450
How is hepatitis A treated?
Supportive...this is self-limited and doesn't lead to chronic disease
451
What can be given for pre- and post- exposure prophylaxis for HAV?
Immune globulin
452
What are the 3 main modes of transmission for Hepatitis B?
1. Blood transfusions
2. Sexual contact
3. Perinatal transmission
(it is spread via contact with bodily fluids)
453
What 3 serological tests for HBV can be done in acute phase?
1. HBsAg
2. HBeAg
3. HBV-DNA
454
What is HBsAg mean?
Hepatitis B surface antigen (marker of active infection)
455
What does HBeAg mean?
High viral load, infectivity, and replication
456
What does HBV-DNA tell you?
Sensitive marker indicating viral replication
457
What 2 things happen to serological tests with recovery of HBV?
1. HBV-DNA and HBsAg disappear
| 2. Anti-HBs, Anti-HBc, and Anti-HBe appear (antibodies to Hep B surface antigen, core antigen, and HBe)
458
When does HBV-DNA and HBsAg disappear after Hep B infection?
Around 6 months after its appearance
459
What indicates chronic infection with Hep B?
Persistence of surface antigen (HBsAg) beyond 6 months
460
How long is HBsAg detected in serum of patients with chronic Hep B?
Lifelong
461
What is seen with serological testing in a patient with no hepatitis B disease, but who had the hepatitis B vaccine?
Positive HBsAb (Hepatitis B surface antibody), but every other antigen and antibody will be negative
462
Which Hep B marker is present during active infection, but doesn't differentiate between acute and chronic infection?
HBsAg
463
Which Hep B marker is consistent with previous infection or positive response to immunization?
HBsAb
464
Which Hep B marker tells you there was a previous infection which has now resolved?
HBcAb
465
Which Hep B marker correlates with a high rate of replication, and its presence correlates with a high rate of infectivity?
HBeAg
Think of E as evil or very infectious... E antigen as Excess because it can spread to Everyone
466
True or False: Almost ALL kids born to mothers with HBeAg positivity will develop chronic Hep B?
TRUE: When HBeAg is positive, the mother is highly infectious
467
The earlier the age of infection with Hep B, the ___ the incidence of chronic HBV?
Higher (90% for infants, 10% for adults)
468
What are the 2 most feared complications of chronic HBV infection?
1. Fulminant hepatic failure
| 2. Hepatocellular cancer
469
Which type of hepatitis can result in liver disease, cirrhosis, and is associated with an increased incidence of hepatocellular carcinoma?
Hepatitis C
HepC is associated with liver Cancer and Cirrhosis
470
What is the most common bloodborne infection in the US?
Hep C
471
What is the most common cause of chronic viral hepatitis?
Hep C
472
How is hepatitis C transmitted?
1. Blood transfusions
2. Sexual contact
3. Perinatal transmission
Via contact with bodily fluids- Same as Hep B
473
True or False: Most infections with Hep C in children are asymptomatic
True
474
What should Delta antigen make you think of?
HDV
475
What is unique about Hepatitis D?
It cannot replicate by itself- Requires the presence of HBsAg to provide its outer coat
D is Dependent or Deficient
476
How is Hepatitis E transmitted?
Fecal-Oral route
477
Where is Hep E most common in?
Parts of Asia, Africa, and Mexico
478
What exposure if Hepatitis E associated with?
Contaminated water
479
True or False: Hepatitis E can lead to chronic hepatitis
FALSE
