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GI Flashcards

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1
Q

VACTERL

A

Vertebral

Anorectal

Cardiac

Tracheal

Esophageal

Renal

Limb Anomalies

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2
Q

Esophageal atresia commonly occurs with what other anomaly?

A

Tracheoesophageal fistula

-distal esophagus connects with posterior trachea-

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3
Q

What is this? When does it present?

A

Esophageal atresia - maternal poly hydramnios

Vomiting up first feed

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4
Q

Reflux, back arching, stiffness, and torticollis

A

Sandifer’s Syndrome = GERD

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5
Q

What percentage of kids with GERD resolve without treatment by age 2?

A

60%

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6
Q

What is the most common cause of esophagitis?

A

Candida

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7
Q

How do you treat GERD?

A

Positioning after feeds

Thicken formula w/ rice cereal

Antacids, H2 blockers, PPIs

Motility agents = metoclopramide, erythromycin

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8
Q

How do primary gastric ulcers present in the first month of life, neonatal period, preschool, and > 6 yrs?

A

1st month: GI bleed/perforation

Neonatal: recurrent vomiting, slow growth

Preschool: Periumbilical, postprandial pain + vomiting

> 6 yo: epigastric abdominal pain, + blood loss/anemia

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9
Q

Gastric ulcers following surgery or head trauma?

A

Cushing

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10
Q

Stress gastric ulcers or those related with burns?

A

Curling ulcers

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11
Q

Colic

A

Frequent, complex abdominal pain and crying in infants < 3 months

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12
Q

Sudden onset loud crying

Circumoral pallor

Distended tense abdomen

Feet cold

*Relief with passage of feces/flatus*

A

Colic

R/o other causes

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13
Q

When and how does pyloric stenosis present?

A

Nonbilious vomiting

After 3 weeks, up to 5 months

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14
Q

What is the “olive” felt on exam of a pt. with pyloric stenosis?

A

Duodenal bulb

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15
Q

How do you diagnose pyloric stenosis?

A

U/S - 90% Senstive

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16
Q

What is this?

A

Pyloric stenosis

Also look for

string sign, double tract sign, shoulder sign

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17
Q

How does duodenal atresia present?

A

Bilious vomiting without abdominal distention

**First day of life**

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18
Q

What is this? How do you treat it?

A

Duodenal atresia - double bubble sign

NG tube, IVF, surgery

**Associated with malrotation, esophageal atresia, and heart disease**

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19
Q

Moms with polyhydramnios might have an infant with what?

A

GI atresia

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20
Q

How does volvulus present?

A

Gastric: Severe abrupt epigastric pain, intractible emisis - failure to pass NG tube

Intestinal: Vomiting, abdominal pain

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21
Q

What is the most common cause of acute intestinal obstruction under 2 yo?

A

Intussusception - Ileocolic (90%)

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22
Q

What things can cause “lead point” for intussusception to develop? (6)

A

Viral illness

Meckel’s diverticulum

Polyp

Lymphoma

Henoch-Schonlein purpura

CF

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23
Q

Intermittent colicky abdominal pain, bilious vomiting, and currant jelly stool.

A

Classic triad of Intussusception

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24
Q

Who do you diagnose intussusception?

A

US: Target/donut sign, Pseudokidney

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25
Impression: Paucity of bowel gas in film, air enema partially reduces it in film B.
Intussusception
26
What is the rule of 2's for Meckel's diverticulum?
2% of the population 2 inches long 2 feet from iliocecal valve \< 2 yo 2% symptomatic
27
What are the signs of symptomatic meckel's diverticulum?
Intermittent painless rectal bleeding Obstruction Diverticulitis \*\*Can mimic appendicitis\*\*
28
What is the perforation rate in kids with appendicitis after 48 hours?
\>65% \*\*Can't localize pain\*\* Pain first, then V/D or anorexia
29
Which kids with possible appendicitis get CTs?
Indicated if diagnosis is equivocal
30
How do you treat appendicitis?
Surgery Broad spec antibiotics if perfed for 7 days
31
What are causes of constipation in the neonatal period? (5)
Hirschprungs Intestinal pseudo-obstruction Hypothyroidism Cows milk protein intolerance Low K, High Ca
32
What is the cause of Hirschprungs Megacolon? What is associated with?
Absence of ganglion cells in bowel M \> F, Down Syndrome
33
How do you diagnose and treat Hirschprung's Disease?
Rectal suction biopsy - need submucosa Rectal manometry
34
How do you treat an anal fissure?
Sitz baths, fiber supplements, increased fluid
35
What is appropriate initial management of the following: 14 yo girl with 2-month hx of **crampy diffuse abdominal pain** with anorexia nad 4.5 kg weight loss. Pain **unrelated to meals** no diarrhea or constipation.
Rectal exam, stool exam CBC, ESR Review of family/emotional stress \*\*Do not refer to eating disorder clinic\*\*
36
True or false: **Extraintestinal** manifestations of IBD are _more commonly_ seen in **Crohn's**.
True
37
**Perianal fistula**, sclerosing cholangitis, pyoderma gangrenosusm and **ankylosing spondylitis** are seen with what?
Crohns
38
IBD + bloody diarrhea, anorexia, weight loss, pyoderma gangrenosum, sclerosing cholangitis is most likely what?
Ulcerative colitis
39
How do you treat **Crohns**?
Steroids Aminosalicylates MTX AZA Cyclosporine Metronidazole Sitz baths TNF-α inhibitors
40
How do you treat UC?
Aminosalicylates Steroids Colectomy
41
Abdominal pain with intermittent diarrhea and constipation _without_ organic basis
Irritable Bowel Syndrome Must exclude other pathology CBC, ESR and FOBT
42
What is the most common cause of diarrhea in children?
Viral - rotavirus
43
Diarrhea and emesis = Diarrhea and fever = Diarrhea and tenesmus -
Non-inflammatory Inflammatory Large Colon Involvement
44
What does fecal leukocytes infer?
Invasive cytotoxin organism Shigella, Salmonella
45
Patients with enterohemorrhagic E. coli and Entamoeba histolytica have ___________ fecal leukocytes.
Minimal to none
46
What is the BRAT diet for diarrhea?
Bread Rice Applesauce Toast
47
If a kid has E. coli 0157:H7 do you treat with antibiotics?
No - higher incidence of HUS
48
Pseudomembranous colitis
Post-antibiotic c diff infection Treat with PO metronidazole or PO Vanc
49
When is surgery indicated for abdominal umbilical hernias?
Symptomatic Strangulated Grows larger after age 1 or 2
50
Perianal itching at night
Enterobius vernicularis - pinworm Albendazole or mebendazole
51
Mild anemia, abdominal pain, diarrhea tenesmus Perianal itching
Trichuris trichuia - whipworm Albendazole or mebendazole
52
Pneumonia Intestinal obstruction Liver failure
Ascaris lumbricoides Albendazole or mebendazole
53
Intense dermatitis Loeffler's pneumonitis Anemia/GI symptoms
Necator americanus & Ancylostoma duodenale Hookworm (skin penetration) Albendazole or mebendazole
54
Dermatitis, pneumonitis Anemia, GI symptoms Diarrhea 3-6 weeks Superimposed bacterial sepsis
Strongyloides stercoralis (skin) Ivermectin
55
Myalgias Facial periorbital edema Conjunctivitis Pneumonia, myocarditis, encephalitis, nephritis, meningitis
Albendazole
56
What is a weird cause of irreversible developmental delay in kids?
**Intestinal worms** Necator or a. duodenale - hookworms Strongyloides
57
What is the most common type of inguinal hernia?
Indirect \> direct \> femoral
58
How can you distinguish an inguinal hernia from a hydrocele?
Hernia increases with straining
59
15 yo girl with spots on her lips has crampy abdominal pain + bleeding
Peutz-Jeghers
60
Multiple intestinal polyps, tumors of soft tissue/bone (mandible)
Gardner's syndrome Aggressive surgical removal of polyps - high malignant potential
61
Carcinoid Tumors
Tumors of **Enterochromaffin** cells in intestine Appendicitis Carcinoid Syndrome
62
Carcinoid Syndrome
Inc. serotonin Vasomotor disturbances Bronchoconstriction
63
Familial Polyposis Coli
AD - APC mutation Hematochezia, cramps, diarrhea Resection of affected colonic mucosa
64
Juvenile polyposis coli
2-10 years Bright red painless bleeding with bowel movement Iron deficiency
65
What is the most common childhood bowel tumor?
Juvenille polyposis coli
66
When does short bowel syndrome occur
With loss of at least 50% small bowel Dec. Na and K Acidosis - loss of bicarb
67
How do you treat short bowel syndrome?
TPN Small feeds PO Metronidazole to treat bacterial overgrowth
68
5 yo girl presents with protuberant abdomen and wasted extremities
Gluten induced enteropathy
69
Celiac disease is asociated with which genetic types?
HLA-B8 DR7, DR3, DQW2
70
Bx: Vilous shortening inc. crypt depth, increased inflammatory cells in lamina propria of small bowel
Tropical Sprue Abx 3-4wks Folate and B12
71
Explosive watery diarrhea with abdominal distention in response to lactose
Lactose deficiency (AR) Eliminate from diet
72
Gilbert Syndrome
Benign - unconjugated hyperbilirubinemia
73
Crigler Najjar I (AR)
**Glucuronyl Transferase** mutation **Unconj.** **bili** in first 3 days of life \*\*Absence of hemolysis\*\* Need liver transplant
74
Crigler Najjar 2 (AD)
**Glucuronyl transferase mutation** **Kernicterus unusual** Unconj. bili in first 3 days - resolves **Phenobarbital** for 7-10 days
75
Alagille Syndrome
Absence or dec. # of **bile ducts** Occular, vertebral, and CV abnormalities Unusual facies
76
Zellweger Syndrome AR
Progressive degeneration of liver and kidneys Fatal in 6-12 months \*\***Absence of peroxisomes** on hepatic cells\*\*
77
Extrahepatic Biliary Atresia
Acholic stool, polysplenia, malrotation Drain or liver transplant
78
Which is the only hepatitis virus that is a DNA virus?
Hep B
79
What causes most of the cases of hepatitis in children?
Hep A
80
10 yo boy is diagnosed with Hep A, how would you treat the parents and siblings not sick?
IVIg
81
What causes neonatal hepatitis?
Most from systemic disease i.e. **sepsis** CMV, HSV, HIV Congenital syphilis & toxo
82
How do you treat neonatal hepatitis?
**Abx** for bacterial associated **Acyclovir** for HSV **Ganciclovir** and **foscarnet** for CMV
83
How do you treat chronic (autoimmune) hepatits?
Steroids Azathioprine
84
What causes **Reye's Syndrome**?
URI/chicken pox or ASA Improvement Abrupt protracted vomiting 5-7 days after illness onset
85
How do you treat Reye's Syndrome?
**Control ICP** 2/2 cerebral edema Supportive management
86
What is the most likely manifestation of α1-antitrypsin deficiency in the newborn?
Jaundice (neonatal cholestasis)
87
Jaundice Portal HTN, liver failure Tremors Delayed puberty
**Wilsons Disease** - Excessive copper deposition in brain and liver **Low ceruloplasmin** High serum copper Kayser-Fleischer rings
88
How do you treat Wilson's Disease
Zinc - block Cu absorption Penicillamine Restrict copper
89
Hepatoblastoma
Associated with **Beckwith-Wiedemann syndrome** Large abdominal mass, R lobe **αFP**, CT, MRI **Resect**, **cisplatin** and **doxorubicin**
90
Inc. abdominal girth, hmegaly, vomiting, pain or Chest pain, coughing, hemoptysis
**Echinococcus** - domestic and wild canines Liver and/or lungs **Anaphylaxis** 2/2 rupture and spillage **Surgery** or **albendazole**
91
Abd. pain, distention, hmegaly Anemia, inc. ESR, nonspecific ALT slightl leukocytosis
**Amebic abscess** - from disseminated infection Metronidazole Chloroquine Aspiration

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