GI Flashcards
(298 cards)
1
Q
Recurrent abdominal pain definition
A
Once/week for last 2 months
2
Q
What meds should you consider for functional abdomial pain
A
Anticholinergic, amitriptyline, SSRI
3
Q
Definition of IBS
A
- Pain and relief with defection or onset associated with change in for or frequency of bowel movements
- At least once per week over the course of 2 months
- Tends to occur in families
- No organic cause
4
Q
Rx for IBS
A
Reduce sorbitol, fructose, cruciferous veggies, increasing soluble fiber, SSRIs/TCAs
5
Q
Pattern: Pain in upper abdomen, no signs of gastritis on endocsopy, esophageal pH testing
A
Non-ulcer dyspepsia
6
Q
Pattern: acute, incapacitating, periumbilical pain; anorexia, nausea, vomiting, HA, pallor, photophobia, symptom-free periods
A
abdominal migraine
7
Q
Test for Sphincter of Oddi Dysfunction
A
ERCP manometry, HIDA scan
8
Q
What is the cause of familial mediterranean fever
A
serositis causing abdominal pain
9
Q
Vomiting and fever
A
infection, inflammation
10
Q
Vomiting and tenderness/guarding
A
inflammation
11
Q
vomiting and tachycardia, loss of skin turgor, dry mucous membranes
A
Dehydration
12
Q
vomiting and sclerodactylyl
A
scleroderma
13
Q
vomiting and loss of dental enamel
A
GERD, bulimia
14
Q
Vomiting and adenopathy
A
neoplasm
15
Q
vomiting and high pitched bowel sounds
A
obstruction
16
Q
vomiting and absent bowel sounds
A
ileus
17
Q
asterixis
A
uremia, liver failure
18
Q
Vomiting and air-filled distended loops
A
ileus, pseudo-obstruction
19
Q
vomiting and retained food in upper endoscopy
A
gastroparesis
20
Q
What evaluation would you do for dysphagia?
A
upper GI, endoscopy, esophageal manometry
21
Q
4 anatomic congenital causes of dysphagia
A
Esophageal web, tracheobronchial remnant, vascular ring, Schatzki ring (ring of mucosa/muscular tissue in distal esophagus)
22
Q
What can esophageal strictures that cause dysphagia be caused by?
A
caustic ingestion or chronic GERD
23
Q
Ingestion of alkalis can cause what injury
A
deep liquefaction necrosis through all layers
24
Q
Ingestion of acids cause what injury
A
Thick eschar that limits depth of injury, bitter taste limits ingested volume
25
Pattern: salivation, refusal to drink, nausea and vomiting, epigastric pain, burns or ulcerations to lips or mouth, fever and leukocytosis
Caustic ingestions
26
Rx of caustic ingestions
oral administration of water or milk to dilute, intubation if airway edema, EGD within 48 hours to assess burns, broad spectrum antibiotics for suspected perforation/mediastinitis
27
How to detect radiolucent foreign bodies in esophagus
endoscopy
28
Within how many hours can button batteries cause perforation?
4 hours
29
When does GERD peak
4 months
30
Risk factors for GERD
Down syndrome, MRCP, prematurity
31
Test for gastroparesis
nuclear med gastric emptying
32
Pattern: baby fails to pass meconium (multiple)
Hirschsprung, anal stenosis, intestinal peudo-obstruction, hypoTH, meconium plug
33
What genetic disorder predisposed to Hirschsprung?
Down
34
What are dx tools for Hirschsprung
unprepared barium enema, full thickness biopsy and do ACh staining
35
Rx for Hirschsprung's
Colonic resection, endorectal pull-through
36
Pattern: delayed passage of meconium, signs of obstruction, FTT, enterocolitis, soiling rare, anal fissure/fecal impaction rare, behavioral problems rare, small stool caliber
Hirschsprungs
37
Pattern: frequent soiling, difficulty toilet training, stool in the rectal vault on PEx, very large stools, no FTT
Functional constipation
38
GI bleeding in infant
milk protein allergy
39
GI bleeding in child
anal fissure, juvenile polyp, swallowed epistaxis, PUD, intussusception
40
GI bleeding in adolescent
IBD, bacterial enteritis, anal fissure, Mallory-Weiss, polyp
41
Pattern: 16yo with colonic adenomas
Familial adenomatous - polyposis APC gene mutation, 100% risk ofCA
42
Pattern: small bowel and colonic adenomas and supranumerary teeth
Gardner's syndrome, APC mutation, 100% risk of colon CA
43
Pattern: hamartomatous polyps, lip/gum freckling, requiring polypectomy
Peutz-Jegher's; sl increase in colon CA
44
Pattern: hamartomatous polyps in small bowel and colon
Juvenile Polyposis Syndrome PTEN, SMAD4, BMPR1 gene mutations, 10% risk of colon CA
45
Pattern: colonic adenomas, endometrial/renal/GBM
Hereditary non-polyposis colon cancer
46
Pattern: 2.5 yo with intermittent painless rectal bleeding that can become infected, followed by intussusception and can cause obstruction
Meckel's Diverticulum
47
What is the diagnosis for Meckel's diverticulum?
Technetium-pertechnetate scan, increased sensitivity with ranitidine
48
What tests to do to confirm serologic H pylori cause of peptic ulcer dx?
urea breath hydrogen testing or stool H pylori antigen testing
49
Caveat to interpreting serologic H pylori testing
May be old infection
50
Rx for H pylori
PPI plus two antibiotics (amoxicillin and clarithromycin) for 14 days
51
What are causes of secretory diarrhea?
cholera, toxigenic e. coli, C. difficile, cryptosporidiosis
52
What are causes of inflammatory diarrhea
salmonella, shigella, staph aureus, yersinia, campylobacter, B cereus
53
Do you need to treat salmonella?
No. carriers are typically asymptomatic
54
Do you need to treat shigella?
Bactrim, pt always symptomatic, person to person transmission
55
Diarrhea and reactive arthritis
salmonella, shigella, yersinia, campylobacter
56
Diarrhea and bloody diarrhea
HUS
57
Diarrhea and short incubation
C. perfringens, B. cereus
58
Diarrhea and seizures
shigella
59
Pattern: diarrhea for >1 week, stool cultures negative
parasitic - giardia, cyclospora, isospora
60
Pattern: fever 1-2 days, vomiting followed by 5 to 7 days diarrhea, no stool wbcs
Viral - rota adeno astro noro
61
Causes of Diarrhea >1 day in first month of life
Cow's milk protein allergy, sucrase-isomaltase, gluc-galact malabsorption, pancreatic insufficiency from Schwachman-Diamond syndrome
62
Causes of diarrhea in 1 month to 2 years of age
Toddler's diarrhea, post-infectious enteropathy, parasitic (giardia lamblia), rota no nror and adeno
63
Suspicious of diarrhea after camping/daycare
stool antigen for giardia and treat with metronidazole
64
Causes of diarrhea in 2 to 18
Celiac sprue, post-infectious, excessive juice, IBS, IBD, laxative abuse
65
Pattern: small volume of diarrhea, bloody, mucoid, urgency and tenesmus
colitis, UC or infectious
66
Pattern: diarrhea, distension, gas, explosive
giardiasis or sorbital excess
67
Dx for celiac disease
EGD with biopsies
68
Dx for IBD
colonoscopy with biopsies
69
Dx for colitis
stool WBC's
70
Dx for milk protein allergy
stool eosinophils
71
Dx for CF, Schwachman-Diamond
Fecal fat
72
Dx for giardia
stool antigen
73
Dx for carbohydrate malabsorption
stool reducing substances
74
Pattern: protracted diarrhea of infancy - longer than 2 weeks in infant (multiple)
chronic enteropathies, microvillus, inclusion disease, tufting enteropathy
75
Pattern: protracted diarrhea in childhood (multiple)
autoimmune enteropathy, celiac disease, post-infectious diarrhea
76
Best oral rehydration
pedialyte
77
Pattern: 10wk old with 2wk h/o watery, mucoid stools with strongs of bright red blood, gassy.
Milk protein allergy
78
Soy has what percentage cross over allergen with cow's milk
40%
79
Can cow's milk protein ingested by mom cross into breastmilk?
yes
80
What are two protein-losing enteropathy?
Lymphangiectasia, Crohn's disease
81
What is Toddler's diarrhea?
malabsorption of sorbitol and fructose
82
Pattern: steatorrhea, acanthocytosis
abetalipoproteinemia
83
Pattern: PLE, hypogamm, steatorrhea, lymphedema, lymphopenia
lymphangiectasia
84
What is malabsorbed in lysinuric protein intolerance
dibasic AAs
85
What is malabsorbed in Harnup disease
free neutral AAs
86
What is malabsorbed in blue diaper syndrome
tryptophan
87
What is malabsorbed in acrodermatitis enteropathica
zn
88
What is malabsorbed in Menke's disease
cu
89
What is malabsorbed in terminal ileal disease (Crohn's)
Folate, B12
90
Pattern: diarrhea, abdominal distension, proximal muscle wasting, weight loss, anorexia, abdominal pain
Celiac disease
91
Pattern: diarrhea, anemia, dermatitis herpetiformis or other immune disease
Celiac disease
92
What HLA class I molecule is associated with celiac disease?
gliadin, DQalphaBeta, haplotypes found in >95% of patients
93
Celiac disease is associated with what other immune disease
IgG deficiency and hypogammaglobulinemia
94
How would you screen for celiac disease?
Tissue transglutaminase IgA, antiendomysial antibodies (anti-gliadin not sensitive or specific)
95
gold standard for celiac disease diagnosis
upper endoscopy with biopsy
96
Dx for lactase deficiency
lactose breath hydrogen testing, lactase activity on duodenal biopsy or simple challenge/withdrawal
97
Pattern: Eskimo child, diarrhea, abdominal pain, bloating with pureed fruits or juices or with starch/cornstarch
sucrase-isomaltase deficiency
98
Dx of sucrose-isomaltase deficiency
acid hydrolysis of stool first, hydrogen breath testing, enzyme activity in biopsy during upper endoscopy
99
Rx for sucrose-isomaltase deficiency
Restriction of sucrose containing foods, enzyme replacement with yeast enzyme sacrosidase (Sucraid)
100
Inheritance of sucrose-isomaltase and glucose-galactose deficiency
AR
101
Pattern: diarrhea at birth, dehydration and metabolic acidosis increase and lactose containing formula fed infant
Glucose-galactose malabsorption
102
Rx for glucose-galactose malabsorption
fructose only carbs pt can eat
103
What % of CF pt has pancreatic insufficiency?
85-90% by one year
104
How do you monitor pancreatic insufficiency in CF patient?
Fecal elastase
105
Pattern: pancreatic insufficiency, bone marrow failure (cyclic neutropenia, defect in neutrophil chemotaxis, thrombocytopenia, anemia) metaphyseal dysostosis, FTT, short stature, oily, sticky foul smelling stools
Schwachman-Diamond Syndrome
106
Differences between Schwachman-Diamond and CF
nl sweat test, no CF mutation, metaphyseal lesions, fatty pancreas on imaging, infection more generalized and not just primarily pulmonary
107
Major cause of morbidity and mortality for Schwachman-Diamond patient
pyogenic infections
108
Crohn's or UC?
| Transmural, skip lesions
Crohn's
109
Crohn's or UC?
| Bimodal age, first peak during adolescence
Crohn's
110
Crohn's or UC?
| obstructive small bowel disease, RLQ pain, fibrostenotic
Crohn's
111
Crohn's or UC?
| cramping, diarrhea, bleeding colonic diseae
Crohn's
112
Crohn's or UC?
| inflammatory becomes structuring, perforating
Crohn's
113
Crohn's or UC? systemic signs, malaise, anorexia, growth failure/weight loss, pubertal delay
Crohn's
114
Crohn's or UC? perianal disease, skin tags, fistulae
Crohn's
115
Crohn's or UC? fistulae between loops of bowel (bowel to vagina or bladder or bowel to skin)
Crohn's
116
Crohn's or UC? erythema nodosum, arthritis, aphthous ulcers, clubbing, episcleritis/uveitis, renal stones and gallstones
Crohn's
117
Crohn's or UC? acute abdomen
Crohn's
118
Crohn's or UC? anemia, thrombocytosis, hypoalbuminemia
Crohn's
119
Crohn's or UC? Anti-saccharomyces
Crohn's
120
Crohn's or UC? fecal calprotectin and lactoferrin (neutrophil proteins shed in stool)
Crohn's
121
Crohn's or UC? non-caseating granulomas on upper endoscopy and colonscopy
Crohn's
122
Crohn's or UC? on upper GI/SBFT, thumbprinting, string sign, cobblestoning
Crohn's
123
Rx for Crohn's
corticosteroids, aminosalicylates, flagyl, immunomodulators, anti-TNF biologics infliximab
124
Crohn's or UC?
| Limited to mucosal layer and to colon sparing upper GI
UC
125
Crohn's or UC? bloody, mucoid, purulent diarrhea, tenesmus, urgency, frequency, cramping, nocturnal stools
UC
126
Crohn's or UC? pyoderma gangrenosum, PSC, chronic active hepatitis, anklyosing spondylitis (HLA B27)
UC
127
Crohn's or UC? risk of colon CA, requiring surveillance colonoscopies every 1-2 years for dysplasia
UC
128
Crohn's or UC? crypt abscesses, crypt branching on biopsy
UC
129
Crohn's or UC? pseudopolyps, continuous erythema, loss of vascularity
UC
130
Crohn's or UC? toxic megacolon, fevers, hypoalbuminemia
UC
131
Rx for UC
5-ASA mesalamine
132
Crohn's or UC? pouchitis
UC
133
Crohn's or UC? cured by surgical excision
UC
134
Pattern: weakness, rhabdomyolysis, neutrophil dysfunction, arrhythmia, seizure, AMS, sudden death in child with malnutrition just started feeds again
Hypophosphatemia
135
Pattern: arrhythmias, weakness, nausea and vomiting with refeeding
hypokalemia
136
Pattern: arrhythmias, tetany, nausea, vomiting
hypomagnesemia
137
What vitamin deficiency is a part of refeeding syndrome?
thiamine
138
What can happen with serum glucose in refeeding syndrome?
hyperglycemia
139
Daily fluid requirement for infants and children
100ml/first 10kg + 50ml/next 10kg + 20ml/remainder
140
How much water is in human milk or formula?
89%
141
How much caloric requirement for 20kg?
20kg -- 1500kcal+20kcal/kg for each kg above 20kg
142
Additional calories required for: hypermetabolic state due to recent surgery
20%
143
Additional calories required for: multiple trauma
25%
144
Additional calories required for:Severe infection
50%
145
Additional calories required for: uncomplicated starvation
50%
146
Additional calories required for: third degree burns
100%
147
Predominant protein in breast milk
Whey
148
What three proteins in human milk protect child again local infection?
IgA, lactoferrin, lysozyme
149
How much protein is needed in infants
1) during first month
2) by 6th month
3) premature infants
1) 2 - 2.4g/kg/day
2) 1.5g/kg/day
3) 3.5g/kg/day
150
What are three major categories of lipids in Western diet?
triglycerides
phospholipids
sterols (cholesterol)
151
How many carbons on
1) SCTriglyceride
2) MCT
3) LCT
1) 12
152
Which are essential fatty acids?
Linoleic
| Linolenic
153
Pattern: scaly dermatitis, hair loss, diarrhea, poor wound healing, growth failure
Essential fatty acid deficiency
154
How soon can deficiency in essential FAs occur in infants?
Within 2 weeks
155
Pattern: premature infant, scaly skin, diarrhea, poor wound healing, growth failure?
EFAD
156
Pattern: child with hepatobiliary or pancreatic disease with sacly skin, growth failture
EFAD
157
Pattern: Child on long term TPN without IV lipids, diarrhea, poor wound healing
EFAD
158
What is daily recommended % of calories of EF needed to prevent deficiency?
2-4%
159
How much Linoleic acid is in
1) Human milk
2) commercial formulas
3) cow's milk
1) 3-7%
2) 10%
3) 1%
160
Recommendation for fat intake in children.
1) % total fat
2) % saturated
3) cholesterol
1)
161
What milk type has most whey?
Breast milk
162
What milk type has most casein?
Cow's milk
163
What LCFAs are found in highest concentration in breast milk in 1st month?
DHA, ARA
164
What are DHA and ARA LCFA's useful for?
Improving vision and cognition
165
What triglyceride is best for premature infants? Why?
MCT because they have decreased amount of intraluminal bile acids and decreased absorption of LCFA.
166
What vitamin deficiency is this?
| CHF, tachycardia, peripheral edema
B1 wet
167
What vitamin deficiency is this?
| Neuritis, peripheral paresthesia, irritability, anorexia
B1 dry
168
What vitamin deficiency is this?
| Confusion, ataxia, opthlamoplegia
B1 Wenicke-Korsakoff
169
What vitamin deficiency is this?
Seborrheic dermatitis, angular stomatitis, photophobia, loss of visual acuity, burning an ditching of eyes, corneal vascularization, glossitis, poor growth
B2
170
What vitamin deficiency is this?
| Preemie on prolonged phototherapy
B2
171
What vitamin deficiency is this?
| Peripheral neuritis in child with suspected TB, seb derm, cheilosis, sideroblastic anemia
B6 - needed for iron utilization for hemoblogin synthesis
172
What vitamin deficiency is this?
| Breast fed infants of vegan mothers, macrocytic anemia, hypersegmented neutrophils, ataxia, periphral neuropathy
B12
173
What vitamin deficiency is this?
| Pt s/p distal small bowel resection
B12
174
What vitamin deficiency is this?
| Petechiae, poor wound healing, easy fractures of bone, friable bleeding gums with loose teeth, microcytic anemia
C - scurvy
175
What vitamin deficiency is this?
| Dermatitis of sun-exposed skin
B3
176
What vitamin deficiency is this?
| macrocytic anemia/leukopenia, poor growth, imparied cellular immunity, glossitis, diarrhea, neural tube defects
B9 (folate)
177
Goat's milk is deficient in what?
Folate
178
Pattern: dermatitis, anorexia, glossitis, muscle pain, insomnia, alopecia
biotin
179
What are 3 water-soluble vitamins that can cause toxicity?
Niacin, Vitamin B6, Vitamin C
180
Pattern: skin flushing, tingling, itching, dizziness, nausea, liver test abnormalities
Niacin toxicity
181
Pattern: sensory neuropathy, progressive ataxia, altered sense of touch and pain
B6 toxicity
182
Pattern: nausea, diarrhea, cramps, kidney stones (oxalate and cysteine nephrocalcinosis)
Vit C
183
3 types of patients at high risk for fat sol vitamin deficiency
chronic liver disease, pancreatic insufficiency, short bowel syndrome
184
Antibiotic therapy can cause deficiency of what vitamin?
vit K
185
Renal disease could cause deficiency of what vitamin?
vit D
186
Pattern: night blindness, retinal degeneration, xerophthalmia, photophobia, conjunctivitis, keratomalacia, follicular hyperkeratosis, poor growth, impaired resistance to infection
Vit A deficiency
187
Pattern: enlargement of costochondral junctions, chostochondral beading widening of epiphyses with thickening of the wrists and ankles, bowing, craniotabes
Vit D deficiency
188
Pattern: hemolytic anemia in premature infants, ataxia, hyporeflexia, decreased vibratory and position sensation, proximal muslce weakness, ophthlamoplegia/retinal dysfunction, neurocognitive changes
Vit E deficiency
189
Pattern: easy bruisability/soft-tissue hemorrhage, hemorrhagic disease, prolonged PT and PTT, defective bone and collagen production
Vit K deficiency
190
Pattern: dry, rough cracking skin and alopecia, carotenemia, pseudotumor cerebri, hepatosplenomegaly, bone pain in children
Vit A toxicity
191
Pattern: hypercalcemia, anorexia, vomiting, abdominal pain, constipation, convulsions
Vit D toxicity
192
Pattern: tired and weak, decreased work and school performance, slow cognitive and social development during childhood, difficulty maintaining body temperature, decreased immune function, glossitis
Iron deficiency
193
Pattern: Myositis, cardiomyopathy, macrocytic anemia, loss of skin and hair pigmentation
selenium deficiency
194
Pattern: rash, poor wound healing, impaired cellular immunity, anorexia, diarrhea, growth failure, low alkaline phosphatase
Zinc deficiency
195
Pattern: bullous and pustular lesion of oral, anal, genital areas and extremities, alopecia, diarrhea, opthalmologic problems (blepharitis, conjunctivitis, photophobia, corneal opacities)
Acrodermatitis enteropathica, AR disorder defect in zinc absorption
196
Pattern: microcytic anemia which does not respond to Fe supplementation, neutropenia, depigmentation of hair and skin, bone abnormalities
Cooper deficiency
197
Pattern: 2-3 mo male with loss of milestones/neurodegenerative disease, truncal hypotonia/seizures, FTT, abnormal, lightly pigmented, kinky hair, eyebrows, and eyelashes, connective-tissue and skeletal abnormalities
Menkes
198
What is the mutation in Menkes disease
X-linked (mutation of Xq13.3 gene) of impaired tranport of dietary Cu from the intestine
199
Major difference b/w Kwashiorkor and marasmus
Kwashiorkor is deficiency of protein. Marasmus inadequate caloric intake
200
Pattern: lethargy, apathy, irritability, anorexic, poor growth, loss of muscular tissue, immunodeficiency, edema, alopecia, scaly, erythematous dermatitis with darkening at sites of irritation
Kwashiorkor
201
Pattern: failure to gain weight, loss of fat and muscle, wasted, emaciated appearance, hypothermia, bradycardia, no hepatomegaly
marasmus
202
Difference in Kwashiorkor and Marasmus
Kwashiorkor - hepatomegaly, edema, anorexia; marasmus none of that
203
Which vitamins are typically deficient in Crohn's patients?
iron, folate, vitB12, zinc, selenium, ADEK, ca, mg
204
Pattern: newborn with fulminant hepatitis
metabolic, tyrosinemia, galactosemia, fructosemia
205
Reducing substances in urine and fulminant hepatitis
galactosemia
206
liver failure after introduction of fruit juices
fructosemia
207
liver failure and succinylacetone in urine
tyrosinemia
208
Pattern: liver failure, jaundice, increase conjugated bilirubin, inc AST/ALT
Alpha-1 antitrypsin deficiency
209
Pattern: fetal hydrops, profound cholestasis and early death, iron deposition in liver
Neonatal iron storage disease, familial, increased iron and ferritin; due MRI of abdomen
210
3 causes of neonatal hepatitis
Tyro, galacto, fructosemia
Alpha-1 antitrypsin deficiency
Iron storage disease
211
Most common cause of neonatal hepatitis
Infection
| TORCHES, adeno, echo, coxsackie
212
Pattern: liver problem at birth, SGA, sepsis, enlarged liver, spleen, rashes
hepatitis from infection
213
Why don't you always see elevated conjugated bili in newborns?
Liver is still so immature
214
What lab work is typically associated with neonatal liver infection?
high WBC, low platelets
215
Dx galactosemia
reducing substance in urine
216
Dx fructosemia
liver failure after fruit juices
217
Dx tyrosinemia
urine succinylacetone
218
Pattern: increased conjugated bilirubin with elevated AST/ALT, jaundice resolves in first 6 months
alpha-1 antitrypsin deficiency
219
Dx alpha-1 antitrypsin
alpha-1 antitrypsin, genotype ZZ
220
Pattern: fetal hydrops, profound cholestatis, early death, iron deposition in liver and OTHER organs, present very sick
neonatal iron storage disease, increased iron, increased ferritin, MRI T2
221
Cause of neonatal iron storage
familial
222
Only hep virus that is DNA
Hep B
223
Transmission of HepA
poor hygiene, contaminated food and water
224
Pattern: child between 5 to 14 years, low grade fever, RUQ pain, jaundice, increased liver size, ANOREXIA
Hep A
225
If you suspect fulminant hepatitis, what tests should you order
PT/PTT, protime, serum ammonia, low serum glucose
226
Does Hep A cause chronic hepatitis?
No
227
What test do you order for Hep A?
antibody only, look at IgM
228
Which hep has the longest incubation?
HepB
229
Which hep can be spread horizonally
Hep B
230
Pattern: arthritis, rash, arthalgyria, liver function impairment
Hep B
231
Who can clear HepB virus - infected neonates or pt that acquire as adult?
Neonates will not clear
232
Consequences with HepB chronic.
Chronic active hepatitis, cirrhosis, hepatocellular carcinoma
233
Acute HepB serology
HB surface antigen, HBE antigen
234
What is the only protective HepB antibody
HB surface antibody
235
What is the serology for HepB patient who is clearing infection?
HB surface antigen not detectable, IgM HBcore high, no surface antibody yet - that is the window
236
Which Hep is orally transmitted?
A/E (vowels)
237
Which Hep is blood transmitted?
B/C (consonant)
238
Pattern: acute disease asymptomatic, chronic hepatitis
HepC
239
Which 2 hep can cause cancer?
B/C (consonants)
240
Is HepC viral antibody protective?
No
241
Dx for Hep C
PCR antigen
242
Rx Hep C
Interferon and ribavirin
243
Pattern: pt with hepB, eastern european, mediterranean
Hep D
244
Dx HepD
IgM to HepD
245
Pattern: teenager with HepE during pregnancy
fulminant liver failure
246
Pattern: child with liver AND spleen enlarged, adenopathy, jaundice and other hep signs
EBV virus
247
Which viruses tend to cause acute hep in immunocompromised children?
CMV, herpes, varicella
248
Drugs that can cause acute hepatitis
acetaminophen, INH, valproate, MTX, 6MP, halothane
249
What is characteristic lab work pattern in child with acetaminophen overdose?
Elevated AST/ALT, no hyperbili, increased PT/INR, increased ammonia
250
Rx for drug toxicity acute hepatitis?
N-acetyl cysteine
251
Mushroom - red cap with white spots
amanita phalloides
252
What combination of drug and infection can lead to Reye and Reye-like syndromes?
aspirin and varicella
253
What industrial toxins can cause acute hep
glue sniffing, polyvinyl alcohol, CCL4
254
Which Heps can cause chronic hep?
HepB/C
255
Rx of chronic hep?
Fluid and sodium restrction, treatment of encephalopathy, transplatnation
256
If you are suspicious of chronic hepatitis but bilirubin and/or AST/ALT are normal, what should you check?
PT, albumin
257
Pattern: HB surface antigen positive, no HB surface antibody
Chronic HepB, no clearance
258
Dose core antigen and antibody matter with HepC
Nope, it does nothing really
259
What are signs of active replicating HepB?
HBeAg +/- DNA PCR
260
Rx HepB chronic
Interferon and antiviral
261
Time course of organ involvement in alpha-1 antitrypsin
Liver in childhood
| Lung disease in childhood or adulthood
262
Pattern: child with cirrhosis and variceal bleeding?
Alpha-1 antitrypsin deficiency
263
when in childhood do you see cirrhosis and portal HTN in CF?
mid-childhood
264
Rx hepatitis in CF
shunt procedure then transplant
265
What organs accumulate cooper in Wilson's
Liver, CNS, kidney, eye
266
Dx Wilson
low serum copper, ceruloplasmin, high 24hr urine copper, liver copper on biopsy
267
Pattern: acute fulminant hepatitis and hemolytic anemia
Wilson's disease, liver accumulates, liver damage and die, copper released from dying cells and RBCs lyse
268
Rx for Wilson's
Penicillamine, trientene, transplantation
269
Fulminant liver disease with tyrosinemia; what is the worst sequelae?
Hepatocellular carcinoma
270
Rx tyrosinemia
NTBC - stops tyrosine degradation, can stop HCC risk
271
Pattern: chronic hepatitis signs, jaudice, mainly cholestasis and really bad pruritus
Progressive familial intrahepatic cholestatic disease
272
What is progressive familial intrahepatic holestatic disease
defect of bile acid metabolism/excretion
273
Pattern: pt with short gut syndrome getting parenteral feeds, elevated liver enzymes
parenteral nutrition induced
push enteral, and omega 3 intralipid
274
Pattern: child with arthryalgia, arthritis, IBD or DM, signs of chronic liver disease, serum protein highly elevated, but serum albumin is low
Hypergammaglobulinemia in autoimmune chronic hepatitis
275
Rx for autoimmune
steroids, 6MP, azathioprine
276
Pattern: Full-term infant with CONJUGATED hyperbilirubinemia w/in first 4 weeks of life
Biliary atresia
277
Prog of baby with biliary atresia who does not get biliary drainage?
Death within 1-2 years of life
278
All jaundice baby should get what test?
Total bili and direct to look for hyper conjugate bili for biliary atresia workup
279
When does Kasai procedure need to be done?
280
Pattern: biliary atresia baby with Kasai, but now having recurrent cholangitis, jaundice, portal HTN, cirrhosis
failing biliary drainage
281
Pattern: pulmonary stenosis, short stature, triangular facies, butterfly vertebrate, jaundice, xanthromas, pruritus
Alagille
282
Pruritus should make you think of what
Alagille (paucity of intrahepatic bile ducts) or familial intrahepatic cholestatic disease
283
Pattern: female, school-aged, abdominal mass, RUQ pain, intermittent jaundice and fever
Choledochal cyst
284
What is sclerosing cholangitis?
chronic inflammation causing focal areas of fibrotic narrowing and dilation of the intra and extrahepatic bile ducts
285
Liver problems associated with UC
Autoimmune chronic hepattitis and primary sclerosing cholangitis
286
Pt with primary sclerosing cholangitis, what can you tell parents who don't want to treat?
end-stage liver disease and cholangiocarcinoma can develop
287
Pattern: pt with Langerhan's cell histiocytosis and signs of liver problem
secondary sclerosing cholangitis
288
Sequelae of frequent cholelithiasis
cholangitis, intrahepatic abscesses, pancreatitis
289
pattern: hi alk phos and GGT and intermittent abdominal pain
cholithiasis
290
Rx of cholelithisis
ursodeoxycholic acid, removal
291
Pattern: female, colicky, RUQ pain referred to right scapula, fever, jaundice, increased bili and alk P
cholecystitis
292
What supervening bacterial infection can be seen with cholecystitis?
E.coli, enterococcus
293
Pattern: pt has no stones, salmonella/shigella prior
non-calculus cholecystitis
294
Pattern: epigastric pain with vomiting, increased amylase and lipase, enlarged pancreas on imaging of abdomen
pancreatitis
295
Why pancreatitis could lead to jaundice?
Swollen pancreas pushes on 2nd or 3rd part of duodenum and compresses segment that common bile duct and pancreatitic duct enters jointly as ampulla of vater
296
What is location of liver cancer that causes jaundice?
Porta hepatis
297
Which liver cancer is common in children
hepatoblastoma
298
Pattern: jaundice, abscess
amoebic abscess,
