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Flashcards in GI Deck (34):
1

Features of Crohn's Disease

ThE PUSHPIN
T: transmural ulcers
E: erythema nodosum
P: perianal fistulas
U: uveitis
S: skip lesions - top to bottom
H: hepatic disease
P: pyoderma gangrenosum
I: inflammatory markers (ESR, CRP)
N: noncaseating granulomas

2

Tests for Celiac disease

Stool:
- split fats
- reducing substances

Blood:
- antiendomysial antibodies
- anti-TTG (more sensitive)
- anti-DPG (highest specificity)

Gold standard: upper endoscopy with duodenal biopsy showing villous atrophy

3

Irritable bowel syndrome

1. Noninvasive testing (CBC, ESR, anti-TTG, stool guiac -->
2. Fiber trial -->
3. EGD and/or colonoscopy -->

If these fail, you can diagnose IBS

4

Hirschprung Disease

Aganglionic segment of bowel (lack of parasympathetic innervation) that is narrow or contracted that can result in magacolon proximal to that segment.

The affected segment is the narrow segment.

5

Pyloric stenosis

- Non-bilious projectile vomiting
- Labs: hypochloremic hypokalemic metabolic alkalosis
- Pylorus: > 14 mm long or > 4 mm thick

6

Volvulus

- Bilious emesis
- Malrotation -> poorly fixed bowel -> bowel wraps around SMA (may cause ischemic bowel) -> bloody stools
- Double bubble sign on imaging
- Gold standard study: upper GI series
- May see "corkscrew" appearance of duodenum

7

Duodenal Atresia

- Bilious emesis on DOL 1
- possible jaundice due to increased enterohepatic circulation
- KUB: double bubble (only if incomplete atresia)

8

Intussusception

- Often in ileocecal area
- Currant jelly stools
- Abdominal pain, bilious emesis, palpable mass
- Ages: 3 months - 6 years

9

Meckel's Diverticulum

- Contains all 3 layers of bowel wall
- Large volumes of painless rectal bleeding
- Most present before 2 years of age
- Found in 2% of population
- Located 2 ft from ileocecal valve
- Most are 2 inches in length

10

What is the inheritance pattern for familial adenomatous polyploid?

Autosomal dominant

11

Presentation for familial adenomatous polyposis

Painless rectal bleeding -> polyp found on evaluation in a child less than 10 years of age

12

When is the colon resected in a child with FAP?

* Yearly screening for polyps after 10 years of age

- Once large adenomas (>1 cm) are found
- After age 25 years

13

What is esophageal perforation associated with?

- Marfan syndrome
- Ehlers-Danlos
- Epidermolysis bullosa
- Ingestion of bases

14

What is a single umbilical artery associated with?

VACTER-L syndrome

15

What are the five things that can cause rectal prolapse?

- Constipation
- Diarrhea
- Polyps
- Trichuris/Whipworm
- Shigella

16

What is congenital hepatic fibrosis associated with?

Polycystic kidney disease
Can lead to varices and portal hypertension

17

What is gallbladder hydrops and what is it associated with?

- Right upper quadrant pain from acute swelling or distention without gallstones
- Associated with fasting, HSP, Kawasaki syndrome, strep pharyngitis, TPN

18

What is primary sclerosing cholangitis and what is it associated with?

- Chronic cholestatic liver disease from autoimmune inflammation -> fibrosis of the intrahepatic and extrahepatic biliary tree
- ERCP: beading and stenosis of the biliary ducts
- Associated with ulcerative colitis

19

How do you differentiate hepatocellular jaundice from cholestatic jaundice?

- Hepatocellular jaundice: associated transaminitis
- Cholestatic jaundice: marked elevation in alkaline phosphatase

20

What will be the clinical findings of neonatal cholestasis?

- Jaundice, pale stools, hepatomegaly
- ⬆️ conjugated bilirubin
- HIDA scan: uptake without excretion due to obstructive process

21

What causes kernicterus: conjugated or unconjugated bilirubin?

Unconjugated bilirubin

22

What are the clinical features of biliary atresia?

- ⬆️ conjugated bilirubin
- Can result in liver failure

23

What are the clinical findings of a choledochal cyst?

- Congenital cystic dilation of biliary tree
- Sxs: RUQ abdominal pain, abdominal mass, nausea, vomiting, pancreatitis
- Increased risk of cancer

24

What are the clinical features of alagile syndrome?

- Neonatal jaundice
- Liver:
• Paucity of bile ducts
- Heart:
• Pulmonary stenosis
• TOF
- Features:
• Small chin -> triangular jaw
• ⬆️ cholesterol, xanthomas
• Eye abnormalities
• Acholic stools

25

What are the features of Gilbert's Syndrome?

"GUC DRC"
Gilbert's
Unconjugated
Crigler-Najjar
Dublin Johnson
Rotor
Conjugated

- Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
- Autosomal recessive
- Benign
- Noted at times of illness or stress

26

What are the features of Crigler-Najjar Syndrome?

"GUC DRC"
Gilbert's
Unconjugated
Crigler-Najjar
Dublin Johnson
Rotor
Conjugated

- Glucuronyl transferase deficiency ➡️ ⬇️ bilirubin conjugation
- Type I: NO DIRECT BILIRUBIN; jaundice in first few days of life; lifelong phototherapy
- Type II: some glucuronyl transferase activity

27

How is Wilson's disease treated?

Penicillamine, a copper chelator

28

How do you screen family members for Wilson's disease?

Obtain a ceruloplasmin level
- Primary copper carrying protein made in the liver
- If low, suggests Wilson's disease

29

What is cholangitis?

- A medical emergency
- Infection in the biliary tract
- Charcot's triad: fever, RUQ pain, leukocytosis

30

What is the most common etiology of nodular gastritis?

H. Pylori

Gold standard for Dx: EGD with bx
Can be seen in Crohn's disease

31

What is Zollinger Ellison syndrome?

- Gastrin tumor of the pancreas -> multiple GI ulcerations
- Diagnose with high fasting gastric level
- Associated with MEN I (PPP tumors: Pituitary, Parathyroid, Pancreas

32

What are the clinical features of ulcerative colitis?

ULCERS IN ABDomen

Ulcers (mucosal and submucosal)
Large intestine (rectum always involved)
Clubbing of fingers
Extra-intestinal manifestations (e.g. Erythema nodosum)
Remnants of old ulcers (pseudopolyps)
Stools bloody
Inflamed, red granular mucosa/submucosa
Neutrophil invasion
Abscesses in crypts
Biochemical markers of inflammation (⬆️ESR)
Diarrhea (esp. in pancolitis)

33

What are the clinical features of congenital hypothyroidism?

- Constipation
- Delayed anterior fontanelle closure
- Hoarse cry
- Poor growth
- Umbilical hernia

34

What are some prophylactic medications that may be used in patients with cyclic vomiting?

(May be a FHx of migraines or IBS.)

Amitriptyline
Cyproheptadine
Propranolol

(A diagnosis of exclusion, so make sure some sort of work up is done first.)