GI Flashcards by MA CARMELA CONCEPCION SALES

Inheritance of Cleft Lip

Most are multifactorial inheritance; also autosomal dominant in families (most with isolated cleft palate)

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Tx of CLAP

Treatment—surgical correction
− Lip at 3 months of age
− Palate at <1 year

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Causes of chronic diarrhea (infant)

• Postinfectious lactase
deficiency
• Milk/soy intolerance
• Chronic diarrhea of
infancy
• Celiac disease
• Cystic fibrosis

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Causes of chronic diarrhea (child)

Postinfectious
lactase deficiency
• Irritable bowel
syndrome
• Celiac disease
• Lactose intolerance
• Giardiasis
• Inflammatory bowel
disease

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Causes of chronic diarrhea (adolescent)

Irritable bowel
syndrome
• Inflammatory
bowel disease
• Lactose intolerance
• Giardiasis
• Laxative abuse

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Diarrhea associated with:

Nurseries, daycare

Enteropathogenic E. coli

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Enteropathogenic E. coli TX

Supportive care in severe cases, neomycin or colistin

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Enterotoxigenic /Traveler’s diarrhea

_______

E. coli

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Enterotoxigenic /Traveler’s diarrhea Tx

Supportive care trimetho prim-sulfamethoxazole in severe

cases

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Enterhemorrhagic E. coli Association

Hemorrhagic colitis, HUS

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Enterhemorrhagic E. coli Tx

No antimicrobial therapy in suspected cases due to ↑ risk

of HUS; supportive care only

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Salmonella Tx

Treatment indicated only for patients who are ≤3 months

of age, toxic, has disseminated disease, or S. typhi

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Shigela Tx

Trimethoprim/sulfamethoxazole

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Diarrhea caused by person to person sprad

Shigella, Campylobacter

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Tx of Campylobacter

Self-limiting; erythromycin speeds recovery and reduces

carrier state; recommended for severe disease

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Yersinia enterocolitica Tx

No antibiotic therapy; aminoglycosides plus a third-generation cephalosporin for infants ≤3 months of age or with culture-proven septicemia

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Bacteria asstd with food poisoning

Staphylococcus aureus

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Tx for Cryptosporidium

Raising CD4 count to normal is best treatment. No proven
therapy (antimicrobial); strong supportive care; may try
rifabutin

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What syndrome?

– Pancreatic insufficiency
– Neutropenia
– Malabsorption

Schwachman-Diamond Syndrome

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– Lymph fluid leaks into bowel lumen
– Steatorrhea
– Protein-losing enteropathy

Intestinal lymphangiectasia

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– Osmotic diarrhea
– Acidic stools

Disaccaridase Deficiency

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– Severe fat malabsorption
form birth
– Acanthocytes
– Very low to absent plasma
cholesterol, triglycerides, etc.

Abetalipoproteinemia

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° Weight, height, and nutritional status is normal, and no fat in stool
° Excessive intake of fruit juice, carbonated fluids, low fat intake usually present in history

Chronic nonspecific diarrhea of infancy

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Diarrhea with carbohydrates—__________

CHO malabsorption

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Weight loss and stool with high fat—______

think malabsorption

Dxtics for fat malabsorption ° Most useful screening test is stool for fat ______ ° Confirm with ______

(Sudan red stain) 72-hour stool for fecal fat (gold standard for steatorrhea)

Steatorrhea is most prominent with _______ all require a | sweat chloride

pancreatic insufficiency;

Serum _______ is also a good screen (reflects residual pancreatic function)

trypsinogen

CHO malabsorption—screen with ______

reducing substances in stool (Clinitest

Test for CHO malabsorption ___________—after a known CHO load, the collected breath hydrogen is analyzed and malabsorption of the specific CHO is identified

Breath hydrogen test

Screening for CHON malabsorption

Screen—spot stool α1-antitrypsin level

_________—only common primary infection causing chronic malabsorption

Giardiasis

Small-bowel disease causing malabsorption— 1 2 3

gluten enteropathy, abetalipoproteinemia, lymphangiectasia

Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) types

– Isolated EA – Isolated (H-type) TEF – EA and distal TEF

What type of EA presents chronically and diagnosed later in life with chronic respiratory problems

H-type—

Tx of EA with TEF

Treatment—surgical ligation of TEF and resection with end-to-end anastomosis of esophageal atresia

What is the dx? − Postprandial regurgitation − Signs of esophagitis—arching, irritability, feeding aversion, failure to thrive − Obstructive apnea, stridor, lower airway disease (cough, wheezing

Gastroesophageal Reflux Disease (GERD)

GERD Dx ______—quantitative and sensitive documentation of acid reflux (normal pH in lower esophagus is <4 only 5−8% of time)

Esophageal pH monitoring (best test)

Endoscopy findings of GERD

Endoscopy—erosive esophagitis and complications

GERD _______—to document aspiration

Radionucleotide scintigraphy (Tc)

GERD Tx _______—first-line with overall best safety profile

H2-receptor antagonist (ranitidine, cimetidine, famotidine)

GERD Tx ________—most potent for severe reflux and esophagitis

Proton pump inhibitor (omeprazole, lansoprazole, pantoprazole)

GERD Type of Sx

fundoplication for refractory esophagitis, strictures, chronic pulmonary disease, continued obstructive apnea

What is the dx − Nonbilious, projectile vomiting − Still hungry and desire to feed more − Usually age ≥3 weeks (1 week to 5 months)

Pyloric Stenosis

Dx of Pyloric Stenosis

best test is ultrasound (a target-like appearance in cross-section)

Tx of Pyloric Stenosis

− Rehydrate, correct electrolytes (NaCl, KCl) | − Pyloromyotomy

MC association with Duodenal Atresia

Down syndrome

Other associations with Duodenal atresia

malrotation, esophageal atresia, congenital heart defects, anorectal malformation, renal anomalies

Clinical presentation of duodenal atresia

− Bilious vomiting without abdominal distention on first day of life (obstruction just distal to ampulla) − Polyhydramnios prenatally − Many with jaundice (increased enterohepatic circulation)

Xray of duodenal atresia

X-ray shows classic double bubble with no distal bowel gas.

Xray of duodenal atresia

Surgery—duodenoduodenostomy

− Incomplete rotation of intestine during fetal development | − Superior mesenteric artery acts as axis for rotation

Malrotation and Volvulus

Malrotation and Volvulus ______ may extend from cecum to right upper quadrant (RUQ) to produce duodenal obstruction

Ladd bands

SSx of Malrotation and Volvulus

− Most present in first year of life with acute or chronic incomplete obstruction − Bilious emesis, recurrent abdominal pain with vomiting

An acute small-bowel obstruction in a patient without previous bowel surgery is suspicious for_________

volvulus (acute surgical abdomen)

Barium enema of volvulus

Barium enema shows malposition of cecum (mobile cecum is not situated in the right lower quadrant); upper gastrointestinal will show malposition of ligament of Treitz

UTZ findings of volvulus

Ultrasound will show inversion of superior mesenteric artery and vein (superior mesenteric vein to the left of the artery is suggestive) and duodenal obstruction with thickened bowel loops to the right of the spine

Etiology of Meckel Diverticulum

− Remnant of embryonic yolk sac (omphalomesenteric or vitelline duct), lining similar to stomach − Most frequent congenital gastrointestinal anomaly

CX of Meckel

May have partial or complete bowel obstruction (lead point for an intussusception) or develop diverticulitis and look like acute appendicitis (much less common presentation

Dx of Meckel

Meckel radionuclide scan (Tc-99m pertechnetate

MC type of intussusception

most ileal-colic

intussusception usually follows what infection?

Commonly following adenovirus or rotavirus infection, upper respiratory infection, otitis media

Other associations of intussusception

Associated with HSP (Henoch-Schönlein purpura)

intussusception may also occur with a leading point such as?

Meckel diverticulum, polyp, neurofibroma, | hemangioma, malignancy

Pathophysio of “black currant jelly” stool

bowel drags mesentery with it and produces arterial and venous obstruction and mucosal necrosis

SSx of intussusception

− Sudden onset of severe paroxysmal colicky abdominal pain; straining, legs flexed − Progressive weakness − Lethargy, shock with fever

PE of intussusception

slightly tender, sausage-shaped mass on right in cephalocaudal axis

DX and Tx of Intu ______ is the next study of choice as it is far safer than the previously-used barium enema (0.1 vs. 2.5% risk of perforation); it may be therapeutic and prevent the need for immediate surgery

Air enema

Tx of Intu ________—most will reduce if done within 48 hours of presentation (goes down to half after that time)

Radiographic reduction under fluoroscopy

If surgical—if manual operative reduction is not possible or bowel is not viable, then __________

resection and end-to-end anastomosis

PE of Functional Constipation

large volume of stool palpated in suprapubic area; rectal | exam shows vault filled with stool

Etiology of Hirschprung

absence of a ganglion cells in bowel wall beginning at internal anal sphincter and extending variably proximally

SSx of Hirschprung

− Suspect in any full-term infant with a delay in passage of meconium (>24 hours)

TX of Hirschprung

``` Treatment—surgery (most with temporary colostomy) and wait 6−12 months for definitive correction (most achieve continence) ```