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Flashcards in GI Deck (157):
1

A patient with JIA presents with epigastric pain, what is the most likely underlying cause?

Inhibition of prostaglandin synthesis (use of NSAIDs)

2

What is the best treatment in a patient with post op intestinal obstruction?

Decompression of the abdomen

3

What is the definition of functional dyspepsia?

Pain in the upper abdomen or periumbilical region that occurs at least once a week for >2 months

4

What is the treatment of functional dyspepsia?

Elimination of exacerbating factors such as NSAIDs or soda
Can also use h2blockers or PPIs

5

When should you test for h pylori in a patient who presents with symptoms of functional dyspepsia ?

Routine testing for h pylori is NOT indicated for functional dyspepsia

6

What is the treatment of abdominal migraine?

Removal of triggers such as caffeine or nitrate containing foods and reducing psychological stress
Can also use propranolol, ciproheptadine and sumatriptan

7

What should you consider in a patient with abdominal pain who presents with urinary retention, tachycardia and dry mouth?

Inappropriate use of anticholinergic for abdominal pain

8

What might be the diagnosis in a patient with several weeks of watery diarrhea, abdominal distention and no fever in a child who attends daycare?

Giardia

9

What is the best test for diagnosis of giardia?

Antigen stool studies

10

What is the treatment for giardia?

Metronidazole or nitazoxanide or tinidazole

11

What two tests might be indicated when a patient presents with a large amount of watery diarrhea?

Cholera or clostridium difficile

12

What is the optimum mixture of oral rehydration fluid?

2% glucose and 90 mEq NaCl

13

What is the appropriate prophylaxis against travelers diarrhea?

Bismuth subsalicylate or
Bactrim

14

When is the only time antibiotics should be considered for E. coli diarrhea ?

If no improvement after several days and only if shiga toxin negative

15

What are the main signs of HUS?

Renal failure
Thrombocytopenia
Hemolytic anemia

16

What type of bacteria is likely the cause of green foul smelling diarrhea that occurs 2 days after a picnic?

Salmonella

17

What is the appropriate treatment of salmonella / typhoid fever?

Rocephin or cefotaxime

18

What disease has the classic finding of rose spots as well as fever and muscle aches?

Typhoid fever

19

What is the diagnosis in a patient with bloody diarrhea and seizure ?

Shigella

20

What is the treatment of choice for shigella diarrhea?

Bactrim

21

What lab abnormality is common with shigella infection?

High bands

22

What is the appropriate treatment for campylobacter?

Erythromycin or azithromycin

23

What diagnosis should you consider in a patient with fever and crampy periumbilical or RLQ pain that is relieved with defecation?

Campylobacter

24

What do you do to treat an asymptomatic child who is c diff positive but under 6 months old?

No treatment

25

What is the treatment of yersinia colitis?

No treatment

26

What is the treatment for c diff?

Oral flagyl

27

What is the definition of chronic diarrhea ?

Diarrhea >2 weeks that cannot be attributed to acute gastroenteritis

28

What is the mechanism by which neuroblastoma can cause diarrhea ?

Vasoactive intestinal peptides

29

What is proper way to screen for fat malabsorption?

A 3 day fecal fat measurement

30

What is the most common cause of diarrhea in children under age 3?

Toddlers diarrhea

31

What 3 symptoms can NOT be present in the diagnosis of toddlers diarrhea ?

Poor growth
Fever
Melena

32

What is the treatment of toddlers diarrhea?

Decrease carbohydrates
Increase fat and high fiber
Removal of cold foods from diet

33

What is the difference between milk protein allergy and food sensitivities?

Milk protein allergy is IgE mediated but food sensitivity is non igE mediated

34

What are the symptoms of food protein enterocolitis syndrome (FPIES)?

Vomiting and bloody diarrhea ...commonly due to cow and soy milk

35

What are "starvation stools"?

Frequent passage of loose green stools due to malnutrition

36

What disease presents with steatorrhea and RBCs with spiney projections ?

Abetalipoproteinemia

37

What are the long term sequelae of abetalipoproteinemia?

Retinal damage and neurological sequelae

38

What are the findings in a patient with intestinal lymphangiectasia?

Protein losing enteropathy with low protein, hypogammaglobulinemia, lymphedema and lymphopenia

39

What diagnosis should you consider in a patient with non bilious vomiting within the first 6 months of life who had low birthweight and polyhydrambios in utero?

Antral web

40

What is seen on imaging in a patient with antral web?

radiolucent filling defect in PRE pyloric region

41

What is the electrolyte abnormality found in pyloric stenosis?

Hypochloremic metabolic alkalosis with severe hypokalemia

42

What is the diagnostic criteria for pyloric stenosis?

Pyloric length >14 mm or muscle thickness >4 mm

43

What is the likely diagnosis in a patient with progressive non bilious vomiting and high indirect bilirubin?

Pyloric stenosis

44

What diagnosis should you consider in a patient with vomiting and elevated anion gap with hypoglycemia?

Inborn error of metabolism

45

What is the classic imaging finding in a patient with duodenal atresia?

Double bubble on X-ray

46

What disease presents with bilious vomiting on the first day of life?

Duodenal atresia

47

What do you do if a newborn presents with bilious vomiting?

If only one episode ...observe. If multiple episodes...Abdominal X-ray

48

How would malrotation present ?

Bilious vomiting and abdominal tenderness/distention with crampy abdominal pain and bloody stool

49

What do Ladd bands cause?

Volvulus- construction of large and small bowel

50

What are the X-ray findings seen with volvulus?

Decreased intestinal air and corkscrew appearance of duodenum

51

What is an annular pancreas?

The pancreas forms a ring around the intestine causing obstruction

52

What is the anatomical cause of malrotation?

Cecum fails to descend and compresses the duodenum

53

What is the most valuable test for diagnosing gerd in an older child?

Upper endoscopy and biopsy

54

When should gerd be worked up or treated?

Posturing
FTT
Apnea

55

What is an upper Gi series used to evaluate ?

Assess malrotation and hiatal hernia

56

What is the mechanism of action of ondansetron?

Serotonin receptor antagonist

57

Which risk factors cause higher risk of complications in infants with gerd?

Prematurity
Neurological impairment
Family hx GERD

58

What is the treatment for cyclic vomiting ?

Fluids, zofran and lorazepam

59

What are 3 causes of severe episodic vomiting?

Cyclic vomiting
Pancreatitis
Metabolic defects

60

What diagnosis is associated with forceful vomiting, weight loss and dysphagia?

Achalasia

61

What is the disease that presents with parotitis, dry mouth and poor tear production?

Mikulicz's disease

62

What is the most common etiology of parotitis?

Idiopathic

63

What should you consider in a patient with parotitis with high fever and tenderness?

Staph aureus

64

What is the diagnosis and treatment of a mucocele on the floor of the mouth?

Ranula- excision

65

What is the diagnosis and treatment of a midline mass on the floor of the mouth?

Ectopic thyroid - do not remove

66

What is the main presentation of ectodermal hypoplasia ?

Underdeveloped or absent teeth

67

How do you diagnose ectodermal hypoplasia?

Skin biopsy shows lack of sweat pores

68

What is the inheritance pattern of ectodermal hypoplasia?

X linked

69

What is the presenting finding in a patient with hallermann streiff syndrome ?

Underdeveloped small teeth

70

What is the diagnosis in a patient with liver disease, tarry stools and hematemesis ?

Esophageal varices

71

What should you suspect in a patient with coughing who can only drink liquids ?

Foreign body

72

What should you suspect in a patient with coughing while feeding, copious oral secretions and inability to pass a feeding tube?

TE fistula

73

What is the treatment for TE fistula?

Npo and drainage of the esophagus before surgery

74

How to NSAIDs cause GI symptoms ?

Interfering with prostaglandin synthesis

75

What is the best first study when evaluating a child with abdominal pain?

Plain KUB

76

What is the best diagnostic study when PUD is suspected ?

Upper GI endoscopy and biopsy for H pylori

77

What are the treatment options for PUD?

H2 blocker
Sucralfate
Prostaglandin analogues
PPI

78

Which prostaglandin can not be used in pregnant teens ?

Misoprostol

79

What is the mechanism of action of prostaglandin analogues ?

Enhanced bicarb production and decreased gastric acid production

80

What should you do if a patient with abdominal pain is positive for H pylori serology?

Confirm with fecal antigen or breath test (remember that positive h pylori does not prove that this is the cause of abdominal pain)

81

What is the proper treatment for h pylori?

PPI + clarithromycin + amoxicillin/metronidazole (14 days)

82

How do you diagnose Zollinger Ellison syndrome ?

fasting gastrin levels

83

How can you diagnose celiac disease?

Screen for high IgA against tissue transglutaminase or endomysial antibodies
Confirm with biopsy!

84

What diagnosis should you consider in a patient with anemia who has had a small bowel resection ?

B12 deficiency / pernicious anemia

85

What two things could block B12 absorption in the terminal ileum?

Parasites or IBD

86

What is the treatment for irritable bowel syndrome ?

High fiber diet and decreased emotional factors

87

What diagnosis should you consider in a patient with bulky, pale foul smelling stools and proximal muscle wasting?

Celiac disease

88

What are 4 causes of rectal prolapse?

Cystic fibrosis
Constipation/increased intraabdominal pressure
Meningomyelocele
Parasites

89

How can you distinguish cystic fibrosis from shwachman diamond syndrome?

Both cause malabsorption but shwachman diamond is associated with bone abnormalities

90

What electrolyte abnormality is common with cystic fibrosis ?

Hyponatremia

91

What disease must be ruled out in a patient with meconium plug syndrome?

Cystic fibrosis

92

What is the inheritance pattern for Gardner syndrome ?

Autosomal dominant

93

What diagnosis presents with supernumerary teeth and pre-malignant polyp in the large and small intestine?

Gardner syndrome

94

What diagnosis should you consider in a teenager with chronic crampy abdominal pain, fever,anemia and low albumin?

Ulcerative colitis

95

What antigen is associated with both Crohn's an UC?

HLA B27

96

What is first line treatment for ulcerative colitis? What are other drug options ?

5 amino salicylates...can also use corticosteroids, 6MP, methotrexate, azathioprine, cyclosporine or tacrolimus

97

When should you get a barium enema in a patient suspected of having UC?

Never - risk of perforation!

98

What is the risk of cancer with UC?

20% risk per decade after the first 10 years of disease

99

What are 3 main extracolonic manifestations of UC?

Arthritis
Mucocutaneous lesions
Liver disease

100

What one lab finding may be important in a child with short stature?

ESR (r/o Crohn's)

101

What disease presents with skip lesions on X-ray with are transmural with non caseating granulomas?

Crohns

102

What diagnosis should you consider in a patient with pyoderma gangrenosum of the foot and arthritis?

Crohns

103

What disease should you consider in a patient with erythema nodosum and renal stones ?

Crohns

104

What disease should you consider in a patient with uveitis and liver disease?

Crohns

105

In which inflammatory bowel disease is surgery curative ?

Ulcerative colitis

106

What is the purpose of medication use in patients with Crohns ?

To decrease morbidity - meds do not change long term course

107

What is the rate of remission and relapse with steroid treatment for Crohns ?

Steroid induce remission in 70% with small bowel involvement but relapse rate is high once steroids are weaned

108

What might be the cause of crampy SEVERE periumbilical pain in a febrile child?

Yersinia

109

What diagnosis should you consider in an 8 month old child with bilious vomiting and sausage like mass in abdomen ?

Intussusception

110

What is the treatment for intussusception?

Air enema

111

What diagnosis must be ruled out in a child older than 6 years old who gets intussusception?

Lymphosarcoma (lead point)

112

What is the most common cause of a palpable abdominal mass in infants?

Multicystic dysplastic kidney

113

What should you consider in a 2 y/o child who is afebrile but appears septic?

Intussusception

114

What is the first thing to do to distinguish upper from lower GI bleeding?

Nasogastric lavage

115

What diagnosis presents with constipation, poor growth, umbilical hernia and delayed closure of fontanelle?

Congenital hypothyroidism

116

What diagnosis presents with infants who strain to pass small liquid stools but resolves by age 1?

Anal stenosis

117

What test helps determine whether blood is the mothers or the infants ?

Apt test

118

What syndrome presents with increased risk for Hirschsprung's?

Down syndrome

119

What are 3 possible causes of a lower GI bleed in the newborn ?

Hirschsprung's
Malrotation
NEC

120

What are 2 main causes of painless rectal bleeding?

Meckels
Juvenile polyp

121

How do you test for entamoeba histolytica?

Serology

122

What is the treatment for entamoeba histolytica?

Flagyl for colitis or liver abscess
Iodoquinol for asymptomatic disease

123

What is a cause of bloody diarrhea in a patient in preschool who is from Native American reservation in southwestern United States?

Entamoeba histolytica

124

How do you diagnose meckels?

Technetium 99m pertechnetate scintigraphy

125

Where is a meckels diverticulitis typically located and how long is it?

Rule of twos - presents at age 2 with 2 types of tissue (gastric and intestinal), found 2 feet from ileocecal valve and is 2 inches in length. Presents in 2% of the population

126

What is the cause of alagille syndrome?

Intrahepatic biliary atresia

127

What is the treatment for biliary atresia?

Kasai (anastomoses between liver and intestine) - only done if child is younger than 2 months

128

What is the first test to rule out biliary atresia? What is the method of confirmation of disease?

Ultrasound then HIDA. Confirm with biopsy

129

What is the most common cause of cholestatic jaundice in a newborn?

TPN

130

How can you distinguish jaundice due to cholestasis vs hepatocellular disease?

Cholestasis causes high alkaline phosphatase
Hepatocellular disease causes high ALT

131

What enzyme deficiency is the cause of Gilbert syndrome ?

Glucuronyl transferase

132

What diagnosis should you consider in a patient with elevated bilirubin after recent illness? His brother had the same phenomenon...

Gilbert syndrome

133

A child presents with elevated LFTs and high ammonia. He is lethargic. History positive for recent URI with medication given for fever. What is the diagnosis? What if this is the second episode?

Reye syndrome
If second episode, think inborn error of metabolism!!!

134

What is the treatment for Wilson's disease? What side effect can occur from the treatment?

D penicillamine
Can cause aplastic anemia

135

What is the most specific test for diagnosis of pancreatitis?

Abdominal ultrasound

136

A patient presents with epigastric pain that radiates to the back and vomiting. He is most comfortable laying on his side in the fetal position. Amylase is normal. What is the diagnosis?

Pancreatitis - remember lipase is more specific for pancreatic disease

137

What abnormal lung findings are associated with pancreatitis?

Pulmonary edema
Pleural effusion

138

What 5 lab abnormalities are associated with acute pancreatitis (other than elevated amylase and lipase)?

Hyperglycemia
Hypocalcemia
Elevated BUN
Anemia
Coagulopathy

139

What test may reveal the underlying cause of a patient with epigastric pain and vomiting?...his father died from atherosclerosis disease

Serum lipids -- Chronic pancreatitis is caused by hyperlipidemia

140

What diagnosis should you consider in a patient with recurrent epigastric pain and hx of hyperparathyroidism?

Hypercalcemia causing pancreatitis

141

Abdominal pain that radiates to the shoulder is likely from what organ?

Gallbladder

142

What are 4 main risk factors for gallstones ?

Cystic fibrosis
Ileal resection
Ceftriaxone
TPN

143

What diagnosis should you consider in a patient with fever, jaundice, abdominal and shoulder pain and intolerance to fatty foods?

Cholecystitis

144

A 15 year old boy presents with right shoulder pain, vomiting and lethargy, what is the best diagnostic tool and treatment?

Abdominal US - surgery for cholecystitis

145

What is the difference in presentation between cholecystitis and cholelithiasis?

Cholecystitis presents with should pain and lethargy
Cholelithiasis presents with jaundice and hepatomegaly

146

What is the best study to diagnose hepatitis A?

IgM (IgG levels persist for life)

147

Ok what populations is hepatitis A more common?

Native Americans and Alaskans
(Not commonly seen in Asians)

148

What are the typical symptoms of hepatitis A?

Flu like symptoms (but 90% are asymptomatic)

149

When is hep B surface antigen present?

Present during active infection but does not differentiate acute vs chronic

150

When is hep B surface antigen antibody (HBsAb) present ?

Previous infection or past immunization

151

What does high HBeAg indicate ?

High infectivity

152

When is anti-HBcAg positive ?

Indicates recent infection (remain elevated up to 6 months)

153

What is the most common cause of chronic viral hepatitis?

Hep C

154

What does hepatitis D virus require to replicate ?

HBsAg

155

How is hepatitis E transmitted? Where is it common?

Fecal oral
Asia, Africa and Mexico

156

Which types of hepatitis can cause chronic infection ?

B and C and D

157

What are the classic X-ray findings of acute appendicitis?

Sentinel loop and absence of air in the RLQ