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2023 RC Blue's Clues > GI and Nutrition > Flashcards

GI and Nutrition Flashcards

1
Q

FAP = Familial Adenomatous polyposis

A

numerous (>100) adenomatous polyps in intestines. Risk colorectal cancer, hepatoblastoma, medulloblastoma. Epidermoid cysts.

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1
Q

8-year-old girl who has hyperpigmented macules in her mouth and a history of GI bleeds. Her dad and brother have something similar. What type of cancer is she at risk for?

A

Peutz Jeghers syndrome
- mucocutaneous hyperpigmented macules + GI polyps (benign, in small intestine, can have bleeding/intuss)
- inherited cancer syndrome AD for colorectal ca
- annual upper and lower endoscopy by age 8 or if symptoms
- polyps present while young

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2
Q

button battery ingestion

A

if < 12 hr, can do honey or sucralfate
emergent removal within 2 hr if esophageal or gastric (<5 yr and >20mm)

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3
Q

GI Complications of CF

A
  • exocrine pancreatic insufficiency
  • pancreatitis
  • CF related diabetes d/t damage to pancreas
  • meconium ileus in younger pt
  • distal intestinal obstructive syndrome (DIOS) in older pt (obstruction, RLQ pain and palpable mass)
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4
Q

FPIES

A
  • diagnosis gold standard: oral food challenge by allergist
  • Age 2-7 mos with intro solids or formula
  • Milk, soy, rice, oat egg (classic is rice)
  • sx: profuse vomiting, pallor and/or lethargy, diarrhea (no resp or rash sx) very severe vomiting
  • may need anti-emetic and IV fluids d/t dehydration
  • eliminate trigger food
  • no need to eliminate from maternal diet
  • refer to allergist
  • oral food challenge can be done to see if they’ve outgrown (usually by age 3-5 yrs) - try 12-18. mo later
  • don’t need stool tests, imaging or endoscopy
  • no epi pen needed
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5
Q

Infant Dyschezia

A

ROME criteria
- < 9 mo
- straining prior to defecation with crying, facial discoloration for >10 mins before successful or unsuccessful passage of stool
- no other health problems
- NOT constipation

Reassurance

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6
Q

Rumination disorder

A
  • repeated regurgitation of food 1+ month
  • often daily, not in sleep
  • usually presents at 3- 12 mo
  • treatment behavioural and gum chewing
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7
Q

how many ml in oz

A

1 oz = 30 ml
formula is 20cal/ oz or 0.67 cal/mil

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8
Q

NAFLD

A
  • chronic hepatic steatosis
  • start screening in age 9-11 for all obese children or overweight with other obesity risk problems (Ex. diabetes, OSA). Screen q2-3 yr
  • screen with ALT (>2x ULN for >3m)
  • liver US is not used for NAFLD - you would need elastography
    don’t do US

management
- counsel on diet and exercise
- rpt labs q1-6 mo
- r/o other liver problems if symptomatic or red flags

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9
Q

Pediatric acute liver failure

A

INR >1.5 not correcting with vitamin K and encephalopathy OR >2 without encephalopathy

with signs of liver damage, no chronic liver problem

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9
Q

hepatoblastoma associated geentic conditions

A

beckwith wiedemann or other hemiphyperplasia or overgrowth syndromes

screen with AFP
AXR and AUS

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10
Q

celiac long term complication

A

lymphoma

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11
Q

EoE diagnosis

A

EGD and biopsy (>15 eosinophils per HPF or signs of eosinophilic inflammtion

don’t need PPI response for diagnosis

Management
- dietary management (2-6 food elimination)
- PPI can be used for symptoms
- swallowed steroids x 6-8 weeks

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12
Q

H pylori

A
  • don’t do urea breath test if you think theres an ulcer from h pylori

Diagnosis
- upper endoscopy with biopsy (2 weeks post PPI, 4 weeks post abx)

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13
Q

Oral rehydration therapy

A

15 min to 30 min after administration of oral ondansetron.
Mild: ORS 50ml/kg over 4h
Mod: ORS 100ml/kg over 4h
Severe: IV 20-40ml/kg x1h

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14
Q

Galactossemia

A

What is it: inability to convert galactose into glucose (missing GALT enzyme), and this causes galactose to build up in the body ( brain, liver and other tissues)

Inheritance pattern: AR

Age of Onset: first few DOL/ within a few days of starting formula (may be delayed by soy formula use)

Presentation: jaundice, vomiting,diarrhea, hepatomegaly, poor feeding, lethargy, E.coli sepsis, cataracts

Labs: hypoglycemia, increased plasma galactose, hyperbilirubinemia, abnormal LFTs, metabolic acidosis, glycosuria, hemolytic anemia

Dx: SHOULD BE PICKED UP ON NMS, , elevated galactose, reduced GALT enzyme activity, increased plasma amino acids and molecular genetic testing

Tx: immediate removal of galactose (all dairy) while you do confirmatory testing

Outcomes: if not treated (with dietary modification) then liver failure, sepsis, and neonatal death, despite treatment- there is an increased risk of DD, speech problems and abnormalities of motor function. Almost all females will have premature ovarian insufficiency

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15
Q

Crohn’s

A

Crohns
“Gum to Bum”
Abdominal Pain
Diarrhea
Perianal disease
Weight loss, growth failure

Involves any part of GI tract
Skip lesions
Rectal Sparing
Fistula, Abscess, Stricture
Linear ulcers
Transmural involvement

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15
Q

protein losing enteropathy diagnosis

A

stool A1AT

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16
Q

Ulcerative Colitis

A

Rectal bleeding
Bloody diarrhea
Abdominal pain
NO perianal disease
Risk for toxic megacolon

Colon only
Continuous (Paintbrush)
No rectal sparing
No fistula, abscess, stricture
Inflammation limited to mucosa
No granulomas or Crypts

risk of primary sclerosis cholangitis

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17
Q

short stature, neutropenia, bone marrow failure, pancreatic insuff

A

schwachman diamond syndrome

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18
Q

high a1at in the stool

A

protein losing enteropathy

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19
Q

high fecal elastase

A

pancreatic insufficiency
- CF
- Schwachman diamond
- chronic pancreatitis

20
Q

most common cause of low weight and poor growth in IBD

A

poor nutritional intake

21
Q

genetic mutation of the polyposis syndromes

A

autosomal dominant

22
Q

peutz jaghers syndrome associated condition

A

Hereditary Hemorrhagic Telangectasia - look for telangectasias

23
Q

inherited colorectal ca syndromes

A

FAP = Familial Adenomatous polyposis- numerous (>100) adenomatous polyps in intestines. HIGH risk colorectal cancer, hepatoblastoma, medulloblastoma, glioblastoma, Epidermoid cysts.

PJS = Peutz Jeghers syndrome: mucocutaneous hyperpigmented macules + GI polyps

JPS= Juvenile polyposis syndrome - polyps, liver AVMs

Cowden syndrome- hamartomas and malignancies of breast, thyroid, uterus, GI, kidney, skin

HDGC- Hereditary diffuse gastric cancer

Hereditary PDAC- Familial pancreatic duct adenocarcinoma

24
Q

8-year-old girl who has hyperpigmented macules in her mouth and a history of GI bleeds. Her dad and brother have something similar. What type of cancer is she at risk for?

A

colorectal cancer
Peutz jeghers syndrome

25
Q

pediatric acute liver failure criteria

A
  1. no history of chronic liver disease
  2. biochemical evidence of acute liver injury
  3. hepatic based coagulopathy
    - encephalopathic: INR >1.5
    - no encephalopathy: INR >2
    * INR not corrected by Vit K
26
Q

King’s College criteria for liver transplant

A

Tylenol
- pH<7.3
OR
- INR >6.5 AND Cr >300 AND Gr 3-4 encephalopathy

Other
- INR > 6.5
OR
- 3 of the following:
- age < 10 or >40
- bili > 300
- INR > 3
- duration jaundice to encephalopathy > 7 days
- etiology non hepatitis A/B or idiosyncratic drug rxn

27
Q

eye finding in alagille

A

posterior embryotoxin

28
Q

most common presentation A1AT deficiency

A

jaundice (often in first 1-2 mo)

lliver problems happen first, lung disease happens over time

often neonatal cholestasis improves by 6-8 mo, only small % go on to cirrhosis

29
Q

wilson disease genetics

A

autosomal recessive

30
Q

DAT neg hemolytiv anemia, Fanconi RTA, and elevated AST

A

wilson’s disease

31
Q

low serum ceruloplasmin

A

wilsons disease

32
Q

conditions associated with celiac

A

T1D
IgA deficiency
down syndrome
Turner syndrome
Williams syndrome
other autoimmune disorder
first degree family hx with celiac

33
Q

dermatitis herpetiformis

A

rash in celiac

34
Q

diagnosis celiac

A

positive blood work is screen
needs biopsies

35
Q

celiac screening in age <2yo

A

need to check DGP, TTG-IgA doesnt work well in <2yo

36
Q

differential terminal ileitis

A

crohns
lymphoma
yersinia
tuberculosis
CGD
eosinophilic gastrointestinal disease

*normal finding: lymphonodular hyperplasia

37
Q

differential organic constipation

A

hypothyroidism
celiac
lead poisoning
medications
cystic fibrosis - esp chemo
CNS: hirshprung, CP, neural tube defects
electrolytes: HYPERcalcemia, HYPOkalemia
Idiopathic

38
Q

treatment infant GERD

A

dietary modification first line for 2-4 weeks
then hydrolyed formula
then PPI

*ranitidine can be used if PPIs not available

39
Q

first line treatment for pinworms

A

mebendazole or albendazole

40
Q

bloody infectious diarrhea

A

salmonella (usually bloody)
Yersinia (usually)
shigella
campy
e.coli

41
Q

colic criteria

A

episodes lasting >3 hr per day for 3 days per week for >1 week

42
Q

treatment infant ruimnation

A

frequent holding and social interaction

43
Q

cyclic vomiting syndrome diagnosis

A

2+ episodes of nausea and hyperemesis in past 6 mo
stereotypical episodes
return to usual state of health in between
not attributable to other conditions

*often fam hx of migraine

44
Q

iritable bowel syndrome diagnosis

A

abdo pain > 4 times per month with > 1 of the following symptoms:
- timing related to defecation
- change in frequency of stool
- change in form of stool

*if patient experiences constipation, treat the constipation. if pain persists, then it is IBS-C

45
Q

functional abdo pain

A

occurs at least 4 times per mo
episodic or continuous pain
doesnt meet criteria for other functional

46
Q

Differential of hepatomegaly

A
  • hepatitis (inflammatory)
  • storage disorders (GSD, A1AT, hemochromatosis)
  • infiltrative (benign vs malignant tumors, mets)
  • biliary obstruction
  • posthepatic obstruction (cardiac, thrombus, intrahepatic)
47
Q

gilbert syndrome

A

autosomal dominant
genetic defect in glucuronyl transferase (unable to conjugate bili)
50% of persistent unconjugated hyperbilirubinemia in infants

48
Q

most common indication for liver transplant in children

A

biliary atresia

49
Q

timing for treatment hepatitis B at risk infant with positive mom

A

both HepB vaccine and HepB IG given within 12 hours

50
Q

Meckel’s rule of 2’s

A

2% of population
2:1 male to female
2 ft from IC valve
2% develop bleeding
<2yo most common age
2 types of mucosa in diverticulum: native + hypertopic gastric/pancreatic/colonic

2023 RC Blue's Clues (20 decks)

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