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Flashcards in GI Disorders Deck (60)
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A highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching.

vomiting

- process is coordinated in the medullary vomiting center

1

2-5 yo patient, with early morning onset of vomiting attacks >4x in an hour for several hours, preceded by nausea, pallor, noise and light hypersensitivity, lethargy and headache. Attacks have occured more than 5 times in the past 6 mos, precipitated by infection, psychological or physical stress. Careful investigation in the past months ruled out any other cause of vomiting. Px appears well and asymptomatic in between attacks.

What is the probable diagnosis? What is the treatment for this condition?

cyclic vomiting

- Rome III criteria for fcnl GI disorders (FGID) (both must be present)
1. 2 or more periods of intense nausea and unremitting vomiting or retching lasting hours to days
2. return to usual state of health lasting weeks to months

Consensus definition:
•    At least 5 attacks in any interval, or a minimum of 3 attacks during a 6-month period
•    Episodic attacks of intense nausea and vomiting lasting 1 hr to 10 days and occurring at least 1 wk apart
•    Stereotypical pattern and symptoms in the individual patient
•    Vomiting during attacks occurs ≥4 times/hr for ≥1 hr
•    Return to baseline health between episodes
•    Not attributed to another disorder

- tx: hydration and antiemetics, address complications of vomiting

2

What is the definition of acute and chronic diarrhea?

Acute: sudden onset of excessively loose stools of >10 ml/kg/day in infants or >200 g/day in older children, which lasts < 14 days
Chronic: >14 days

- Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea

3

What are the more probable causes of true constipation in infancy?

Hirschsprung disease
intestinal pseudo-obstruction
hypothyroidism

4

Two types of nerve fibers transmit painful stimuli in the abdomen. Which pain fibers mediate the following:

1. sharp, localized pain
2. poorly localized, dull pain

1. in skin and muscle - A fibers
2. from viscera, peritoneum, and muscle - C fibers

5

Acute epigastric and left upper quadrant pain radiating to the back, characterized as constant, sharp, and boring, accompanied by nausea, emesis, tenderness

probable diagnosis?

acute pancreatitis

6

Acute or gradual periumbilical to lower abdominal pain referred to the back, colicky in character (alternating cramping and painless periods), associated with distention, obstipation, emesis, and increased bowel sounds.

Probable diagnosis?

intestinal obstruction

7

Acute, sharp and steady periumbilical abdominal pain which localizes to lower right quadrant with generalized peritonitis, which may radiate to back or pelvis, accompanied by anorexia, nausea, emesis, local tenderness, and fever if with peritonitis.

probable diagnosis?

acute appendicitis

8

Acute periumbilical to lower abdominal pain, characterized as cramping with painless periods, associated with hematochezia, knees usually in pulled-up position

intussusception

9

Acute and sudden unilateral back pain with referral to the groin, characterized as sharp, intermittent and cramping, associated with hematuria

Probable diagnosis?

urolithiasis

10

Acute dull to sharp back pain with referral to the bladder associated with fever, CVA tenderness, dysuria and urinary frequency

probable diagnosis?

urinary tract infection

11

Red or maroon blood in stools, signifies either a distal bleeding site or massive hemorrhage above the distal ileum

a. hematemesis
b. hematochezia
c. melena

b. hematochezia

12

Moderate to mild bleeding from sites above the distal ileum or major hemorrhages in the duodenum and above tend to cause blackened stools of tarry consistency

a. hematemesis
b. hematochezia
c. melena

c. melena

13

What is the most common cause of bleeding in the GI tract?

Erosive damage to the mucosa

- variceal bleeding secondary to portal hypertension occurs often enough to require consideration

14

What are the specific diagnostic modalities utilized in the following cases:

a. UGIB
b. LGIB
c. small intestines
d. occult blood in stool
e. brisk intestinal bleeding of unknown location

a. UGIB - esophagogastroduodenoscooy (EGD)
b. LGIB - colonoscopy
c. small intestines - capsule endoscopy
d. occult blood in stool - guaiac test
e. unknown location of bleed - RBC scan

15

Prolonged elevation of the serum levels of conjugated bilirubin beyond the 1st 14 days of life

neonatal cholestasis

- Jaundice that appears after 2 wk of age, progresses after this time, or does not resolve at this time should be evaluated and a conjugated bilirubin level determined
- mechanical obstruction of bile flow or functional impairment of hepatic excretory function and bile secretion

16

Idiopathic familial intrahepatic cholestasis associated with lymphedema of the lower extremities

Aagenaes syndrome

- relationship between liver disease and lymphedema is not understood
- Affected patients usually present with episodic cholestasis

17

Rare autosomal recessive genetic disorder marked by progressive degeneration of the liver and kidneys

Zellweger (cerebrohepatorenal) syndrome

- Affected infants have severe, generalized hypotonia and markedly impaired neurologic function with psychomotor retardation.
- fatal in 6-12 mos

18

the most common syndrome with intrahepatic bile duct paucity, marked reduction in the number of interlobular bile ducts in the portal triads, with normal-sized branches of portal vein and hepatic arteriole

Alagille syndrome (arteriohepatic dysplasia)

19

The most common form of biliary atresia, accounting for ∼85% of the cases

obliteration of the entire extrahepatic biliary tree at or above the porta hepatis

20

Ultrasonographic triangular cord (TC) sign, which represents a cone-shaped fibrotic mass cranial to the bifurcation of the portal vein, may be seen in patients with this condition

biliary atresia

21

The most valuable procedure in the evaluation of neonatal hepatobiliary diseases and provides the most reliable discriminatory evidence

Percutaneous liver biopsy

- Biliary atresia is characterized by bile ductular proliferation, the presence of bile plugs, and portal or perilobular edema and fibrosis, with the basic hepatic lobular architecture intact.
- In neonatal hepatitis, there is severe, diffuse hepatocellular disease, with distortion of lobular architecture, marked infiltration with inflammatory cells, and focal hepatocellular necrosis; the bile ductules show little alteration

44

What is the underlying mechanism in diarrhea caused by the ff agents: cholera toxin, ETEC, carcinoid, C. difficile

a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory

f. secretory

- increased secretion, decreased absorption
- watery and large volume
- PERSISTS with fasting

45

What is the underlying mechanism in diarrhea caused by the ff agents: Salmonella, Shigella, amebiasis, Yersinia

a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory

a. mucosal invasion

- organisms cause inflammation, decreases colonic reabsorption, increases motility

46

What is the underlying mechanism in diarrhea caused by the ff agents: lactase deficiency, lactulose, laxative overdose

a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory

e. osmotic

- due to maldigestion, usually low in volume
- STOPS with fasting

47

What is the underlying mechanism in diarrhea caused by the ff agents: short bowel, celiac disease, rotavirus

a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory

b.decreased surface area

- decreased functional capacity
- watery

48

What is the underlying mechanism in diarrhea caused by the ff agents: irritable bowel syndrome, thyrotoxicosis

a. mucosal invasion
b. decreased surface area
c. decreased motility
d. increased motility
e. osmotic
f. secretory

d. increased motility

- decreased transit time
- loose to normal stools

49

Among disk button batteries, coins, or small plastic toys, which should be removed expediently because they can induce mucosal injury in as little as 1 hr of contact time and involve all esophageal layers within 4 hr?

disk button batteries

- Asymptomatic blunt objects and coins lodged in the esophagus can be observed for up to 24 hr in anticipation of passage into the stomach

50

Between acidic and alkali caustic ingestions, which is ingested in greater volume because it is tasteless and not bitter?

liquid alkali substances produce severe, deep liquefaction necrosis; drain decloggers are most common, and because they are tasteless, more is ingested

alkali - liquefaction necrosis
acid - coagulation necrosis

51

What is the recommended acute treatment for caustic ingestion?

a. dilution by milk or water
b. neutralization
c. induced emesis
d. gastric lavage

a. dilution with milk or water

- all other choices are contraindicated