GI disorders Flashcards
(158 cards)
1
Q
TXT for thrush?
A
1L Nystatin - not systemic
2L Azole antifungals (Fluconazoles)
2
Q
If infant is being treated for Thrush what other consideration is there for TXT?
A
Txt of Moms nipples/areolae
or
Boil bottle nipples 20m
3
Q
GER is normal in what age ranges?
A
<8-12mo (Must stop 9-12mo)
4
Q
Considerations if child has GER?
A
Adequate nutrition
No S/S of resp complication or esophagitis
5
Q
When does GER become GERD?
A
FTT or poor growth
Esophagitis - Pain/IDA
Breathing difficulties (Apnea, Wheeze, cough, stridor)
6
Q
Complications of GERD
A
Dyspepsia
Esophageal stricture
Asthma
Barretts esophagus
7
Q
Gold standard for Dx GERD?
A
24hr esophageal pH probe
- admit (intranasal probe)
8
Q
Other Dx tests for GERD?
A
GI - barium flouroscopy
Upper endoscopy
9
Q
GI Barium flouroscopy rules out?
A
Anatomic causes:
- Outlet obstruct (strictures)
- Malrotation
- Hiatal Hernia
10
Q
Best for evaluating GERD progression?
A
Upper endoscopy:
development of PUD, strictures
11
Q
GER/GERD conservative TXT?
A
Lifestyle mod
Casein hydrolysate formula
Common sense -Older PEDs
12
Q
GERD Rx TXT
A
H2 blockers - Ranitidine
Prokinetic - Metoclopromide
PPI
13
Q
GERD surgical TXT
A
Fundoplication - Nissan operation
Jejunostomy - req feeding tubes
14
Q
Esophagitis 3 common causes?
A
GERD
Candida
Rx/Caustic ingestion
15
Q
Primary S/S of esophagitis?
A
Retrosternal/epigastic pain
16
Q
Best method to Dx esophagitis?
A
Endoscopy
17
Q
TXT of Esophagitis? (5)
A
Fluids Viscous lidocaine PPI Sucralfate Metoclopramide
18
Q
Different age Presentations of EOS esophagitis?
A
Young - Vomit, food/drink aversion, FTT
School aged - Vomit, vague abd pain
Adolescents - Dysphagia, food impactions
19
Q
EOS esophagitis is Dx via?
A
Endoscopy + Bx
Barium Swallow
Allergy Patch testing or RAST (blood)
20
Q
Txt EOS esophagitis?
A
High dose PPI
ID and eliminate antigen
21
Q
Fx GI d/o of childhood?
A
Fx ABD pain (+ IBS)
Fx Diarrhea
Fx constipation
22
Q
Peak incidence of Recurrent abd pain ?
A
7-12yo
23
Q
Characteristics of Fx abd pain?
A
Almost daily pain (worse in AM)
Not ass/w meals or defecation
Ass/w Anxiety/perfectionism (school stress)
— Pvt school attendance at times
24
Q
Fx ABD pain criteria?`
A
Once/wk for >2mo AND all -
Abd pain that is episodic or continous
Doesnt fit other GI criteria
No evidence of other processes.
25
A Subset of Fx Abd pain?
Irritable Bowel syndrome
26
Criteria for IBS?
Once/wk >2mo AND all -
* Abd discomfort or Pain + at least 2
1. Defecation helps, 2. change stool freq, 3. stool form
* No evidence of other processes.
27
General characteristics of IBS?
Stool freq/consistency changes w/ pain onset
Stools change from diarrhea to constipation often
Defecation relieves pain
28
Common IBS lifestyle associations?
Anxiety, Peer relationships, Avoids school, 2ndy gains
29
Another name for Fx diarrhea?
Toddler's diarrhea
30
Def of Fx diarrhea?
Freq watery stools in presence of normal growth and weight gain.
31
What are causes of Fx diarrhea?
Excess intake of sweetened liquids
32
Criteria of Fx diarrhea?
ALL
- Daily painless >2 large unformed stools while awake
- S/S lasts >4w
- S/S onset 6-36mo age
- No FTT
33
Fx d/o mgmt?
Normal activies right away (break cycle)
Fiber, probiotics, CBT, amitriptyline, SSRI
Good rapport w/ pt/family
Lifestyle mod (S/S diary, reassure, relax, diet)
34
Constipation is defined as?
<3 stools/wk OR or passage of hard pellet stools >2wks
35
Common ages constipation can occur?
6mo - Solid foods started
2-3yo - Fx constipation (toilet training)
4-5yo - School starts
36
Fx constipation is defined as?
Voluntary withholding stool (retentive posture)
<3 stools/wk
Large diameter painful stools
Encorpresis
37
Txt of Fx constipation?
Polyethylene glycol or milk of magnesia (stool soft)
Mineral oil
Sits on toilet 1st thing in AM and after meals
38
Gastro-colic reflex is?
Urge to defecate following a meal.
39
Encopresis is?
>4yo regular passing of stool other than in a toilet.
40
What gender is encopresis more common in?
Males
41
Etiology of encopresis?
```
Chronic constipation (MC cause)
Non-retentive soiling (Emotional/situational)
```
42
Encopresis work up is tailored how?
Similar to a constipation W/U
| +- KUB (fecal mass size, placement, rectal dilation)
43
If Hirsachsprungs dz is suspected what are specific studies?
Anal manometry
Colonoscopy
Barium Enema
44
Mgmt of encopresis due to MC cause?
```
--- Fx constipation
Education
Lfestyle mod (diary)
Diet changes (fluid/fiber, exercise, less cow milk)
Rx - Stool softeners
+- disimpaction if needed 1st
```
45
Mgmt of encopresis due to other causes?
--- Emotional/situational
| CBT, diet, lifestyle
46
Celiac disease is defined as?
Allergy to Gluten ingestion leading to malnutrition
47
Celiac disease is AKA?
Sprue gluten-sensitive enteropathy
48
Celiac disease is ass/w what conditions?
DM1
Thyroiditis
Turner syndrome
Trisomy 21
49
S/S of celiac disease?
```
Diarrhea +- constipation
Abdominal bloating
FTT, Irritable
Decreased appetite, Ascites
Extra-intestinal manifestations (list if possible)
```
50
Ascites is a sign of what lab diagnostic?
Hypoproteinemia (ass/w celiac disease, etc)
51
Extra-intestinal manifestations of celiac disease?
```
Osteoporosis
Pulm hemorrhage
Seizures or encephalopathy
Dermatitis
Herpetiformis
Erythema nodosum
```
52
Dx of celiac disease is made by?
(While eating gluten products)
Serum IgA anti-GLIADIN ABs
IgA tiss Transglutaminase AND anti-ENDOMYSIAL ABs
Endoscopic SML intestine Bx
53
Endoscopic SML intestine Bx can be used to determine what? How?
Celiac disease
- - Villous atrophy
- - Crypt hyperplasia
- - Mucosal inflammation
- - Increased intraepithelial lymph
54
TXT of celiac disease?
Lifelong gluten avoidance
55
What is ok to eat w/ celiac disease?
Oats, Rice, Tapioca, Corn, Buckwheat
| ALL in small quantities
56
Allergic Colitis is AKA? defined as?
Milk protein allergy --- Milk/soy protein induced colitis
57
When does allergic colitis typically resolve w/ PEDs?
6-18mo
58
Allergic collitis is MC w/ formula fed or breast fed?
Formula fed
59
S/S of allergic collitis?
+- Abd distention
Gas and Fussiness after feeds
Loose stools that are blood streaked
60
What is typically absent in allergic colitis?
N/V or ABD pain
61
Allergic colitis W/U?
CBC
| EOS in feces and rectal mucosa via Bx
62
TXT of Allergic Colitis?
Diet modification
| Casein hydrolysate
63
Acute gastroenteritis is def as?
Inflammation due to viral/bacterial/parasitic infection of the GI tract.
64
MC cause of diarrhea during winter months?
Rotavirus
65
Predominate S/S timeframe of Rotavirus
3-4d - Vomiting
| 7-10d - Diarrhea
66
Viral AGE ass/w ocean cruises?
Norovirus
67
Norovirus viral species?
Calcivirus
68
Norovirus vs Rotavirus - are they clinically different?
NO
69
Organisms causing typhoid fever?
Salmonella typhi or paratyphi
70
Clinical picture of typhoid fever?
Fever - HA
ABD pain worse over 48-72hr
Nausea - decreased appetitie
Constipation w/ inconsistent diarrhea
71
UNtxt - typhoid fever can progress to?
Sig weight loss
Occ. Hematochezia or Melena
Bowel perf (rare in PEDs)
72
UNtxt typhoid fever may last how long?
2-3wks
73
A pt may be a chronic carrier of what AGE related organism?
Salmonella typhi or paratyphi
74
Non-typhoidal salmonella is transmitted via?
```
Infected animals (Chicken, reptiles, turtles)
Contaminated food - Diary, eggs, poultry
```
75
Colony count req and Incubation period of Non-typhoidal salmonella?
1K-10 Billion - incubates 6-72hr (typically <24h)
76
Dysentery is defined as?
Bloody/Mucous diarrhea w/ high fever (+- febrile seizures). Foul smelling. Bleed may be significant.
77
Causes of dysentery?
Shigella Dysenteriae (shiga toxin)
Ambeic dysentery (E. Histolytica)
E. Coli 0157:H7
Severe C. Jejuni
78
Colony count req and Incubation period of Shigella?
10-100 - incubates 1-7D
79
Enterotoxin producing organisms?
V. Cholerae
| ETEC (E.Coli)
80
V. Cholerae and ETEC (E.Coli) will produce what s/s?
No/Low fever
| 4-5 loose watery stools (involving ileum) for 3-4d
81
Inflammation GI tract location of
Dysentery vs
Enterotoxigenic Dz vs
C. Jejuni?
Dysentery - Colon or rectum
Enterotoxigenic - Ileum
C. Jejuni - Jejunum, ileum, colon
82
C. Jejuni is transmitted via?
```
Person to person (A2M)
Contaminated food (Raw milk/cheese - poultry)
```
83
C. Jejuni Mgmt?
SL unless complicated > ABX
84
C. Jejuni concerning complications?
High fever, septicemia
Grossly bloody diarrhea
>1wk S/S
85
Y. Enterocolitica transmitted via?
Pets
| Contaminated foods
86
Y. Enterocolitica infantile/toddler presentation?
Diarrhea illness
87
Y. Enterocolitica older children presentation?
Terminal ileum lesions or LAD of mesenteric
| mimic appendicitis or Crohns
88
What are post infectious manifestations of Y. Enterocolitica?
Arthritis
Rash
Spondylopathy
89
TXT of Y. Enterocolitica?
Supportive only (Ciprofloxacin if invades out of GI)
90
Clostridium Difficile is AKA?
Pseudomembranous colitis
91
C. Diff is typically transmitted via?
P2P contact (admit - pt to pt)
92
How does C. diff develop?
ABX use disrupts NL flora of bowel
93
C. Diff MGMT?
DC ABX
| Metronidazole or Vancomycin
94
E. Histolytica AGE infection occurs in what geograph?
Warmer climates
95
G. Lamblia AGE is ass/w what demograph?
Day care centers
96
AGE G. Lamblia is transmitted via?
P2P
Contaminated food
Freshwater/well water (infected feces (cysts)
97
S/S of AGE G. Lamblia?
Insidious onset
- Nausea, Gassy, abd distention
- Anorexia / wgt loss
- watery diarrhea
- 2ndy lactose intolerance
98
AGE G. Lamblia is a gradual or sudden onset?
Gradual (insidious onset)
99
AGE Cryptosporidium parvum presentation in Immuno-compentent individual?
Mild, watery diarrhea
100
AGE Cryptosporidium parvum presentation in Immuno-suprressed individual?
MC AIDS pt - Severe - prolonged diarrhea
101
Principles of AGE TXT?
```
Correct dehydration/lytes - Most important
Supportive
+- ABX
+- Anti-diarrheal agents
+- Anti-emetic agents (Zofran)
```
102
Complications of anti-diarrheal agents for TXT of AGE?
Worsens infectious/inflammatory process causing toxic megacolon.
103
ABX are always recommended for what organisms of AGE?
```
S. Typhi
Sepsis
Infants <3mo w/ nontyphoidal salmonella
C. Difficile
Shigella outbreaks
```
104
Shigella ABX TXT?
Cephalosporin or Ciprofloxacin
105
Salmonella ABX TXT? And immuno-compromised?
Ciprofloxacin
| --- X-imm = Ampicillin
106
E.Coli ABX TXT?
Ciprofloxacin, Azithromycin, TMP/SMZ
| NOT FOR O157:H7
107
Why do we not TXT E.Coli O157:H7?
Toxin producing bacteria will lyse from ABX
108
C. Diff ABX TXT?
Metronidazole
109
Giardia ABX TXT?
Metronidazole,
| --- Albendazole, Furazolidone, or Quinacrine
110
INITIAL IV Rehydration - for AGE TXT dosing?
Bolus - 20mL/kg isotonic (NS/LR) over 20m
(10mL/kg if neonate)
MAX 3 boluses before admission
111
MAINTENANCE IV Rehydration - for AGE TXT dosing?
```
4mL/kg/hr - 1st 10kg wgt
-
2mL/kg/hr - 2ND 10kg wgt
-
1mL/kg/hr - each 1 kg wgt (after 20kg)
HOURLY > DAILY then
HALF over 1st 8hrs > HALF over next 16hrs
```
112
MC DM in child hood?
DM1
113
DM1 pathophys?
Autoimmune of pancreatic beta-cells = permanent insulin deficiency
114
DM2 pathophys?
Insulin resistance +- insulin deficiency (exogenous obesity)
115
DM Dx criteria requirment?
```
2 seperate tests of
>126 FG
>200 Random glu
>200 OGTT w/ 2hr post feed or 75g Glucose load.
>6.5 Hgb A1c
```
116
Pre-DM lab values?
100-125 FG
140-199 OGTT
Hgb A1c 5.7-6.4%
117
3 P's of DM
Polydipsia
Polyphagia
Polyuria
118
S/S of DM?
3 P's
- Enuresis
- Fatigue/weak/wgt loss
- Blurry vision
- Yeast infections
119
Glucosuria will appear on UA if?
Glucose is above renal threshold >160-190
120
Define Honeymoon period in terms of DM?
3-6mo no more than 2yrs where Beta-cells not completely destroyed yet.
121
Insulin requirements of DM pt?
0.4-0.6 U/kg/d - honeymoon
0.5-1 U/kg/d - prepubertal w/ DM >1-2yrs
1-2 U/kg/d - Middle adolescence (growth hormone)
122
When to check insulin regimen intervals?
Before meals, bedtime, 2-3am
123
A1C goals of PEDs?
<6yo - 7.5-8.5%
6-13yo - <8%
13-18yo - <7.5%
124
Blood glucose goals of PEDs?
<5yo - 80-180
School aged - 80 - 150
Adolescents - 70 - 130
125
Complications of DM1?
Hypoglycemia
Hyperglycemia
DKA
126
S/S of DM hypoglycemia?
HA, vision changes, confusion, seizures (Neuro)
| Tremors, Tachy-C, Sweating, Anxiety (Catecholamines)
127
TXT of hypoglycemia?
If mild - Sugar intake
Severe (seizures/LOC) - Glucagon
If admitted - IV GLU
128
Concepts/complications ass/w or causing hyperglycemia?
```
Dawn phenomenon (Common)
Somogyi phenomenon (rare)
```
129
Dawn phenomenon is?
1. Physiologic Growth hormone release all night
| 2. Early AM HYPERglycemia persisting to morning
130
Somogyi phenomenon is?
1. Too large of a nightime insulin dose
2. Early AM HYPOglycemia
3. Rebound hyperglycemia by morning
131
TXT of Dawn phenomenon?
Increase evening insulin dose
132
TXT of Somogyi phenomenon?
Decrease evening insulin dose
133
When would DKA occur?
DM1 is not dectected/Dx
Poor compliance
Extra stress
134
DKA pathophys?
* (1. Not enough insulin)
2. Hepatic oxidaiton of fatty acids to Ketones
3. Metabolic acidosis
135
What does DKA do to anion gap?
Elevates it
136
Most common complication of DM1
Hypoglycemia
137
DM polyuria is due to?
Hyperglycemia causing osmotic diuresis
138
DM polydipsia is due to?
Osmotic diuresis of polyuria causes dehydration
139
DM N/V is due to?
Metabolic acidosis
140
Breathing pattern related to DKA?
Kussmaul respirations (metabolic acidosis)
141
DM causing electrolytes to?
*Intra-RBC k+ is depleted
| PO4 and NA+ is depleted as well
142
What causes fruity breath odor of DKA?
Acetone
143
Expected labs of DKA?
| GLU - ABG pH - Bicarb
GLU - (200 to >1000)
ABG pH - <7.3
Bicarb - <15
144
DKA TXT?
Fluid/lyte replacement
Insulin - correct acidosis/hyperglycemia
(Never rapidly shift osmo/fluids)
145
Most serious complication of DKA is?
Cerebral edema
146
Pathophys of cerebral edema in context of DKA?
Rapid reduction of hyperglycemia due to insulin admin
147
What electrolyte should be measured often and fixed in DKA?
K+ (DECREASED)
148
TXT of cerebral edema?
IV mannitol, intubation/vent
149
Other Chronic complications of DM1?
```
Retinopathy - annual exam
Nephropathy - annual UA for MICRO-Alb
Coronary Dz - Annual Lipids/BP
Addisons Dz/Thyroiditis - annual TFTs
PUD
Neuropathy
Celiac Dz
```
150
What Rx can slow/stop microalbuminuria?
ACEI
151
MC form of DM2?
Peripheral insulin resistance >
Hyperinsulinemia >
Pancreatic failure of insulin secretion
152
Biggest difference of DM1 vs DM2 when considering labs?
No auto-antibodies
153
Skin condition ass/w DM2?
Acanthosis nigricans
154
DM2 TXT?
Lifestyle mod
1L Rx - Metofrmin
Insulin therapy
155
What does MODY stand for?
Maturity onset DM of youth.
156
What is MODY?
Inherited forms of mild DM w/out insulin resistance
157
Primary ABNL finding of MODY?
Insufficent insulin for glycemic stimulation
158
TXT of MODY?
+- Sulfonylureas
