GI & Nutrition Flashcards
(28 cards)
Abdominal Wall Defects
- eviscerated bowel with no covering
- evisceration of multiple abdominal organs, covered by peritoneum
- defect at linea alba, covered by skin
Which one is associated with left lateral insertion of umbilical cord relative to defect?
Which one is usually an isolated defect?
Which one is associated with congenital hypothyroidism?
Which one is often associated with cardiac dz, NTDs, or trisomies?
Abdominal Wall Defects
- Gastroschisis
- -eviscerated bowel with no covering
- -umbilical cord inserts to left of defect
- -usually isolated - Omphalocele
- -evisceration of multiple abdominal organs, covered by peritoneum
- -umbilical cord inserts at apex
- -often associated w cardiac dz, NTDs, trisomy 18 (Edwards) - Umbilical Hernia
- -defect at linea alba, covered by skin
- -umbilical cord inserts at apex
- -often associated with congenital hypothyroidism
Naming the Vitamins
A B1 B2 B3 B5 B6 B9 B12 C D2 D3
Naming the Vitamins
A: retinoic acid B1: thiamine B2: riboflavin B3: niacin B5: panthothenic acid B6: pyridoxine B9: folate B12: cobalamin C; ascorbic acid D2: ergocalciferol D3: cholecalciferol
Vitamin Deficiency Syndromes
- fissures at corners of lips, hyperemic tongue and oropharynx, normocytic normochromic anemia, seborrheic dermatitis
- burning feet
- echymoses, bleeding gums, petechiae, coiled hair
Vitamin Deficiency Syndromes
- B2 (riboflavin)
- -angular chelosis, stomatitis, glossitis, normocytic normochromic anemia, sebeorrheic dermatitis - B5 (pantothenic acid)
- -burning feet - C (ascorbic acid)
- -echymoses, bleeding gums, petechiae, coiled hair
Vitamin Deficiency Syndromes
- megaloblastic anemia, hypersegmented neutrophils
- -> two vitamins
Which one is also associated with peripheral neuropathy of dorsal column tracts?
- Associated with s/s of bleeding, increased prothombin time and INR?
Vitamin Deficiency Syndromes
B9: folate
- -megaloblastic anemia, hypersegmented neutrophils
- -NTDs
B12: cobalamin
- -megaloblastic anemia, hypersegmented neutrophils
- -peripheral neuropathy of dorsal columns (confusion, parasthesias, ataxia)
K
–s/s bleeding, increased prothombin time and INR
Vitamin Deficiency Syndromes
- poor night vision, hypoparathyroidism, dry skin, dry eyes
- dry beriberi (peripheral neuropathy), wet beriberi (dilated cardiomyopathy), and Wernicke-Korsakoff
- diarrhea, dermatitis, dementia, death
- peripheral neuropathy
- rickets
Vitamin Deficiency Syndromes
A: retinoic acid
–poor night vision, hypoparathyroidism, dry skin, dry eyes
B1: thiamine
–beriberi, Wernicke-Korsakoff
B3: niacin
–pellagra: diarrhea, dermatitis, dementia, death (4 Ds)
B6: pyridoxine
- -peripheral neuropathy
- -must be administered with INH
D: ergocalciferol/cholecalciferol
- rickets
- -bone pain, impaired growth, fractures, skeletal deformities, short stature
- -muscle weakness and cramps
- -dental problems
Vitamin Toxicity Syndromes
- pseudotumor cerebri, hyperparathyroidism
- hypercalcemia, polyuria, polydipsia
Vitamin Toxicity Syndromes
A: retinoic acid
–pseudotumor cerebri, hyperparathyroidism
D: ergocalciferol, cholecalciferol
–hypercalcemia, polyuria, polydipsia
Neonatal GI Anatomic Abnormalities
- choking, coughing, and regurgitation with initial feeding; polyhydramnios; failed insertion of gastric tube reaches proximal esophagus; large amount of air in bowels; aspiration pneumonia
- cyanosis and respiratory distress immediately after birth or during feeding; improves with crying
- cyanosis and respiratory distress immediately after birth; polyhydramnios; deviation of abdominal viscera into thorax –> pulmonary hypoplasia, scaphoid abdomen; Xray shows displaced cardiac silhouette, bowel in thorax, gasless abdomen
- polyhydramnios; vomiting with initial feeding; NO respiratory distress; Xray shows air in stomach and proximal duodenum
- stridor, dysphagia in neonate; successful insertion of gastric tube
Neonatal GI Anatomic Abnormalities
- Esophageal Atresia with Tracheoesophageal Fistula
- -most common type is esophageal atresia with distal fistula - Bilateral choanal atresia
- -narrowing or blockage of nasal airway
- -infants prefer to breath thru nose except when crying - Congenital diaphragmatic hernia
- Duodenal atresia
- -“double bubble” sign - Anomalous vascular branches of aorta
- -stridor and dysphagia due to compression of trachea and esophagus
Esophageal Atresia and Tracheoesophageal Fistula
–choking, coughing, and regurgitation at initial feeding; polyhydramnios; failed insertion of gastric tube that reaches proximal esophagus; large amount of air in bowels; aspiration pneumonia
- Most common type?
- Half associated with VACTERL
EA and TEF
- most common type: upper esophageal atresia, with distal TE fistula
- VACTERL: Vertebral anomaly; Anal atresia; Cardiac defect; TE fistula; Renal anomaly, Limb anomaly
Metabolic Enzyme Deficiencies in the Newborn
- vomiting, lethargy, poor weight gain, jaundice, hepatosplenomegaly, convulsions, bilateral cataracts
- -Dx?
- -Dx if hypotonia and nerve deafness are also present? - cataracts
Metabolic Enzyme Deficiencies in the Newborn
- Galactosemia
Dx: galactose-1-P-uridyltransferase deficiency
–increased risk of E. coli neonatal sepsis
Dx: Uridyl-diP-galactose-4-epimerase deficiency
–hypotonia, nerve deafness
- Galactokinase Deficiency
NB: autosomal recessive
DDx: delayed passage of meconium
- obstruction at rectosigmoid; normal meconium consistency
- obstruction at ileus; viscous or inspissated meconium consistency
DDx: delayed passage of meconium
*greater than 48 hours
- Hirschsprung Disease
- -obstruction at rectosigmoid
- -normal meconium consistency - Meconium Ileus
- -obstruction at ileus
- -viscous or inspissated meconium
Physiologic Jaundice in the Newborn: unconjugated hyperbilirubinemia
- What enzyme is responsible for conjugation of bilirubin?
- What is the name of the complication that requires tx or prevention with phototherapy?
Physiologic Jaundice in the Newborn: unconjugated hyperbilirubinemia
Pathophysiology
1. increased bilirubin production due to high Hct
- decreased bilirubin clearance due to low UGT activity
(uridine diphosphogluconurate glucuronosyletransferase) - increased enterohepatic recycling bc sterile newborn gut cannot break down bilirubin into urobilinogen for fecal excretion
Prevent kernicterus with phototherapy
Presentation: reflux, painless bloody stools in infant age 2-8 weeks; personal or family hx of eczema
Dx?
IgE-mediated?
Prognosis?
Milk-protein allergy
- -non IgE mediated immunologic response to dairy or soy proteins in breast milk or formula
- -spontaneous resolution by 1 yr
can continue breastfeeding, but Mom refrains from dairy and soy
Cyclic Vomiting Syndrome
–recurrent, predictable pattern of acute and frequent vomiting that resolves spontaneously with no symptoms in between episodes
Association?
CVS
–associated with migraines
DDx: intestinal obstruction and bilious vomiting in the neonate
- few hours after birth; bilious vomiting; NO abdominal distention; “double bubble” sign with no distal bowel gas; often have prenatal polyhydramnios
- bilious vomiting at 3-7d; abnormal location of superior mesenteric vessels; Ligament of Trietz on right side of abdomen; small bowel obstruction with corkscrew appearance; duodenal obstruction with “bird’s beak” appearance; xray shows gasless abdomen; may have rapid deterioration
- bilious vomiting within 24 hours after birth; abdominal distention; air-fluid levels on abdominal film; “triple bubble” sign; due to intrauterine vascular accident often associated with intrauterine exposure to cocaine or tobacco
- bilious vomiting and abdominal distention immediately after birth; no passage of meconium; “ground glass” on xray with dilated loops of bowel proximal to obstruction
- bilious vomiting, abdominal distention, and bloody stools 10-12 days after birth; pneumatosis intestinalis on xray
DDx: intestinal obstruction and bilious vomiting in the neonate
- Duodenal atresia
- -assoc: Trisomy 21 - Malrotation with volvulus
- -incomplete bowel rotation during 7-12wks EGA - Jejunoileal atresia
- Meconeum ileus
- -assoc: CF - Necrotizing enterocolitis
- -assoc w preterm and VLBW; assoc with reduced mesenteric perfusion due to congenital heart dz or hypoperfusion
- -poor perfusion leads to infection
DDx: Breast Feeding Failure Jaundice vs. Breast Milk Jaundice
- Which one begins at 3-5d, and peaks at 2w?
- Which one presents in the first week of life?
- Breast milk jaundice is due to elevated levels of what enzyme in breast milk?
- Which one has s/s of dehydration and “brick red” urate crystals in the diaper?
Dx: Breast Feeding Failure Jaundice vs. Breast Milk Jaundice
Breast Feeding Failure Jaundice
- -first week of life
- -lactation failure
- -s/s dehydration
- -“brick red” urate crystals in diaper
Breast Milk Jaundice
- -begins at 3-5d; peaks at 2w
- -high levels of beta-glucuronidase deconjugates intestinal bilirubin –> increased enterohepatic circulation
Bilirubin Metabolism in the Newborn
- Hgb is metabolized to unconjugated bilirubin, which is conjugated by what enzyme?
- Conjugated bilirubin is de-conjugated in the intestine by what enzyme?
- Conjugated bilirubin –> reduced by bacterial dehydrogenase –> eliminated as what product?
Bilirubin Metabolism in the Newborn
- Unconjugated bilirubin is conjugated by hepatic uridine di-P-gluconurate glucuronosyltransferase
- Conjugated bilirubin is de-conjugated in the intestine by beta-glucuronidase –> enterohepatic recycling
- Conjugated bilirubin –> reduced by bacterial dehydrogenase –> eliminated as fecal urobilinogen
DDx: Conjugated Hyperbilirubinemia
- Biliary Atresia
- Dubin-Johnson Syndrome
- Galactosemia
- Which one is AR and asymptomatic except for mild scleral icterus?
- Which one presents with clay-colored stools, dark urine, and an enlarged liver?
- Which one is due to galactose-1-P uridyl transferase deficiency?
DDx: Conjugated Hyperbilirubinemia
Dubin-Johnson Syndrome
–AR; asymptomatic except mild scleral icterus
Biliary Atresia
–clay-colored stools, dark urine, enlarged liver
Galactosemia
–deficient galactose-1-P uridyl transferase
Nonbilious projectile vomiting in a boy age 1-2m
- -still hungry and desires to feed more
- -small olive-shaped mass palpated in abdomen
Dx?
What type of metabolic alkalosis?
Pyloric Stenosis
Hypochloremic, hypokalemic metabolic alkalosis
Metabolic Alkalosis Pathophys
- vomiting –> loss of HCl, NaCl, H2O
- loss of gastric HCl –> hypochloremic
- loss of NaCl, H2O –> hypovolemia –> RAAS
- -Angiotensin II –> increased HCO3 reabsorption
- -Aldosterone –> increased H, K secretion
- Exclusively breastfed infants need what vitamin supplementation?
- Four viral infections that are contraindications to breastfeeding?
- Do not give cow’s milk before what age?
- Vit D supplement for exclusively breastfed infants
* in strict vegetarian mothers, also supplement B12 - HIV, CMV, HSV (on breast), HBV (if infant not vaccinated)
- -contraindications to breast feeding
- -other contraindications: breast cancer, substance abuse - No cow’s milk before age 1 yr
* Fe Deficiency Anemia RFs
- -cow’s milk before age 1 yr
- -prematurity
- -maternal Fe deficiency
Celiac Disease
Name of IgA Ab?
Two endocrine associations?
Tx: gluten free diet
Celiac Disease
Pathophys
- -HLA-DQ2
- -immune-mediated damage to duodenal villi
Features
- -Peds: abdominal distention, F2T, diarrhea
- -extensor surface rash (dermatitis herpetiformis)
- -weight loss, Fe deficiency anemia
Labs
–IgA anti-tissue transglutaminase Ab
Duodenal Biopsy
–flattening of villi; crypt hyperplasia; intraepithelial lymphocytes
Associations
- -T1DM
- -autoimmune thyroiditis
Intussusception
URI causes what histopathologic finding?
Most common association with recurrent intussusception?
Intussusception
Etiology and Associations
- -post adenovirus, rotavirus infxn, URI –> hypertrophy of Peyers patches
- -assoc w HSP
- -leading point (eg, Meckel diverticulum esp in recurrent)
Features
- -severe paroxysmal colicky abdominal pain
- -weakness, lethargy, fever
- -black currant jelly stool
- -sausage-shaped mass
- -doughnut or target appearance on US
Meckel Diverticulum
What type of ectopic tissue is present in the diverticulum?
Meckel Diverticulum
ectopic gastric tissue –> secretes HCl –> small bowel mucosal ulceration –> painless hematochezia
Rule of Twos
- -2 yrs of age
- -2 percent of population
- -2 types of tissue
- -2 inches in size
- -2 ft from ileocecal valve
- most common congenital GI anomaly
Etiology
–remnant of embryonic yolk sac, lining similar to stomach
Features
- -intermittent painless rectal bleeding
- -may become lead point for intussusception
Dx Test
–Tc-99m pertechnetate scan
Moderate to severe dehydration requires IV fluid resuscitation.
What type of fluid for resuscitation?
IV fluid resuscitation
- -use isotonic (normal) saline
- -add dextrose (D5) for MIVF
DDx
- prenatal: polyhydramnios; bilious vomiting on 1st day of life; no abdominal distension; Xray: double bubble with no distal bowel gas
- prenatal: polyhydramnios; intrauterine cocaine or tobacco exposure; bilious vomiting on 1st day of life; abdominal distention; Xray: triple bubble with no distal bowel gas
- bilious vomiting and abdominal distention; delayed passage of meconium (48 hours); dilated loops of bowel proximal to rectosigmoid junction; digital exam –> release of stool and gas
- bilious vomiting and abdominal distension; delayed passage of meconium; dilated loops of bowel proximal to obstruction; Xray: bubbly or granular “ground glass” appearance in RLQ
- Duodenal Atresia
- Jejunal or Ileal Atresia
- Hirschsprung Disease
- Meconium Ileus
