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Ped's GI > Ped's GI > Flashcards

Ped's GI Flashcards

1
Q

What is the underlying cause of infectious esophagitis

A

Most common in immunocompromised patients

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2
Q

What are the types of Infectious esophagitis

A
  1. Candida
  2. CMV
  3. HSV
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3
Q

Key terms for this diagnosis- odynophagia, endoscope shows linear yellow-white plaques

A

Candida

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4
Q

Key terms for this diagnosis- odynophagia, endoscope shows large superficial shallow ulcers

A

CMV

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5
Q

Key terms for this diagnosis- odynophagia, endoscope shows small deep ulcers

A

HSV

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6
Q

What is the treatment for Candida

A

Fluconazole PO

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7
Q

What is the treatment for CMV

A

Ganciclovir

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8
Q

What is the treatment for HSV

A

Acyclovir

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9
Q

key terms for this diagnosis- history of atopic disease - allergies, asthma, eczema, allergic inflammatory esophageal inflammation causing dysphagia

A

Eosinophilic esophagitis

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10
Q

Eosinophilic esophagitis will show what on an endoscope?

A

multiple conrrugated rings

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11
Q

Treatment for Eosinophilic esophagitis

A

Remove foods that cause allergic response

topical steroids with an inhaler without a spacer

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12
Q

What is causing pyloric stenosis?

A

hypertrophy and hyperplasia of the muscular layers of the pylorus causing a functional outlet obstruction

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13
Q

what is the most common cause of intestinal obstruction in infancy

A

pyloric stenosis

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14
Q

When is pyloric stenosis most common ?

most common in whom?

A

95% is present in the first 3-12 weeks of life
rare in older than 3 months
most common in white males

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15
Q

What are the s/s of pyloric stenosis?

what is the physical s/s

A 
*NON-bilious vomiting 
regurgitation projectile vomiting 
vomiting after feedings
dehydrated 
malnutrition
jaundice 
metabolic alkalosis
-Right of the umbilicus=  olive shaped non-tender mobile hard pylorus, felt especially after the infant has vomited
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16
Q

What is the best imaging for Pyloric stenosis?
what is the second line imaging?
What will both show?

A

Ultrasound = elongation and thick pylous

upper GI = string sign from and delayed gastric emptying

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17
Q

Treatment for Pyloric stenosis

A

Pyloromyotomy

re-hydrate

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18
Q

What is the rule of “2’s” with Meckle’s Diverticulum

A 
2% of the population 
2% symptomatic
2 feet from the iloeocecal valve 
2 inches in lenght 
2 types of ectopic tissue- gastric or pancreatic
2 years of age * most common
2 times more common in boys
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19
Q

What is Meckel’s diverticulum actually made of?

A

Persistent portion of embryonic vitteline duct - yolk stalk

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20
Q

What are the s/s of Meckel’s diverticulum

A

Usually asymptomatic - may be seen incidentally during abdominal surgery

  • PAINLESS rectal bleeding or ulceration - if there is ectopic gastric tissue
  • periumbilical pain that radiates to right lower quad
  • can cause intussusception, volvulus or obstruction
  • adults = divercitulitis
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21
Q

What is the best diagnostic test for Meckel’s diverticulum

A

Meckel’s scan - looks for ectopic gastric tissue in the ileal area

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22
Q

Treatment for Meckel’s diverticulum

A

surgery- excision

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23
Q

What is intussuscepiton ?

when is it common to occur?

A

Common after a viral infection

intestinal segment invaginates “telescopes” into adjoining intestinal lumen causing a bowel obstruction

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24
Q

At what ages is intussuscepiton most common

A

2/3 of children
common between 6 months - 18 months of age
usually less than <1 year old

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25
Q

What area is intussusception most common?

A

ileocolic junction
*lead points: meckel diverticulum, enlarged lymph node, hyperplasia of peyer’s pathces, bening tumors, malignant tumors, hematomas, foreign body

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26
Q

What are the s/s of intussusception

what are physical sign/symptoms

A 
TRIAD : 
1. vomiting 
2. abdominal pain - colicky
3. blood in poop "current jelly stools" 
usually lethargic
Sausage-shaped mass in right upper abdomen or hypochondrium and emptiness in RLQ
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27
Q

What is the Dance sign?

What condition is it seen in?

A

intussusception

Sausage-shaped mass in right upper abdomen or hypochondrium and emptiness in RLQ

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28
Q

What is the best imaging to diagnosis intussusception

A

Barium contrast enema * boht diagnostic and therapeutic

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29
Q

Treatment for intussusception

A

Barium or air insufflation enema
(both diagnostic and therapeutic)
surgery if refractory
IV fluids

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30
Q

What is an autoimmune inflammatory disease secondary to alpha-gliadin

A

Celiac disease

alpha-gliadin is in gluten

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31
Q

Exposure to alpha-gliadin is in gluten will lead to what in the intestines in celiac disease

A

loss of villi and absorptive area

impaired fat absorption

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32
Q

celiac disease is common in whom?

A

females

european descent - irish and finnish

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33
Q

Key terms for this diagnosis- diarrhea, bloating, steatorrhe, growth delays, weight loss, pruritic rash that is papulovesicular on extensor surfaces, neck, truck and scalp

A

celiac disease

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34
Q

Malabsorption and Dermatitis herpetiformis are diagnostic for what?

A

celiac disease

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35
Q

Endomysial IgA antibody
Transglutaminase Antibody
both positive in what disease ?

A

celiac disease

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36
Q

What is the definitive diagnosis for celiac disease

A

small bowel disease

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37
Q

Treatment for celiac disease

A

gluten free diet- NO wheat, rye, barley

CAN HAVE- oats, rice, corn

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38
Q

What is the most common cause of Appendicitis

A

Feacalith *
inflammation
malignancy
foreign body

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39
Q

What are all the physical exam findings for Appendicitis

A
  1. Rovsing sign
  2. Obturator sign
  3. Psoas sign
  4. McBurney’s point
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40
Q

What is Rovsing sign

what is most indicate ?

A

RLQ pain with LLQ palpation

Appendicitis

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41
Q

What is Obturator sign

what is most indicate ?

A

RLQ pain with internal and external hip rotation with bent knee

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42
Q

What is Psoas sign

what is most indicate ?

A

RLW pain with right hip flexion/extension- raise leg with resistance

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43
Q

What is McBurney’s point

what is most indicate ?

A

1/3 distance from the anterior superior iliac spine and navel

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44
Q

What is the best diagnostic imaging for Appendicitis

A

CT scan
ultrasound
leukocytosis

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45
Q

Treatment for Appendicitis

A

Appendectomy

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46
Q

What is a chronic idiopathic disorder with NO organic cause

A

Irritable bowel syndrome

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47
Q

What is the hallmark s/s of Irritable bowel syndrome

A

abdominal pain associated with altered defecation (bowel habits)
diarrhea & constipation or alternation between the two

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48
Q

Who is Irritable bowel syndrome most common in?

A

most common in women

Late teens - early 20’s

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49
Q

What is the patho of Irritable bowel syndrome

A

chemical imbalance in the intestines - serotonin and acetylcholine causing abnormal movements and spasm = abdominal pain “visceral hypersensitivity”

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50
Q

What is the ROME II criteria

what condition is it seen in ?

A

Irritable bowel syndrome
1. Abominal pain or discomfort with 2/3 for 12 weeks
doesn’t have to be 12 weeks in row
2. relief with defecation
3. change in stool frequency and formation

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51
Q

What are ALARM symptoms of Irritable bowel syndrome

A
  1. Bleeding - occult blood stool, anemia, blood in stool
  2. anorexia or loosing weight, night time pain, family history of cancer
  3. diarrhea causing dehydration, severe constipation or fecal impaction
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52
Q

Treatment of Irritable bowel syndrome

A
  1. lifestyle change- stop smoking, eat low fat unprocessed food
  2. Diarrhea- Dicyclomine, loperamide
  3. Prokinetics, bulk-forming laxatives, saline or osmotic laxatives
  4. TCA- Amitriptyline & Serotonin receptor for pain
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53
Q

Key terms for this diagnosis- RLQ pain that is crampy, weight loss, diarrhea with no blood, malabsoprtion of B12 & Fe deficiency

A

Chron’s Disease

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54
Q

What area are most commonly affected in Chron’s Disease

A

ANY segment of the GI tract
Mouth to anus
Transmural level

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55
Q

What are complications of Chron’s Disease

A 
Perianal disease 
fistulas 
stricture
abscesses
granulomas
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56
Q

What is the best diagnostic imaging for Chron’s Disease

what will it show?

A

Skipped lesions - normal areas interspersed between inflamed areas with cobblestone appearance
Barium = string sign
labs- ASCA +

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57
Q

What is the best drug for chron’s disease- treats anti-immatory

A

Oral mesalamine - Asacol

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58
Q

what are the topical mesalamines effective in the distal colon

A

Mesalamine

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59
Q

What medication works mainly in the Colon

A

Sulfasalazine

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60
Q

what drug has rapid acting on anti-inflammation and used for acute flares of chron’s disease

A

Corticosteroids

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61
Q

Azathrioprine and Methotrexate are steroid spraing agents for what GI disorder?

A

Immune Modifying agents

Chron’s disease

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62
Q

What is the most common type of hernia present in children?

what ages to repair?

A

umbilical - usually resolves by 2

if still present at age 5 surgery

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63
Q

What food have Vitamin C in them?

A

Raw citrus fruits and green vegetables

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64
Q

Which Vitamin deficiency- malasie, wakenss, vascular fragility, recurrent hemorrhages in gums, skin (perifollicular), impaired wound healing and hyperkaratoic papules

A

Vitamin C - ascorbic acid

- Scurvy

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65
Q

Ascorbic acid is also known as what ?

A

Vitamin C

66
Q

Scurvy is seen in what vitamin deficiency?

A

Vitamin C

67
Q

Key terms for this vitamin deficiency

Hyperkeratosis, Hemorrages, Hematolgic (anemia)

A

Vitamin C

68
Q

RIckets is what?

A

Vitamin D deficiency- softening of bones in children

69
Q

Osteomalacia is what?

A

Vitamin D deficiency in adults- diffuse point pains, muscle weakness and fractures
*looser lines

70
Q

Treatment for Vitamin D deficiency

A

Ergoclciferol

71
Q

What vitamin- helps with vision, immune function, embryo development, hematopoiesis, skin and cellular health

A

Vitamin A

72
Q

Key terms for this vitamin deficiency- vision changes especially night blindness, impaired wound healing, squamous metaplasia*, bitot spots (white spots on conjunctiva)

A

Vitamin A deficiency

73
Q

Thiamine is what vitamin?

A

B1

74
Q

Riboflavin is what vitamin?

A

B2

75
Q

Niacin or Nicotinic acid is waht vitamin?

A

B3

76
Q

Pyridoxine is what vitamin?

A

B6

77
Q

Cobalamine is what vitamin?

A

B12

78
Q

What is the most common cause of B1 deficiency?

A

Thaiamine- Alcohol abuse will decrease thiamine intake

79
Q

What are the 3 types of Thiamine deficiencies?

A
  1. Beriberi
  2. Wernicke’s Encephalopathy
  3. Korsakoff’s Dementia
80
Q

Key terms for this condition caused by a vitamin deficiency-
DRY: parathesias, demyelination, peripheral neuropathy, symmetric impariment of sensory, motor reflexes, anorexia, muscle cramps and wasting
WET: high output failure, dilated cardiomyopathy, edema

A

Beriberi- Thiamine B1 deficiency

81
Q

Key terms for this condition caused by a vitamin deficiency- Ophthalmoplegia (paralysis of ocular muscles)
ataxia and global confusion

A

Wernicke’s encephalopathy - Thiamine B1 deficiency

82
Q

Key terms for this condition caused by a vitamin deficiency- Memory loss especially short term, confabulation this condition is irreversible

A

Korsakoff’s Dementia - Thiamine B1 deficiency

83
Q 
Key term for this vitamin deficiency-
oral lesions
magenta colored tongue 
angular cheilitis 
photophobia- corneal lesions 
Genital scrotal dermatitis
A

Riboflavin- B2

oral-ocular-genital syndrome

84
Q

Key term for this vitamin deficiency- Diarrhea, dementia and dermatitis

A

Niacin- Nictoinic acid -B3
Seen in people with high corn diets
3’Ds

85
Q

Key term for this vitamin deficiency- Alcoholism, isoniazid, oral contraceptives, peripheral neruopahty, flaky skin, heaches, anemia, sore tongue, stomatitis and seizures

A

Pyridoxine - B6

86
Q

Key term for this vitamin deficiency- parasthesias, gait, memory loss, dementia, glossitis, GI problems, macrocytic anemia wiht hypersegmented neutrophils

A

Cobalamine B12

87
Q

What condition- Autoimmune destruction or loss of gastric pariteal cells that secrete intrinsic factor

A

Pernicious anemia

Cobalamine B12 deficiency

88
Q

Pernicious anemia will have what vitamin deficiency?

A

Cobalamine B12 deficiency

89
Q

Schilling test is used to diagnosis what?

A

Pernicious anemia

90
Q

Cobalamine B12 deficiency is seen in what kinds of people?

A

Strict vegans
Alcoholics
Malabsorption - celiac or croh’s disease

91
Q

What condition- Autosomal recessive disorder of amino acid metabolism?

A

Phenylketonuria- PKU

92
Q

Phenylketonuria- lacks what enzyme ? inabilty to metabolize what amino acid?

A

lacks- Phenylalanine hydroxlayase that breaks down
Phenylalaine into tyrosine
when its not broken down leads to accumulation of phenylalanie in body

93
Q

When is screening for PKU done?

A

24 weeks gestation

will lead to irreversible damage if not caught by 3

94
Q

key terms for this diagnosis- Blonde blue-eyed fair skin baby with vomiting, mental retardation, irritability, convulsion, increased deep tendon reflexes, urine has mousy odor

A

Phenylketonuria

95
Q

Treatment for Phenylketonuria

A

LIFETIME diet restriction of phenlyalnine
increase tyrosine intake
foods with phenlyalnine - cheese, ntus, fish, meat, eggs, chicken, milk, legumes, aspartame

96
Q

What is the main treatment for gastroenteritits

A 
Fluid replacents ! PO or IV 
sport drinks 
broth 
IV saline 
pedialyte 
ceralyte
DIET- bland low residue BRAT diet 
ANTIMOTILITY (dont give if invasive aka bloody poop)
97
Q

what is the most common cause of diarrhea in children?

A

Rotavirus

98
Q

Key terms for this diagnosis- ingested contaminated dairy, mayonnaise, meat or egg

A

Staphylococcus

99
Q

Treatment for Staphylococcus gastroenteritis

A

Self-limiting
supportive
should last 1-2 days

100
Q

Key terms for this diagnosis- ingested contaminated food especially fried rice 1-6 hours later have vomiting, cramps, diarrhea

A

Bacillus Cereus

101
Q

Treatment for Bacillus Cereus gastroenteritis

A

Self-limiting

supportive

102
Q

Key terms for this diagnosis- ingested a gram neg rod found in water in poor sanitary overcrowded areas leading to rice water stools

A

Virbrio Cholera

103
Q

which type of diarrhea is fatal due to severe hypovolemia because of severe dehydration

A

Virbrio Cholera

104
Q

Treatment for Virbrio Cholera

A

self-limiting
fluid replacement *
if high fevers-> fluroquinolone or doxycycline

105
Q

Key terms for this diagnosis- most common cause of travelers diarrhea from unsanitary drinking water/ice

A

Enterotoxogenic E. coli

106
Q

Treatment for Enterotoxogenic E. coli

A

Fluroquinolone BID x3 days

107
Q

Key terms for this diagnosis-is a nosocomial infection secondary to alteration of normal flora. common after course of antibiotics

A

Clostridium Difficile

*clindamycin

108
Q

Treatment for Clostridium Difficile

A

Metronidazole

second- vancomycin

109
Q

What makes a gastroenteritis invasive?

A
  1. High fevers
  2. bloody diarrhea
  3. fecal leukocytes
  4. mucus
    * do NOT give anti-motility drugs
110
Q

Key terms for this diagnosis- highly virulent gram neg rod that causes watery diarrhea that is mucoid and bloody. In young children can cause febrile seizures

A

Shigella

111
Q

Shigella will have what apprearnce on a sigmoidoscopy?

A

Puncatate areas of ulceration

112
Q

Treatment for Shigella

A

Bacrium

Trimethoprim-Sulfamethoxazole

113
Q

Key terms for this diagnosis- ingestion of contaminated pork, milk, water or tofu. can appear like an acute appendicitis

A

Yersinia Enterocolitica

114
Q

Treatment for Yersinia Enterocolitica

A

Fluoroquinolones

115
Q

Key terms for this diagnosis- ingestion of contaminated poultry, dairy, meat, eggs, exotic pets (reptiles/turtles) causing pea soup

A

Salmonella

116
Q

What are high risk groups for Salmonella

A
  1. Immunocompromised
  2. Sickle cell* risk of osteomyelitis
  3. post splenectomy
  4. AIDS
  5. Children
  6. Elderly `
117
Q

What are the two types of Salmonella

A
  1. Salmonella gastroenteritis

2. Typhoid Enteric fever

118
Q

Treatment for Salmonella

A

Fluoroquinolones

119
Q

Key terms for this diagnosis- ingestion of undercooked ground beef, unpasturized milk or apple cider, day care, contaminated water. Produces a cytotoxin

A

Enterohemorrhagic E. Coli 0157: H7

120
Q

Treatment for Enterohemorrhagic E. Coli 0157: H7

A

Controversial

if antibiotics could lead to Hemolytic uremic syndrome in kids

121
Q

Key terms for this diagnosis- most common cause of bacterial enteritis in the U.S.
ingested contaminated poultry, raw milk, water, dairy

A

Camplyobacter Enteritis

122
Q

What type of gastroenteritis will possibly lead to Gullain Barre syndrome

A

Camplyobacter Enteritis

123
Q

What gastroenteritis is caused by a gram negative S or seagull shaped organism

A

Camplyobacter Enteritis

124
Q

Treatment for Camplyobacter Enteritis

A

Erythromycin

Fluroquinolones

125
Q

Key terms for this diagnosis- ingestion of contaminated water from streams or wells causing frothy, greasy, foul diarrhea

A

Giardia Lamblia

126
Q

Treatment for Giardia Lamblia

A

kids - Furazolidone

127
Q

Key terms for this diagnosis- fecal oral contaminated, common in immigrant populations. Causes Gi colitis, dysentery and amebic liver abscess

A

Amebiasis- entamoeba histolytica

128
Q

Key terms for this diagnosis- Diarrhea caused by a malabsoprtion of nonabsorbable substances leading to large amounts of watery diarrhea. decreased amount of diarrhea if fasting

A

Ostomtic Diarrhea

129
Q

What are types of Ostomtic Diarrhea

A
  1. Celiac
  2. lactose intolerance
  3. pancreatic insufficiency
130
Q

Key terms for this diagnosis- Diarrhea caused by hormones like serotonine, calcitonin, gastring, thyroxine leading to large volume diarrhea
doesnt change with fasting

A

Secretory Diarrhea

example- laxative abuse

131
Q

What is the definition of constipation

A

< 2 poops in a week
straining
hard stools
feeling of incomplete evacuation

132
Q

What is an outlet delay disorder that will lead to constipation in kids?

A

Hirschsprung’s

133
Q

What types of medications can be used to treat constipation

A
  1. Fiber
  2. Osmotic laxatives - miralax, lactulose, sorbitol, milk of magnesia
  3. Stimulant laxatives- dulcolax, senna
  4. bulk forming laxatives- benefiber, citrucel, fibercon
134
Q 
what class of medication?
Psyllium
A

Bulk forming laxative

135
Q 
what class of medication?
Methylcellulose - citrucel
A

Bulk forming laxative

136
Q 
what class of medication?
Polycarbophil
A

Bulk forming laxative

137
Q 
what class of medication?
Wheat Dextran
A

Bulk forming laxative

138
Q

what class of medication?
golytely
miralax

A

Osmotic laxative

type of Polyethylene Glycol - PEG

139
Q 
what class of medication?
Lactulose
A

Osmotic laxative

140
Q 
what class of medication?
Sorbitol
A

Osmotic laxative

141
Q

what class of medication?
Milk of magnesia
magnesium citrate

A

Osmotic laxative

Saline laxatives

142
Q 
what class of medication?
Bisacodyl- Dulcolax
A

stimulant laxative

143
Q 
what class of medication?
Senna
A

stimulant laxative

144
Q

What is Encopresis

A

Encopresis sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing.
Typically it happens when impacted stool collects in the colon and rectum: the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling (distention) of the bowels and loss of control over bowel movement

145
Q

Treatment for Encopresis

A

laxatives
Rectal suppositories
Enemas

146
Q

what is a diagnostic PKU value?

A

> 600
normal 30-60
goal 120-360

147
Q

Diagnostic criteria for failure to thrive

A
  1. weight falls below the 3rd percentile for age
  2. weight decreases by 2 major lines on the growth chart
  3. weight for length decreases below the 10th percentile
148
Q

What is the most common reasons for failure to thrive

A
  1. Most common envirmoental- feeding technique, improper formula, maternal depression, emtional.
  2. organic- CF, celiac, GERD, infection, heart diease
149
Q

What labs do you want to order if you suspect failure to thrive?

A 
CBC
lead level
UA - urine culutre
CMP 
TSH 
consider vitamin testing
150
Q

Treatment for suspected failure to thrive?

A

FEED THEM!
1.5 times usual calories and protein for their age
sometimes have to admit to monitor feedings

151
Q

IN a mother concerned about “GER” what do you tell her about spitting up ?

A

normal if maintaing weight

no sign of respirtory problems

152
Q

What causes spitting up? or GER

A

immature LES
liquid meals
large and frequent meals
horizontal body position

153
Q

What is the difference between GER and GERD

A

GER is normal spitting up

GERD is a disease state causing poor growth, pain, breathing problems

154
Q

What are some ways GERD can present in an infant?

A 
poor weight gain 
breathing problems
recurrent pneumonia 
cough
wheezing 
apneic spells
155
Q

What is the best imaging for GERD

A

upper Barium swallow to look for obstruction or anatomic problem
24HR pH monitoring
Endoscopy

156
Q

Treatment for GERD in an infant

A
  • if otherwise healthy- no treatment
  • lifestyle changes first - thicker feeds, smaller meals, keep upright
  • if complications- H2 blocker or PPI
157
Q

What is Tracheoesophaeal fistula ? TEF

A

a connection between the trachea and esophagus due to defect during development

158
Q

what is the most common type of Tracheoesophaeal fistula

A

distal Esophageal atrisa with TEF

159
Q

key terms for this diagnosis- polyhydramnios (excess aminotic fluid), infant drooling, mucous and saliva tends to bubble from month

A

Tracheoesophaeal fistula

with or without a Esophageal atrisa

160
Q

What is the best diagnostic test for Tracheoesophaeal fistula

A

if you try to advance an endoscope it will stop

CXR can show the tube coiled in esophagus

161
Q

What is the most common complication of Tracheoesophaeal fistula

A

Aspiration pneumonia

162
Q

Treatment for Tracheoesophaeal fistula

A

Surgery

Ped's GI (2 decks)

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