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56 Cards in this Set
- Front
- Back
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General concepts
A. essential vs nonessential B. importanc eof fats C. water-soluble vitamins D. fat-soluble vitamins |
A. can't by syn vs syn by body
B. role in infant brain dev C. C, B-complex D. ADEK |
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malnutrition
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A. marasmus: thin with loss of muscle and body fat
B. kwashiorkor: proein-def char by edema, abdominal distension, skin pigmentation, thin, sparse hair |
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Malabsorption
A. characteristics B. digestion vs absorption C.evaluation |
A. diarrhea, abdominal distension, impaired growth
B. digestion require digestive enzymes, bile acids absorption: intestinal mucosal surface C. stool studies (Giardia lamblia), CBC for study of RBC (macrocytic , etc), bowel biopsy, albumin (enteropathy) |
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Carb malabsorption
A. etiology B. pathophysio |
A. congenital enzyme def (lactase def)
mucosal atrophy B. undigested sugars osmotically active = water into lumen fermented by bacteria = H gas, CO2, acids stool is watery, acidic and unabs sugars detects as REDUCING SUBSTANCES by positive Clinitest rxn |
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Proteins malabsorption
A. enzymes B. etiology |
A. pepsinogen, pancreatic proteases
B. congenital enterokinase def = hypoproteinemia = edema/growth impairment protein-losing enteropthies (inflamed intestinal mucosa) inflam disorders (Crohn's) |
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Lipids malabsorption
A. normal physiology B. etiology C. sx |
A. bile salt, pancreatic lipase
B. exocrine pancreatic insuf (SC, schwachman-diamond syndrome), intestinal mucosal atrophy, bile acid def, abetalipoproteinemia C. steatorrhea |
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Protein Intolerance
A. most common cause B. sx |
A. cow's milk protein
B. enterpathy: prog diarrhea, vomting, abd pain enterocolitis: acute presentation with diarrhea, sx |
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Celiac Disease
A. def B. sx C. dx |
A. gluten intolerance (wheat, rye, barley oats)
B. diarrhea, vomiting, bloating, aorexia, foulsmelling stools, abd pain C. small bowel bipsy, serum IA endomysial, serum tissue transglutaminase Ig testin |
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Short Bowel syndrome
A. etiology C. tx |
A. lesions of gut: gastroschisis, volvulus, intestinal atresia
necrotizing enterocolitis, Crohn's dz, tumors B. TPN (total parenteral nutiriton) |
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Short Bowel syndrome
A. pathophysio B. complication |
A. carb/fat malabsorption with steatorrhea
if distal small bowel (vit B12, bile acid poor) B. TPN cholestasis, intestinal bacterial overgrowth bone mineralization, renal stone |
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Gastroesophageal Reflux
A. GER vs GERD B. apthophysio C. dx |
A. GER = nl physiologic state vs GERD = pathology with GI or pulmonary sx and sequelae
B. inappropriate transient lower esophageal sphinct relaxation, gastric emptying delay, "happy spitter" C. pH probe measurement, endoscopy, bronchoscopth with alveolar lavage |
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Gastroesophageal reflux
A. sx B. sequelae |
A. infnats: emesis, Sandifer syndrome (torticollis with arching), feeding refusal, constant hunger
older: midepigastri pain relieved by food/antacids but exacerbated by fatty foods, caffeine, supin position B. refluxate --> bronchopulmonary constriction --> aspiration chronic laryngitis, hoarseness, subglottic stenosis esophageal strictures, Barrett's esophagus (stratified squamous epithelium to columnar) |
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GERD
A. conservative tx B. medication C. surgery |
A. upright poistinong, thickening feeds
B. H2-blockers, PPI, motility agents (metoclopramide) C. Nissen fundoplication |
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Onstructions that result in vomiting
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- hypertrophic pyloric stenosis
- malrotation - midgut volvulus - atresias - intussuception -Hirschsprung's disease |
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Pyloric stenosis
A. sx B dx (lab findings) C. tx |
A. nonbilious milky projectile vomiting --> dyhydration
B. olive, hypochloriemic, hypokalemic, metabolic alkalosis C. partial pyloromyotomy |
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Malrotation
A. anatomy B. boys or girls C. sx |
A. 10th week gestation: intestines return to abd + counterclockwise rotation about SMA
lack of fixation = peritoneal bands (ladd's bands) that compress duodenum B. boys C. bilious vomting. distension, blood-tinged stools |
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Malrotation
A. dx B. tx |
A. abdominal xray. upper intestinal contrast imaging
B. volvulus = surgicla emergency, fluid resuscitation |
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Duodenal atresia
A. def B. sex, dz asooc C. sx D. dx sign |
A. failure of lumen to recanalize
B. boys, Down syndrome C. polyhydramnios, scaphoid abdomen with epigastric distension D. doubl bubble on abd xray |
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Jejunoileal atresia
A. sx B. dx |
A. bilious emesis, abdominal distension
B. radiographs, contrast studies |
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Intussusception
A. def/pathophysio B. sex C. sx |
A. invagination of proximal portion o fintestine into more distal portion.
most common: ileocolic intussusception lead point: Meckel's, polyp, Peyer's patch B. males C. bloody currant jelly stool RUQ sausage-shaped amss palaped colicky abdominal pain |
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Intussusception
A. dx B. tx |
A. air or contrast enema
see classic "coil spring" sign B. operative reduction, contrast enemas |
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Acute abdomen pain
A. def (etiology see picture) B. sx to ask in hx C PE findings D. lab orders |
A. self-limited sudden-onset
B. fever, vomiting, diarrhea, constipation, dysuria, worsening pain with eating C. intestinal obstruction = high-piched bowel sounds, distension, visible peristaliss peritonitis: dim bowel sounds, involuntary guarding, rebound tenderness D. imaging, CBC, UA, metabolic panel, pregnancy test, STD test |
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Appendicitis
A. age range B. pathphysio C. sx |
A. 10-12 yo
B. lumen obstructed = distension/ischemia = T10 and periumbilical referred pain C. puriumbilica pain --> RLQ Mcburney's point, leukocytosis with PMN |
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Acute pancreatitis
A. pathophysio B. etiology C. sx |
A. premature activation of enzymes --> autodigestion of pancreatic cells --> edema and necrosis/hemorrhage
B. trauma, infxn (mumps, EBV, hiv, HepA/B) C. periumbilica/epigastric area radiating to back Gray-Turner sign (bluish color of flanks) Cllen sign (bluish color of periumbilical area) |
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Acute pancreatitis
A. dx B. tx C. complication |
A. elevated serum amylase, lipase
B. oral feeding restricted, TPN, abx, surgery to remove necrotic C. pseudocyst: collection of fluid rich in pancreatic enzymes that arsie form pancreatic tissue |
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Cholecystitis
A. def B. assoc dz C. etiology |
A. inflammation of gallbladder assoc with gallstone
acute acalculous cholecystitis = not gallstone related B. sickle cell dz, CF, prolonged TPN C. obstruction of cystic duct --> infxn, necrosis, perforation acalculous cholecystitis: salmonella, shigella, E. coli |
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Cholesystitis
A. sx B. dx C. tx |
A. RUQ PAIN, fever, vomiting, jaundice
murphy's sign (palpation of RUQ during inspiration = intense pain guarding B. cholescintingraphy C. cholecystectomy |
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Chronic abdominal pain
A. classify based on causes |
A. CAP = pain that occurs each month for > 3 months
1. Organic causes: constipation, peptic ulcer dz carb intolerance, inflammatory bowel dz, pancreatitis, parasitic infxn, genitourinary disorders (pyelonephritis, hydronephrosis), congential GI abnl (malrotation, hernia) 2. Nonorganic/functional in femals |
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Chronic abdominal pain
A. classify base don sx |
A. epigastric pain = nonulcer dyspepsia (bloating, nausea)
B. periumbilica pain: classic fxn abdominal pain that doesn't interfere pleasurable activities C. infraumbilical pain: alterations in stool = irritable bowel syn |
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Chornic abdominal pain
A. evaluation B. tx |
A. lab: CBC, electrolyes, liver panel, stool for occult blood, ESR
- screen for H. pylori - lactose breath H testing B. FAP: counseling |
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Constipation vs Encopresis
A. def B. epidemio |
A. consipation: red in defecation
encopresis: dev inapprop release of stool. assoc w/ severe constipation = liquid stool leaks around hard stool B. encoporesis for males |
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Constipation
A. etiology for functional and for organic C. dx |
A. functional fecal retention: inapprop constriction of external anal sphincter
- behavoir: voluntary withholding B. organic causes: Hirschsprung's dz C. organic cause if delayed meconium passage or before toilet training |
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Inflammatory Bowel disease
A. def B. epdiemio |
A. includes ulcerative colitis and Crohn's disease
B. onset is bimodal male perdominance in CD |
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Ulcerative colitis
A. characteristics B. classification C. complications |
A. begins in rectum and extends CONTGUOUS
inflamation is diffuse, limited to mucosa localized to color B. ulcerative proctitis (only rectum) pancolitis (entire colon) C. toxic megacolon: fever, abdominal distension, septic shock incr risk of colon cancer |
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Crohn's disease
A. characteristics B. sx C. complications |
A. segmental inflammation "skip lesions"
transmural inflammation --> fistulas, abscesses involve terminal ileum B. pain, amalabsorption, perianal dz C. acscesses, fistulas, strictures, adhesions |
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Inflammatory Bowel Disease
A. lab dx B. tx |
A. CBC (anemia, leukocytossi), ESR,
stool to rule out infectious enteropathies colonoscopy with biopsies B. sulfasalazine: mild dz (UC) corticosteroids: to acute exacerbation immnosup: longterm metronidazole: CD tx UC cured by total proctocolectomy CD surgery only if persistent bleeding |
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Gastrointestinal Bleeding
A. hematoemesis B. hematochezia C. melena D. why false pos/deg in occult bleeding |
A. vomiting blood (coffee ground)
B. bright red blood htrough rectum (lower GI source) C. dark, tarry stoools (proximal to ligament of Treitz) D. false + b/c high peroxidase content false - b/c vitamin C |
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Uper GI bleding
A. etiology B. tx |
A. swall maternal blood in newborns
gastritis/ulcers, H.pylori Mallory-Weiss tear, foreign body ingestion Varices (portal HTN) B. fluid bolus, stablization of hypovolemia/anemia octreotide vsoconstrict varices H2 blockers or PPI |
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Lower GI bleeding
A. etiology |
A. necrotizing enterocolitis: newborn w/ bleeding or distension
B. juvenile polyps: most common cause C. Hirschsprung's dz D. allergic colitis: sensitization to cow's milk E. infectious enterocolitis: salmonella, shigella, campylobacter, Yersinia, E, coli F. Meckel's diverticulum: outpouching of bowel in terminal iileum. pouch contains acid that can cause painelss acute rectal bleeding G. hemolytic uremic syndrome: vasculitits H. Henoch-Schonlein purpura: IgA-mediated vasculitis I. inflammatory bowel disease |
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Lab assessent of liver injury
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- Aspartate asminotransferase: sensitive but nonspeicifc marker b/c in skeletal, RBC, myocardium
- Alanine aminotransferase: specifc for liver - lactate dehydrogenase: nonspecific but marke rfor hepatocellular necrosis - biliary enzymes: alkaline phosphatase, GGTP, 5NT - bilirubin - protein production (albumin, prothrombin time) |
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Infant jaundice
A. cholestatic jaundice def B. marker for cholestasis C. which is more common: indirect or direct |
A. retention of bile within liver. occurs when direct bilirubin is >2mg/dl or >15%
B. direct hyperbilirubinemia C. indirect |
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Unconjugated hyperbilirubinemia
- differential dx |
A. inspissated bile syndrome: overloaded biliary system due to hemolysis or large hematom
B. UDP-glucuronyl transferse def (3 types) 1. gilbert's syndrome: 50% enzyme absent 2. Crigler-Najjar type 1: 100% enzyme absent 3. Crigler-Najjar type 2: 90% enzyme absent |
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Cholestatic diseases
A. def B. etiology |
A. retention of bile within liver with prolonged elveated direct bilirubin
B. infection (sepsis, hepatitis) metabolic derangement (CF) extrahepatic mech obsturtion (biliary atresia, bile duct stricture) intrahepatic mech obstruction: Alagille syn, paucity of intrahepatic bile ducts) idiopathic (neonatal hepatitis) alpha1-antitrpsin def TPN - assoc dz |
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Cholestatic dz
A. sx |
- jaundice
- light stools - dark urine - hepatomegaly - bleeding (b/c dim hepatic fxn) |
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Neonatal hepatitis
A. def B. sex C. sx d. tx |
A. idiopathic hepatic inflammation
B. male C. 1st week of life = jaundice, hepatomegaly D. falt-soluble ADEK, ursodeoxycholic acid (bile acid) to enhance bile flow but not used unitl biliary osbtruction is ruled out |
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Biliary atresia
A. def B. sx C. dx D. tx |
A. prog fibrosclerotic dz of biliary tree
B. dark urine, pale stools rapid progression of dz with bile duct obliteration and cirrhosis hepatosplenomegaly, steatorrhea, ascites C. intraoperative cholangiogram with lapartomy D. Kasai portoenterostomy (cholangitis is complication) |
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Alagille syndrome
A. def B. sx |
A. AD paucity of intrahepatic bile duct + multiorgan involvement
B. cholestatic liver disease unusal facial characteristics cardiac: pulmonary outflow obstruction, TOF renal, ees (posterior embryotoxon) pancreatic sinfu, hypercholesterlemia |
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Viral Hepatitis
A. pathophysio B. sx |
A. infxn (EBV, HIV, VZV) of hepatocytes, heptobiliary obstruction
B. malaise, RUQ abd pain, ascites, caput medusae, spider hemagiomas, clubbing |
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Hepatitis A. infxn
A. transmission B. sx C. dx |
A. fecal-oral
B. jaundice C. serology: IgM anti-HAV first 6 months IgG anti-HAV lifelong immunity |
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Hepatitis B infection
A. transmission B. sx |
A. perinatal vertical exposure, parenteral (blood, needles, IV drug)
B. acute sx: nonspecific, fulminant liver failure chronic: cirrhosis, heptaic fibrsis, portal HTN, incr risk for hepatocellular carcinoma |
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Hep B infxn
- serology - dx |
- HBsAg: active dz. in vaccine
- HBsAb: protective as result of vaccination or natural infxn - HBcAb: from natural infxn (not vaccination) - HBeAg: acute infxn - HBeAb: rises late in infxn - dx: PCR |
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Hep C infxn
A. transmission B. sx C. dx |
A. perinatal vertical , parenteral
B. chronic infxn: cirrhosis, hepatic fibrosis C. HCV PCR, serology |
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Hep D infxn
A. requirement |
A. need HBsAg for replication
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Hep E infection
A. transmission B. epidemio |
A. fecal-oral
B. pregnant women |
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Autoimmune hepatitis
A. classification B. epidemio C. sx |
A. type 1 dz: ANA or anti-smooth muscle antibody
type 2 dz: anti-liver kidney Ig or anti-liver Ig B. female pre-puberty C. fatigue, rash, nephritis, vasculitis |
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Autoimmune hepatitis
A. dx B. tx |
A. family history of autoimmune dz
elevated serum transaminases, hypergammaglobulinemia, autoantibodies B. corticosteroids, immunosup agens |
