Peds Recall: Gi

Front 1

What is short gut syndrome?

Back 1

Diarrhea from nutrient malabsoprtion and excessive intestinal fluid b/c of massive small intestine loss (volvulus, atresia, nec entercolitis) or resection

Front 2

Ddx for GI bleed in 2 year old.

Back 2

1. meckles
2. intussusseption
3. gastroenteritis
4. Henoch Schoenline purpura
5. HUS
6. cdiff
7. polyps

Front 3

What percentage of salmonella infection of stomach and small bowel have bacteremia?

Back 3

1-5%

Front 4

During what months are bacterial gastroenteritis bugs more prevalent?

Back 4

summer months

Front 5

What blood profile is seen with shigella?

Back 5

Bands(left shift), with normal white count usually. Whereas salmonella has leukocytosis.

Front 6

How does intussusseption present?

Back 6

bloody "currant jelly" stools, bilious emesis, colicky abdomen, tubular shaped mass on abdo exam

Front 7

How does hemolytic uremic syndrome present?

Back 7

thrombocytopenia, anemia, nephopathy. sometimes petechiae, often high blood pressure that must be monitored

Front 8

Shigella or salmonella: which is commonly treated with abx?

Back 8

Shigella. Salmonella is treated under three months.

Front 9

What is the ddx of abdo pain beyond infancy?

Back 9

1. appendicitis
2. enterocolitis
3. cholecystitis
4. constipation
5. dka
6. ectopic
7. gastroenteritis
8. HUS
9. henoch schoenline
10. hepatitis
11. ibd
12. mittelscherz
13. nephrolithiasis
14. ovarian cyst
15. pancreatitis
16. PID
17. pneumonia
18. sickle crisis
19. strep pharyngitis
20. UTI

Front 10

What is lifetime risk of appendicitis? What time of life is most common?

Back 10

6-20%, with peak incidence in adolescence.

Front 11

Why is appendicitis urgent?

Back 11

Risk of perforation is 65% if don't get treated within 48 hours.

Front 12

What is Xray appearance of appendicitis?

Back 12

1. loss of psoas shadow
2. appendicolith in half of cases
3. dilated bowel
4. scoliosis towards right

Front 13

What is most common strep throat symptom after fever, throat/swallowing pain?

Back 13

GI sx, like vomiting and abdominal pain

Front 14

What is relationship if vomiting to pain in appendicitis?

Back 14

Emesis follows pain.

Front 15

What tissues does EBV infect?

Back 15

Oropharyngeal tissues AND, later, B lymphocytes.

Front 16

What is incubation of EBV?

Back 16

30-50 days

Front 17

What is difference b/w adult and child EBV infection?

Back 17

Small kids often asx. Can also find otitis, abdo pain, hepatomegaly, rash.

Also: cannot rely as much on monospot test, which is unreliable under 5 yo. Can instead doe viral capsid antigen testing.

Front 18

Complications of EBV:

Back 18

1. splenic rupture
2. neurologic sequelae (guillan barre, bell palsy, seizures, neuritis, myelitis)

Front 19

What is the most common nematode infection in USA?

Back 19

Enterobius (pinworm). Generally just cause noctural itching, but can get cellulitis secondarily. Do scotch tape test b/c stoll test for ova and parasites often comes back negative.

Front 20

What is treatment for round worms?

Back 20

Albendazole, mebendazole, pyrantel pamoate for pinworm, ivermectin for strongyloides.

Front 21

Which roundworm can cause rectal prolapse?

Back 21

Trichuris (whipworm). Mostly in SE USA.

Front 22

Which roundworm causes autoinfection?

Back 22

Strongyloides, which becomes a real problem in the immunocompromised who can get massive invasion of organs with superimposed sepsis.

Front 23

What kind of gallstone is most common in children?

Back 23

Cholesterol (not pigment, not mixed type) due to an imbalance in lecithin, bile salts, and cholesterol in bile.

Front 24

What are risk factors for gallstones?

Back 24

1. prematurity
2. ileal resection
3. CF
4. TPN or prolonged fasting

Front 25

What labs are useful in gallstones?

Back 25

1. bilirubin (elevated in almost all cases)
2. alk phos (elevated with common bile duct obstr)
3. liver enzymes (elevated with cholestasis)
4. GGT (elevated with common bile duct obstr)
5. serum amylase (elevated with assoc pancreatitis or common bile duct obstr)

Front 26

What are causes of hepatitis?

Back 26

1. hepatitis viruses (ABCDE)
2. non hepatitis viruses (EBV, VCV, CMV, adeno, rota, entero, rubella, flu)
3. trauma
4. metabolic dz (alpha1antitrypsin)
5. Reye syndrome
6. vasc obstruction
7. chemical tox

Front 27

What is biliary atresia? When does it present?

Back 27

Abnormality of intrahepatic or extrahepatic bile ducts, or both. Assoc with polysplenia, intestinal malformation, cong heart dz.

Usually caused after birth, at 4-8 weeks, see increasing jaundice. Reovirus/CMV connection is possible, with inflamm causing damage, but generally unknown etiology.

Front 28

What is the most common cause of abdominal pain in school aged children?

Back 28

Functional abdominal pain.

Front 29

Abdominal pain in children is almost always ________.

Back 29

Benign

Front 30

What tests help you make diagnosis of IBD?

Back 30

1. Colonscopy
2. perhaps barium enema
3. upper GI study

Front 31

What is first line treatment for crohn's disease?

Back 31

1. mesalamine
2. prednisone, budesonide, antibiotics, immunomodulators (6MP) and infliximab are second line

Front 32

What percentage of Crohn's patients have family members with IBD?

Back 32

30%

Front 33

What type of TE fistula present late in infancy?

Back 33

H type, where esophagus and trachea both lead to the correct place, but have a connection between the two. Presents with recurrent aspiration later in life, not cyanosis in the newborn as the others do. H types account for 3% of all TE fistulas.

Front 34

What is the emergency with TE fistula?

Back 34

Cannot tolerate oral secretions; will aspirate.

Front 35

What is currant jelly stool?

Back 35

LATE finding associated with intussusception.

Venous stasis causes blood to enter the intestines, and ischemia leads to mucus drainage. Looks like red jelly.

Front 36

What is the classic age for intussusception?

Back 36

3 months to 6 years, most by 2 years

Front 37

When does intussusception happen? What causes it?

Back 37

Spring and autumn. Likely something viral, but unproven.

Also caused be edema of HSP, hypertrophied Peyer patch, enlarged lymph nodes, Meckel's, polyp, lymphoma, or tumor (most common in adults).

Front 38

What is the treatment for intussusception?

Back 38

Contrast enema (usually air). If that fails, surgery.

Front 39

What is outcome for intussusception?

Back 39

Lethal, usually, if not treated. Up to 80% reduce with enema, in which case mortality is good. 5% recurrence after enema.

Front 40

What drug causes infantile hypertrophic pyloric stenosis?

Back 40

Erythromycin

Front 41

What is feared complication of HSP?

Back 41

Intussusception occurring in HSP is usually ileo-ileal, not ileo-colic, and will not be detected by air or barium enema. Diagnosis requires abdominal ultrasound, and treatment is surgical.

Front 42

What is the recurrence rate of HSP?

Back 42

30%

Front 43

Tx for Hep C

Back 43

Interferon and ribavirin

Front 44

Direct to indirect bilirubin percentage of what indicates direct bilirubinemia?

Back 44

20% or more

Front 45

Which teeth come in first?

Back 45

Central incisions (mandib then maxiallary), then canines (mandib then maxillary), then molars