Uab Pediatric Gi

Front 1

Plain xray findings with appendicitis

Back 1

"sentinel loop" and absence of air in RLQ

Front 2

presentation of acute mesenteric lymphadenitis

Back 2

acute abdomen, but less toxic appearing than appendicitis

Front 3

mechanism of NSAID induced dyspepsia/peptic ulcer disease

Back 3

inhibits cyclooxygenase (enzyme that is essential for prostaglandin synthesis)

Front 4

Definition of Recurrent/Chronic Abdominal Pain

Back 4

3 or more episodes of abdominal pain over greater than 3 months, severe enough to interrupt normal activity

Front 5

Classic parasite that causes abdominal pain

Back 5

Giardia lamblia

Front 6

Symptoms of Giardia infection

Back 6

Several weeks of intermittent watery diarrhea, abdominal distention, anorexia. Afebrile.

Front 7

Historical clues that suggest Giardia infection

Back 7

Drinking bad water on a camping trip, or a child attending daycare

Front 8

Consequences of untreated Giardia infection

Back 8

Persistent diarrhea with malabsorption

Front 9

Diagnostic test for Giardia

Back 9

String test (ELISA).

(O&P: poor sensitivity (only ~50%); ideally would need to test 3 samples.)

Front 10

Treatment for Giardia

Back 10

Flagyl x 7 days, OR nitazoxanide x 3 days

Front 11

Where does watery diarrhea come from?

Back 11

Small intesting; typically high volume but not bloody.

Front 12

Testing for a patient with watery diarrhea

Back 12

No specific tests needed; exceptions: suspicion of C. difficile or cholera

Front 13

Optimal mixture of oral rehydration solution

Back 13

2% glucose and 90mEq NaCl

Front 14

Stool test most indicitave of bacterial diarrhea

Back 14

Neutrophils

Front 15

What do you use to find WBCs in stool?

Back 15

methylene blue

Front 16

4 most common causes of viral diarrhea

Back 16

NARC: Norwalk virus, Adenovirus, Rotavirus, Coronavirus

Front 17

Enteropathogenic E. coli causes what?

Back 17

acute and chronic diarrhea (nonbloody), commonly with fever and vomiting, in neonates and young children (especially in areas with poor sanitation)

Front 18

Enterotoxigenic E. coli causes what?

Back 18

self limited severe diarrhea and cramping - TRAVELER'S DIARRHEA; infantile diarrhea in 3rd world countries (comes from contaminated food and water)

Think entero-TACO-genic

Front 19

Prophylaxis for traveler's diarrhea

Back 19

Not typically indicated, but if asked: bismuth subsalicylate or an antibiotic such as Bactrim

Front 20

Enterohemorrhagic E. coli causes what?

Back 20

diarrhea, HUS (Shiga toxin); food, water, and person-to-person spread

Front 21

Enteroinvasive diarrhea causes what?

Back 21

Similar picture to shigella: fever, stools with blood and mucous, tenesmus; contaminated food

Front 22

Classic description of bacterial diarrhea

Back 22

High fever, small frequent stools, mucous or blood

Front 23

Classic presentation of salmonella diarrhea

Back 23

Green, malodorous stools (NOT bloody) 2 days after a picnic (transmitted by contaminated food)

Front 24

Which can present in a newborn: Salmonella or Shigella?

Back 24

Salmonella

Front 25

Symptoms of typhoid fever

Back 25

Fever, headache, abdominal pain, muscle aches, rose spots

Front 26

Treatment of typhoid fever

Back 26

Ceftriaxone/cefotaxime (only if <1 year or increased risk of systemic illness, such as colitis or immunocompromised) -- typically not recommended because they do not shorten clinical course and can extend the carrier state

Front 27

Classic presentation of shigella diarrhea

Back 27

several days after ingestion: watery diarrhea, fever; bloody diarrhea appears after fever subsides; increased bands on CBC regardless of actual WBC count

Front 28

Treatment of shigella diarrhea

Back 28

Bactrim

Front 29

Transmission method of Shigella

Back 29

person to person (VERY contagious; if no sick contacts, it's not Shigella!)

Front 30

Which can be found in asymptomatic carriers: Salmonella or Shigella?

Back 30

Salmonella

Front 31

What infectious diarrhea can present with similar picture to Shigella?

Back 31

Campylobacter

Front 32

Treatment for Campylobacter diarrhea

Back 32

erythromycin or azithromycin

Front 33

Risk factors for C. diff colitis

Back 33

Recent antibiotic use; repeated enemas; prolonged NG tube placement

Front 34

Treatment for asymptomatic 5 month old with positive C. diff in stool?

Back 34

Treatment not indicated in children younger than 6 months, unless symptomatic.

Front 35

Infection with Yersinia can present with clinical picture similar to:

Back 35

Appendicitis

Front 36

Treatment for Yersinia

Back 36

When limited to GI tract: benign and self-limited; no treatment required.

Front 37

Screening tests for malabsorption of sugars

Back 37

1. Clinitest (tests for reducing substances = all dietary sugars except sucrose); presence of reducing substances correlates with sugar malabsorption

2. Hydrogen Breath Test (normal gut "ferments" sugar --> hydrogen produced --> excreted in lungs); positive test correlates with sugar malabsorption

Front 38

Screening tests for malabsorption of fat

Back 38

1. Fecal fat measurement (requires 3 day stool collection)

2. Serum carotene and PT (indirect tests; correlate with vitamin A and vitamin K absorption)

Front 39

Screening tests for malabsorption of protein

Back 39

Albumin level, total protein

Front 40

Which 2 malabsorptions (sugars, fat, protein) typically occur together?

Back 40

fat and protein

Front 41

Definition of chronic diarrhea

Back 41

Diarrhea beyond 2 weeks that cannot be attributed to an acute gastroenteritis; nutrition and growth are affected

Front 42

What tumor can cause diarrhea and why?

Back 42

neuroblastoma -- produces vasoactive intestinal peptides

Front 43

Normal time course for transient lactase deficiency to resolve

Back 43

3-6 months

Front 44

Protozoan parasite that can cause chronic diarrhea in immunocompetent child

Back 44

Cryptosporidium (especially child in day care); severe cases can result in malabsorption

Front 45

Most common cause of chronic diarrhea in children up to age 3

Back 45

Toddler's diarrhea

Front 46

Classic description of toddler's diarrhea (chronic nonspecific diarrhea)

Back 46

Formed stool in the morning which become progressively looser as the day progresses; growth and development are normal, no fever or melena

Front 47

Treatment of toddler's diarrhea

Back 47

Limit carbs, increase fat and fiber intake, remove cold foods and liquids that stimulate colonic activity

Front 48

Chronic diarrhea following acute gastroenteritis

Back 48

Malnutrition from treatment with high osmolar solutions -- frequent passing of loose green stools ("starvation stools")

Front 49

What is abetalipoproteinemia?

Back 49

rare autosomal recessive disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food. It is caused by a deficiency of apolipoprotein B-48 and B-100, which are used in the synthesis and exportation of chylomicrons and VLDL respectively

(from Wikipedia)

Front 50

Symptoms of abetalipoproteinemia

Back 50

steatorrhea, acanthocytosis (RBCs with spiney projections -- like a porcupine), retinal damage, neurological sequelae

Front 51

Predisposing factors to protracted diarrhea

Back 51

Malnutrition
Chronic infection
Systemic disease
Immunodeficiency

Front 52

What is intestinal lymphangiectasia?

Back 52

a protein losing enteropathy that results in hypoproteinemia, hypogammaglobulinemia, steatorrhea, lymphedema, lymphopenia

Front 53

Causes of neonatal vomiting associated with polyhydramnios

Back 53

antral web, annular pancreas

Front 54

Imaging studies with a radiolucent filling defect in the prepyloric region

Back 54

antral web

Front 55

Elevated indirect bili can occur in what cause of neonatal vomiting?

Back 55

pyloric stenosis (in up to 2.5%)

Front 56

Diagnostic criteria for pyloric stenosis on ultrasound

Back 56

pyloric length greater than 14mm, or pyloric muscle thickness greater than 4mm

Front 57

Air in distal small bowel excludes what 2 causes of neonatal vomiting?

Back 57

duodenal atresia and annulal pancreas

Front 58

Term neonate with bilious vomiting, abdominal tenderness, abdominal distention, possibly passing blood per rectum

Back 58

Malrotation

(NEC is similar, but less common in term infant)

Front 59

Neonate with bilious vomiting and right sided abdominal distention

Back 59

Volvulus

(Ladd bands constrict large and small bowel)

Front 60

Xray findings with volvulus

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gastric and duodenal dilatation, decreased intestinal air, corkscrew appearance of the duodenum

Front 61

GI med to avoid during fundoplication surgery

Back 61

omeprazole (especially in patients with neurological impairment)

Front 62

Mechanism of action of ondansetron

Back 62

serotonin receptor antagonist

Front 63

Pharmacologic treatment for cyclic vomiting

Back 63

cyproheptadine, propranolol, TCA's (similar to migraine treatment)

Front 64

Forceful vomiting, weight loss, dysphagia, FTT

Back 64

achalasia

Front 65

Some sx of achalasia plus abdominal pain and distension

Back 65

gastric outlet obstruction

Front 66

Cyst on the floor of the mouth: "mucocele" vs. "midline mass"

Back 66

Mucocele = ranula (tx with excision); midline mass could be ectopic thyroid (so don't remove it!)

Front 67

parotid swelling, dry mouth, poor tear production

Back 67

Mikulicz's disease

Front 68

Bacterial cause of parotitis

Back 68

staph aureus (more marked tenderness, higher fever than with mumps)

Front 69

Underdeveloped or absent teeth, absent sweat glands

Back 69

Ectodermal hypoplasia; x-linked; diagnosed by skin biopsy

Front 70

Earliest sign of portal hypertension is _______ followed by _________

Back 70

earliest sign: splenomegaly; follwed by ascites, prominent abdominal veins, esophageal or gastric varices

Front 71

Copious oral secretions, polyhydramnios, coughing and cyanosis with initial feeding

Back 71

TE fistula

Front 72

Treatment for NSAID induced ulcers

Back 72

H2 blocker

Front 73

Causes of solid food dysphagia

Back 73

Reflux esophagitis (possibly with esophageal stricture) or eosinophilic esophagitis

Front 74

EGD findings of eosinophilic esophagitis vs. GERD

Back 74

eosinophilic esophagitis: inflammation of entire esophagus with increased eosinophils on biopsy; GERD: ulceration/injury limited to distal 5cm of esophagus

Front 75

Best diagnostic test for H. pylori

Back 75

EGD for biopsy

Front 76

Treatment for H. pylori

Back 76

"triple" therapy: PPI plus 2 antibiotics (amox + Flagyl OR amox + clarithromycin) x 14 days

Front 77

Serologic testing positive for H. Pylori. Next step?

Back 77

Serology has high sensitivity but lots of false positives, so must confirm with another study (fecal antigen or Urea breath test)

Front 78

Zollinger-Ellison Syndrome

Back 78

gastrin-secreting tumor; sx similar to peptic ulcer disease; diagnose by obtaining fasting gastrin levels

Front 79

Bulky, pale, frothy and foul smelling stools; proximal muscle wasting; abdominal distention

Back 79

Celiac disease

Front 80

Dietary management of celiac disease

Back 80

Avoid gluten (wheat, rye); some patients can tolerate oatmeal. Vitamin supplements.

Front 81

Diagnose celiac disease by...

Back 81

upper endoscopy, duodenal biopsy

Front 82

Causes of rectal prolapse

Back 82

CF; things that cause increased intraabdominal pressure (pertussis, tenesmus, chronic constipation); rare causes: meningomyelocele, parasites

Front 83

Causes of malabsorption

Back 83

CF, celiac disease, cow milk and soy allergies

Front 84

"Ground glass" on abdominal film

Back 84

meconium plug syndrome (rule out CF)

Front 85

Extra teeth, premalignant polyps in large and small intestines, osteomas

Back 85

Gardner's syndrome

Front 86

mucosal pigmentation of lips and gums

Back 86

Peutz-Jeghers Syndrome

Front 87

Extraintestinal manifestations of Crohn's disease

Back 87

Pyoderma gangrenosum of the food; erythema nodosum; ankylosing spondylitis/sacroiliitis; arthritis; uveitis (eyes); liver disease; renal stones

Front 88

Chronic cramp and abdominal pain, fever; pain not quite as severe as intussusception

Back 88

Campylobacter jejuni diarrhea or Yersinia (crampy severe periumbilical pain)

Front 89

Child around age 2, afebrile, symptoms mimicking sepsis, no GI symptoms

Back 89

Intussusception (afebrile child who looks toxic)

Front 90

If a child older than 6 gets intussusception, must rule out:

Back 90

Lymphosarcoma (could be "lead point" causing the intussusception)

Front 91

GI abnormalities associated with Trisomy 21

Back 91

duodenal atresia, Hirschsprung's disease

Front 92

Infant with bilious vomiting, poor PO intake and abdominal distention

Back 92

Hirschsprung's disease

Front 93

Infant who strains to pass small liquid stools; remits by age 1

Back 93

Anal stenosis

Front 94

"First thing" to distinguis upper from lower GI bleeding

Back 94

nasogastric lavage

Front 95

Test to determine if GI blood is infant's or mother's

Back 95

Apt test

Front 96

Top 3 differential diagnoses for lower GI bleed in newborns

Back 96

Hirschsprung's disease (with associated colitis), malrotation with associated volvulus (melena), NEC

Front 97

Most common cause of lower GI bleed in 1-2 years old

Back 97

Anal fissure; usually secondary to constipation

Front 98

Top 4 differential diagnoses for preschool (2-5 years old) with lower GI bleed

Back 98

Juvenile polyp; entamoeba histolytica (bloody diarrhea in child from Indian reservation or rural area of south, central, SW US); meckel diverticulum; juvenile polyposis (usually in a child that is older)

Front 99

Labs to differentiate cholestatic jaundice from hepatocellular caused jaundice

Back 99

Cholestatic disease: very high alk phos; hepatocellular disease: very high AST/ALT

Front 100

Enzyme deficiency in Gilbert syndrome

Back 100

Glucuronyl transferase deficiency

Front 101

Lab abnormalities in Reye's syndrome

Back 101

Elevated LFTs and ammonia

Front 102

Most specific test to diagnose pancreatitis

Back 102

Abdominal ultrasound (NOT amylase) -- lipase more specific than amylase

Front 103

Most common genetic causes of recurrent pancreatitis

Back 103

CF, hereditary pancreatitis

Front 104

Conditions that predispose to cholecystitis

Back 104

Hemolytic disease, prolonged TPN, small intestinal disease, obesity, pregnancy

Front 105

Differences in presentation of cholecystitis vs. cholelithiasis

Back 105

Both: dx by ultrasound; abdominanl pain, N/V; cholecystitis: shoulder pain, lethargy; cholelithiasis: hepatosplenomegaly, icterus

Front 106

Best diagnostic test for Hepatitis A

Back 106

IgM-specific antibody

Front 107

Presence of HBsAg (Hepatitis B surface antigen)

Back 107

Acute or chronic (>= 6 months) infection

Front 108

Presence of Anti-HBsAg

Back 108

Previous infection or positive response to immunization

Front 109

Presence of HBeAg

Back 109

High rate of replication --> high rate of infectivity

Front 110

Presence of HBcAg

Back 110

Indicates past infection (IgM to HBcAg --> recent infection (past 6 months))

Front 111

HBV-DNA

Back 111

Sensitive marker indicating viral replication

Front 112

"Window" period with HepB infection

Back 112

Disappearance of surface antigen but before appearance of antibody to surface antigen; but, should have presence of antibody to core antigen (anti-HBcAg)

Front 113

Required for Hepatitis D

Back 113

presence of HBsAg (provides outer coat of HepD)