Term
| camplobacter: incubation, duration, prak ages |
|
Definition
incubation: 1-10d (3-5)
duration: 7d
ages: 1yo, young adults |
|
|
Term
| camplobacter transmission (7) |
|
Definition
food
water
vertical
people
animals
eggs
chicken |
|
|
Term
| what type of diarrhea does camplobacter have |
|
Definition
moderate volume
watery
foul smlling
bloody
mucous
WBC |
|
|
Term
| does camplobacter have vomiting and fever |
|
Definition
vomiting: uncommon
fever: yes |
|
|
Term
| what symptoms in addition to vomiting, diarrhea, and fever does camplobacter have (4) |
|
Definition
headache
malaise
abdominal pain like appendicitis
toxic appearance |
|
|
Term
| what intestinal conditions can camplobacter cause (12) |
|
Definition
chronic diarrhea
travelers diarrhea
colitis/enterocolitis; ulcerative, nodular, pseudomembranous
GIbleed
acute abdomen: cholecystitis, pancreatitis, appendicitis, mesenteric lymphadenitis
IBS
toxic megacolon: colon dilates and lacks peristalsis |
|
|
Term
| what non intestinal conditions can camplobacter progress to (11) |
|
Definition
reiter's syndrome
septic arthritis
bacteremia
glomerulonephritis
carditis
reactive arthritis
meningitis
UTI
hemolytic uremic syndrome
gullian barre syndrome |
|
|
Term
| what is the treatment for camplobacter (2) |
|
Definition
hydration
antibiotic: macrolide (erythromycin) |
|
|
Term
| what are 5 places to check for dehydration |
|
Definition
| sunken eyes, skin turgor, oral mucosa, frontanells, tears |
|
|
Term
| what is the diarrhea in giardia like |
|
Definition
|
|
Term
| why is there diarrhea in giardia |
|
Definition
|
|
Term
| is there vomiting and fever in giardia |
|
Definition
|
|
Term
| other than vomiting, fever, and diarrhea what are the symptoms of giardia (5) |
|
Definition
weight loss
failure to thrive
anorexia
abdominal cramps
belching |
|
|
Term
| how is giardia diagnosed (6) |
|
Definition
stool specimen: motile protozoa
duodenal exam: enterotest capsule, intubation
biopsy: duodenum or jejunum
serology
CIE
ELISA |
|
|
Term
|
Definition
|
|
Term
| what is the diarrhea for pseudomembranous colitis like |
|
Definition
| watery at first them bloody |
|
|
Term
| does pseudomembranous colitis have fever and vomiting |
|
Definition
|
|
Term
| what are signs other than fever, vomiting, and diarrhea in pseudomembranous colitis (5) |
|
Definition
nausea
anorexia
abdominal pain and tenderness
toxic megacolon
perforation of the bowl |
|
|
Term
| how is pseudomembranous colitis diagnosed (4) |
|
Definition
previous antibiotic use
guiac positive stool (occult blood)
fecal leukocytes
conformation: C. diff toxin A or B positive test via PCR |
|
|
Term
| what is the treatment for pseudomembranous colitis (4) |
|
Definition
fluids and supportive care
DC antibiotic
isolation
metrnoidazole |
|
|
Term
| what do you never give to a kid with GI problems |
|
Definition
| anti-peristaltic (imodium) |
|
|
Term
| rotavirus: incubation, duration, ages |
|
Definition
incubation: 48-72 hours
duration: 5-7 days
ages: 5-24 mo |
|
|
Term
| rotavirus transmission (3) |
|
Definition
most in winter
fecal oral
respiratory |
|
|
Term
| what is rotavirus diarrhea like |
|
Definition
large amounts
watery
odorless |
|
|
Term
| is there vomitng or fever with rotavirus |
|
Definition
vomiting: yes
fever: low grade maybe |
|
|
Term
| other than diarrhea, vomiting, and fever what are the symptoms of rotavirus (4) |
|
Definition
pharyngeal redness
rhinitis
otitis media
rapid and severe isotonic dehydration |
|
|
Term
| what are the three complications of rotavirus |
|
Definition
intussecption
necrotizing enterocoltis
SIDS |
|
|
Term
| how is rotavirus diagnosed (2) |
|
Definition
|
|
Term
| what is the treatment for rotavirus |
|
Definition
there isnt
vaccine: 2mo, 4mo, 6mo |
|
|
Term
| salmonella: incubation, duration, location |
|
Definition
incubation: 8-72h
duration: 2-7d
SI and colon |
|
|
Term
| salmonella transmission (9) |
|
Definition
meat, poultry, dairy
summer
marijuana
flies, insects
people |
|
|
Term
| what type of diarrhea does salmonella have |
|
Definition
moderate volume
slimy
foul smelling
blood
mucous
WBC |
|
|
Term
| does salmonella have fever of vomiting |
|
Definition
|
|
Term
| other than diarrhea, fever, and vomiting what is another symptom of salmonella |
|
Definition
|
|
Term
| what abdominal conditions can salmonella cause (5) |
|
Definition
gasteoenteritis
eneric (typhoid) fever
bacteremia
local infection
chronic carrier |
|
|
Term
| what are 4 labs that can diagnosed salmonella |
|
Definition
elevated WBC
Guaiac positive
positive culture
PMN |
|
|
Term
| what is the treatment for salmonella |
|
Definition
IV antibiotic in kids <3mo (meningitis risk)
antibiotic in very sick, immune compormized, or malignancy |
|
|
Term
| shigella: incubation, duration, age, location |
|
Definition
incubation; 1-3d
duration: 3-7d
ages: <10, peak 2
primary and distal colon |
|
|
Term
| shigella type of diarrhea |
|
Definition
small amount
viscous
odorless
bloody
mucous
10-25 times a day
WBC |
|
|
Term
| does shigella have fever and vomiting |
|
Definition
vomiting is very rare
fever |
|
|
Term
| what symptoms other than vomiting, fever, and diarrhea does shigella have (4) |
|
Definition
toxic looking
abdominal cramps
bronchitis
malaise |
|
|
Term
| what are 13 complications of shigella |
|
Definition
dehydration
hyponatremia
bacteremia
sepsis
intestinal prolapse
hemolytic uremic syndrome
uti
pneumonia
eye involvement
senziue
reiter's syndrome |
|
|
Term
| what are 4 lab results to diagose shigella |
|
Definition
positive guaiaae
bandemia
positive culture
protein in stool |
|
|
Term
| what is the treatment for shigella |
|
Definition
|
|
Term
| what are 4 causes of viral gastroenteritis |
|
Definition
rotavirus
enteric adenovirus
norwalk virus
corona voris |
|
|
Term
| what is the diarrhea like in norwalk virus |
|
Definition
| watery, cruise ship virus |
|
|
Term
|
Definition
respiratory illnesS: sneeze, cough, fever
blood shot eyes, clear discharge, photphobia
koplick spots
rash |
|
|
Term
| what and where are koplick spots |
|
Definition
in measles
blush white spot with red halo on buccal and labial mucosa that fade with onset of rash |
|
|
Term
| describe the rash in measles |
|
Definition
maculopapular
cephalocaudal: face and behind ears downward for three days
involves palms and soles |
|
|
Term
|
Definition
|
|
Term
| 3 symptoms of rubella / german measles |
|
Definition
occipital and posterior cervical adenopathy
rash
forchheimer spots |
|
|
Term
| what are forchheimer spots |
|
Definition
| red palate lesions in rubella |
|
|
Term
| describe the rubella rash |
|
Definition
fine or descrete lesions
pink/red
maculopapular
begins at hairline and spreads cephalocaudal |
|
|
Term
| what are 5 symptoms of congenital rubella |
|
Definition
heart lesions
hepatosplenomeagly
blue berry muffin rash (diffuse petechial)
early jaundice
neurological/mental retardation |
|
|
Term
| describe the varicella rash |
|
Definition
macula > papular > vesicles > crusting
pleomorphic: lesions in different stages in clumps all over |
|
|
Term
| describe the shingles (herpes zoster) rash |
|
Definition
follows dermatome
grouped vesicles
very painful
thin walled vesicles
erythematous vesicle base |
|
|
Term
| what is the most common cause of traveler's diarrhea |
|
Definition
| enterotoxigenic E. coli (ETEC) |
|
|
Term
| what are respiratory signs of GERD (6) |
|
Definition
wheezing
asthma
pneumonia
aspiration
laryngospasm
apena |
|
|
Term
| what are esophagitis signs of gerd (9) |
|
Definition
irritability
colic
hiccups
anemia
hematesis
stricture
protein loosing enteropathy
melena
occlut blood loss |
|
|
Term
| what are the regurgitation signs of GERD (3) |
|
Definition
spitting
emesis
failure to thrive |
|
|
Term
| what are some non GI/respiratory signs of GERD (5) |
|
Definition
clubbing of digits
SidS
dystonic posturing
snedifer syndrome
seizure like episodes |
|
|
Term
| how is GERD evalulated (4) |
|
Definition
barium swallow and upper GI series
esophageal pH study
endoscopy
milk scintiscan |
|
|
Term
|
Definition
postural management
thickening of food
antacids
H2 agonists
prokinetics
fundoscoplication |
|
|
Term
| hypertric pyloric stenosis cause |
|
Definition
| muscle hypertrophies within first 3-4 weeks of life due to improperlly formed ganglion cells |
|
|
Term
| who gets pyloric stenosis |
|
Definition
mostly males
strong family history |
|
|
Term
| what are the signs of pyloric stenosis (7) |
|
Definition
gastric waves after earing
projectile vomiting
palpable mass (olive)
hypokalemia
hypochloremia
metabolic acidosis |
|
|
Term
| how is pyloric stenosis diangosed (2) |
|
Definition
dtring like pyloric channel on barium study
conformation: ultrasound/sonogram of pylorus |
|
|
Term
| how is pyloric stenosis treated |
|
Definition
pyloromyotomy
correct electrolytes first to avoid anasthesia complications |
|
|
Term
| what are the two types of constipation |
|
Definition
|
|
Term
| what are two common causes of functional constipation |
|
Definition
switched formula
holding poo |
|
|
Term
| who normally gets functional constipation |
|
Definition
|
|
Term
| why does holding poo cause constipation |
|
Definition
more time in rectum removes water making it hard and painful and then they hold more
stretch receptors get desensitized and increase time in rectum for future poo |
|
|
Term
| treatment for functional diarrhea (2) |
|
Definition
peristaltic stimulant
mineral oil (libricant) |
|
|
Term
| what causes orgaic constipation |
|
Definition
| hirschsprungs disease (anatomical abnormality since birth) |
|
|
Term
| why does hirschsprungs disease cause constipation |
|
Definition
| ganglion cells stop too soon so last 5 cm of rectum has no ganglion cells so it never relaxes after peristalsis |
|
|
Term
| 4 signs of hirschsprung's disease |
|
Definition
hard poo
baby cries
belly distended
always constipated |
|
|
Term
| how is hirschsprungs diagnosed (3) |
|
Definition
barium enema
analrectal manometer
rectal suction biopsy |
|
|
Term
| what does a barium enema show in hirschsprungs |
|
Definition
| large colon with narrowing (rat tail) |
|
|
Term
| how does a analrectal manometer work, how is hirschsprungs diagnosed from it |
|
Definition
two balloons inserted and air is put into proximal and the pressure should drop in distal
in hirschsprungs pressure does not drop in distal because there is no receptive relaxation |
|
|
Term
| what is the diagnostic test for hirschsprungs |
|
Definition
| rectal suction biopsy has no ganglion cells |
|
|
Term
| how is hirschsprungs treated |
|
Definition
| divergent colospony and pull through |
|
|
Term
| what are 6 general questions or observations to see if a kid isnt faking abdominal pain |
|
Definition
weight loss
noctournal pain
emesis
regular school attendance
easy going kid
stable home |
|
|
Term
| what are three physical exam findings that say kid isnt faking abdominal pain |
|
Definition
clubbing
perianal skin tags
abdominal masses |
|
|
Term
| what are 5 lab findings that say kid isnt faking abdominal pain |
|
Definition
decreased albumin or lipase
increased ESR or anemia
occult blood in stool |
|
|
Term
| what are 4 cases of upper GI hemorrhage |
|
Definition
esophageal varices
gastric ulcers
gastritis
duodenal ulcer |
|
|
Term
| what are 7 causes of lower GI hemorrhage |
|
Definition
colonic polyps
anal fissure
intussecuption
mekel's diverticulum
ulcerative colitis
regional enteritis
hemorrhoids |
|
|
Term
|
Definition
| juvenile, benign, inflammatory polyps |
|
|
Term
| what causes anal fissure, what are two signs |
|
Definition
due to long term constipation
bleeding after pooping
rectal bleeding |
|
|
Term
|
Definition
|
|
Term
| what are two inflammatory bowel diseases |
|
Definition
ulcerative colitis
chrons disease |
|
|
Term
| define ulcerative colitis |
|
Definition
mucosal inflammation of the colon
contigous disease (one area, no skips) |
|
|
Term
|
Definition
inflammation of any part of GI tract
transmural inflammation (mucosa, submucosa, adventitia)
skip lesions (not confined to one area) |
|
|
Term
| what is the hallmark of ulcerative colitis |
|
Definition
|
|
Term
| what is the hallmark of chrons disease |
|
Definition
|
|
Term
| what are 5 signs of ulcerative collitis |
|
Definition
abdominal mass
clubbing
mucopurulent discharge
pseudopolyps
chronic: loss of mucosal folds |
|
|
Term
| what is a complication of ulcerative colitis |
|
Definition
|
|
Term
| what are 7 signs of chrons disease |
|
Definition
rectal bleeding
rectal inflammation
terminal ileum inflammation
fistula
stricture
malabsorption and growth failure
clubbing |
|
|
Term
| why does chrons disease have strictures and not ulcerative colitis |
|
Definition
| chrons has transmural inflammation leading to segmental narrowing |
|
|
Term
|
Definition
| thickening and loss of angle of nail bed |
|
|
Term
|
Definition
| congenital jaundice due to hypoplaia of bile ducts |
|
|
Term
| 4 signsle of alagile syndrome |
|
Definition
butterfly vertebrae (vertebral arch defect)
mild pulmonic stenosis
triangular faces
jaundice |
|
|
Term
| how dow you get celiac disease |
|
Definition
inherited genetic susceptability where DQ2 and or DQ8 are needed (but not alone)
triggered by enivornmental trigger (gluten) |
|
|
Term
| how does celiac disease cause problems |
|
Definition
autoimmine
autoantigens (transglutaminase) |
|
|
Term
| what is the disease with the highest prevlience of celiac disease |
|
Definition
|
|
Term
| name 11 diseases associated with celiac disease |
|
Definition
type 1 diabetes
down syndrome
turner syndrome
hashimotos syndrome
selective IgA deficiency
arthritis
autoimmune liver disease
sjogerns syndrome
idiopathic dilated cardiomyopathy
IgA nephrophathy |
|
|
Term
| what is a high indicator you have celiac disease |
|
Definition
| first degree relative with celiac disease |
|
|
Term
| when do gastrointestnal symptoms of celiac disease appear, why |
|
Definition
6-24 months
there isnt gluten in the diet befoe that |
|
|
Term
| what are 12 gastrointestinal symptoms of celiac disease |
|
Definition
diarrhea
vomiting
costipation
ABDOMINAL DISTENSION
abdominal pain
loss of subuctaneous fat (buttox)
FAILURE TO THRIVE
WEIGHT LOSS
MALNUTRITION
DEHYDRATION
irritability
celiac crisis - rare |
|
|
Term
| when do non-GI symptoms appear in celiac disease |
|
Definition
| older children and adults |
|
|
Term
| what are the non-gi symptoms of celiac disease (7) |
|
Definition
dermatitis herpetiformis
dental enamel hypoplasia
osteopenia/osteoperosis
short stature
delayed puberty/menarche
Fe deficient anemia resistant to oral Fe
asymptomatic, silent, or latent |
|
|
Term
| describe a dermatitis herpetiformis rash (5) |
|
Definition
macule > uticarial papule > tense vesicles
severe puritis
gluten sensitive
symmetric
does not usually occur with GI symptoms |
|
|
Term
| why is recognizing dental enamel hypoplasia in celiac disease important |
|
Definition
| sometimes the only presenting sign |
|
|
Term
| why do people with celiac disease get osteoperosis |
|
Definition
| low mineral density from poo absorption |
|
|
Term
| what precent of short kids have cealiac disease |
|
Definition
|
|
Term
| who normally gets Fe deficient anemia with celiac disease |
|
Definition
|
|
Term
| what are 4 rare non-gi symptoms that can occur with celiac disease |
|
Definition
| hepatitis, arthritis, epilepsy, occipital calcifications |
|
|
Term
| what are the clinical signs of celiac disease in a type 1 diabetic (4) |
|
Definition
patient is often asymptomatic
noctournal hypoglycemia
seizures
TTG may be false positive
gluten free diet is a challenge |
|
|
Term
| what is the chance of developing an autoimmue disease with celiac disease |
|
Definition
<2 years gluten exposure 5%
2-10 years 17%
>10 years 24% |
|
|
Term
| how is celiac disease diagnosed |
|
Definition
| seromarkers on blood tests |
|
|
Term
| who should always be checked for celiac disease (5) |
|
Definition
diabetics
hashimotos thyroiditis
down syndrome
turner syndrome
IgA deficiency |
|
|
Term
| what is the most common non-GI symptom of celiac disease in adults |
|
Definition
| Fe deficient anemia resistant to Fe supplementation |
|
|
Term
| what are 12 complications of celiac disease |
|
Definition
autoimmune disease
short stature
dermatitis herpatiformis
recurrent stomatitis
malabsorption
occipital calcifications causing epilepsy
infertility
refractory celiac disease
dental enamel hypoplasia
gluten ataxia
INTESTINAL LYMPHOMA
LACTOSE INTOLERENCE |
|
|
Term
| when do we see lactose intolerance with celiac disease |
|
Definition
| when diagnosis is delayed |
|
|
Term
| what special considerations must be taken for someone with lactose intolerence and celiac disease |
|
Definition
| increased Ca supplementation |
|
|
Term
| what are the three criteria for celiac disease |
|
Definition
enivornmental trigger: wheat, rye, barly
genetic predisposition: HLA DQ2 or DQ8
autoimmune disease: anti-tissue transglutaminase (autoantigen) |
|
|
Term
| what is gluten composed of, what part is a problem in celiac disease |
|
Definition
gliadin - problem
glutenin - alcohol insulable |
|
|
Term
| what is the species of plant making gluten |
|
Definition
| graminease festucoidae hordeae |
|
|
Term
| what are some viral triggers of celiac disease, why can they trigger it |
|
Definition
homologous with glidin
adenovirus 12, 7
RUBELLA
herpes |
|
|
Term
| what are some parasite triggers of celiac disease, why can they trigger it |
|
Definition
homologous with glidin
plasmodium yoelli |
|
|
Term
| what are 5 immune products or cells celiac disease increases |
|
Definition
IL-2
INFy
IL-15
IEL (CD8)
gamma delta T cell |
|
|
Term
| what antibodies are associated with celiac disease (4) |
|
Definition
anti-tissue transglutaminase
auto-gliadin
anti-actin
anti-endomysial |
|
|
Term
| what does transglutaminase do |
|
Definition
| gut enzyme released in injury that spabilizes proteins in granulation tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| component of reticulin CT around smooth muscle |
|
|
Term
| what are 4 changes in the mucosa in celiac disease |
|
Definition
loss of epithelial cells
proliferation of crypt epithelial cells
malabsorption of Fe, folate, Ca, vit D
increased permeability to toxins |
|
|
Term
| what are the 5 ways to diagnose celiac disasse |
|
Definition
trial gluten removal
serology for antibodies
endoscopy
SI histology / biopsy
HLA typing |
|
|
Term
| why would you do serology testing for celiac disease (4) |
|
Definition
identify need for biopsy
screen at risk people
supportive evidence for diagnosis
monitor dietary compliance |
|
|
Term
| what are the three antibody tests for celiac disease |
|
Definition
anti-glyden
anti-endomyceal
anti-tissue transglutaminase |
|
|
Term
| what are the pluses and minuses of anti-glyden antibody testing |
|
Definition
increases suspicion for celiac disease, cheap
poor sensitivity and specificity |
|
|
Term
| what are the pluses and minuses of anti-endomyceal antibody testine |
|
Definition
more specific and sensitive than anti-glyden
false negative in young kids and IgA deficiency, time consuming, expensive, operator dependent |
|
|
Term
| what are the pluses and minuses of anti-tissue transglutaminase testing |
|
Definition
very sensitive and specific, not operator depdent, cheap
false negative in IgA deficiency |
|
|
Term
| which is more specific and why: anti-endomyceal or anti-tissue transglutaminase testing |
|
Definition
| ANTI-ENDOMYCEAL BECAUSE IT CAN DETECT CELIAC IN IGA DEFICIENT PATIENT |
|
|
Term
| what test must you always get in suspected celiac disease |
|
Definition
| ANTI-TISSUE TRANSGLUTAMINASE ANTIBODY SEROLOGY |
|
|
Term
| what are two signs on endoscopy of celiac disease |
|
Definition
|
|
Term
| what must always be done before treatment of celiac disease |
|
Definition
|
|
Term
| what are 8 signs of celiac disease on SI biopsy |
|
Definition
increased ILE (CD8)
loss of polarity
change columnar to cuboidal
laminal propria of cellular infiltrate
crypt elongation
crypt hyperplasia
increased mitotic index
progressive villous flattening |
|
|
Term
| what is the hallmark SI sign of celiac disease |
|
Definition
| TOTAL ARTOPHY OF THE VILLI |
|
|
Term
| what is the main treatment for celiac disease |
|
Definition
| strict gluten free diet for life (wheat, rye, barley) |
|
|
Term
| what is the prognosis of celiac disease |
|
Definition
| total resolution with complete diet adherence |
|
|
Term
| what happens if someone with celiac disease dosent follow the diet |
|
Definition
complications
morbidity
mortality |
|
|
Term
| what nutrients are low as a result of gluten free diet (13) |
|
Definition
Fe
Folate
B12
Vit ADEK
thiamine
niacin
B6
B-carotene
Zinc
essential FA |
|
|
Term
| what are three required nutritional supplements for celiac disease diet and why |
|
Definition
folate: increased absorption in brush border, apoptosis, cell division
Ca and Vit D: bone and mineral density, osteoperosis |
|
|
Term
| what nutrients are low in someone with celiac disease that are bad for pregnancy (8) |
|
Definition
Fe
zinc
folate
B12
protein
Vit K
B6
E |
|
|
Term
| what is the hardest part of celiac disease |
|
Definition
| GETTING COMPLIANCE TO THE DIET |
|
|
Term
| what are ovbious sources of gluten |
|
Definition
bread
bagel
cake
cereal
cookies
pasta
pastries
rolls |
|
|
Term
| what are potential sources of gluten |
|
Definition
wafers
candy
cured pork
drink mixes
gravy
immitation meat
sauce
soy |
|
|
Term
| what are rare potential sources of gluten |
|
Definition
seasonings
MALT FLAVORING
hop extract destrin
caramel color |
|
|
Term
| what are some gluten free options |
|
Definition
amaranth
arrowroot
buckwheat
corn
flax
millet
montina
OATS IF NOT CONTAMINATED
potatoes
wuinoa
rice
sorgum
topica
teff
flour of nuts and beans and seeds
starch
malodextrin
vinegar and alcohol (AVOID MALT) |
|
|
Term
|
Definition
| emesis of bright red (large bleed) or coffee ground vomit |
|
|
Term
|
Definition
|
|
Term
| what are 3 suprious causes of GI bleeding |
|
Definition
food: jello, kool aid, tomato, beet, cranberries
amoxicillin
nasopharyngeal source |
|
|
Term
| how can you determine if a bleed is a true bleed (3) |
|
Definition
NG tube and gastric lavage
gastro-occult
hemoccult |
|
|
Term
| how does a NG tuve and gastric lavage work |
|
Definition
| put NG tuve into stomach, wash it out, and aspirate to see if there is a bleed |
|
|
Term
| how does a hemoccult work |
|
Definition
sees if there is blood in the stool to determine presence of a bleed
testing abilities are limited in emesis |
|
|
Term
| what is the best way to determine location of a bleed, why |
|
Definition
endoscopy
old contrast radiology method does not identify mucosal bleeds |
|
|
Term
| define mallory weiss tear |
|
Definition
| spontaneous tear at gastro-esophageal junction after forced emesis |
|
|
Term
| how does a parent normally explain the symptoms of a mallory weiss tear |
|
Definition
| the vomiting was initially normal yellow and now is full of blood |
|
|
Term
| what are three locations of a mallory weiss tear and their frequencies |
|
Definition
usually extend into gastric side causing most bleeding
20% extend into esophagus
20% have multiple tears |
|
|
Term
| how is a mallory weiss tear treated (3) |
|
Definition
self limited in kids
anti-emetics
stomach decompression |
|
|
Term
| what are three ways to treat a mallory weiss tear if no other methods work |
|
Definition
electrocoagulation
surgery
fel foam embolization of lt gastric artery |
|
|
Term
| what are two other ways to say GERD |
|
Definition
reflux esophagitis
acid reflux |
|
|
Term
|
Definition
|
|
Term
| what are two complications or associations with GERD |
|
Definition
progression to major hemorrhage
hiatial hernia |
|
|
Term
| what is the major acid barrier to GERD |
|
Definition
|
|
Term
|
Definition
| 3-4 CM long smooth muscle with intrinsic and extrinsic pressure and tonic contraction |
|
|
Term
| what causes the extrinsic pressure on the LES (4) |
|
Definition
crus of diaphragm
intra abdominal location
integrity of phreno-esophageal ligament
maintience of acute angle of His |
|
|
Term
| what mechanism causes GERD |
|
Definition
| decrease in LES pressure allows acid into esophagus |
|
|
Term
| what are 4 foods that decreases LES pressure |
|
Definition
| fat, chocolate, ethanol, peppermint |
|
|
Term
| what are 6 GI signalers that decrease LES |
|
Definition
secretin
CCK
glucagon
somatostatin
GIP
VIP |
|
|
Term
| what are 4 hormones or neurotransmitters that decrease LES |
|
Definition
progesterone
prostaglandins
serotonin
dopamine |
|
|
Term
| what are 3 drugs that decrease LES |
|
Definition
morphine
diazepam
barbituates |
|
|
Term
| if stimulated (or antagonized) what receptors would decrease LES (3) |
|
Definition
a antagonist
B agonist
cholinergic antagonist |
|
|
Term
| if stimulated (or antagonized) what receptors would increase LES (3) |
|
Definition
a agonist
B antagonist
cholinergic agonist |
|
|
Term
|
Definition
|
|
Term
| what drugs increase LES (4) |
|
Definition
antacids
metoclopramide
domperidone
cisapride |
|
|
Term
| what substances naturally made in the body increase LES 95) |
|
Definition
gastrin
motilin
substance P
prostaglandin
histamine |
|
|
Term
| why is GERD worse at night (5) |
|
Definition
during sleep there is less LES tone
you are layind down so gravity isnt helping
you are at rest and digest mode
dry swallow stops so peristalsis pushing acid down stops
less saliva production so less alkaline buffer |
|
|
Term
| what are the symptoms of GERD dependent on |
|
Definition
| extent of esophageal and mucosal injury |
|
|
Term
| what two things can increase GERD symptoms |
|
Definition
acid reflux
potency of refluxate |
|
|
Term
| what are 5 complications of GERD |
|
Definition
erosive esophagitis
sentineal fold
barrett's esophagus
reflux stricture
hiatial hernia |
|
|
Term
| what is barrett's esophagus, how is it identified |
|
Definition
pre-cancerous metaplasia of lower esophageal mucosa with tongue like projections
has goblet and columnar cells (abnormal) |
|
|
Term
| how is GERD diagnosed, what are the first two and last two steps |
|
Definition
barium swallow first
esophageal pH studies second
endoscopy
manometry |
|
|
Term
| what is the treatment for GERD (5) |
|
Definition
antacids
H2 receptor antagonist
protein pump inhibitor
pro-kinetic agent
carafate |
|
|
Term
| define erosive gastropathy |
|
Definition
| subepithelial hemorrhage or erosion |
|
|
Term
| what is erosive gastropathy associated with |
|
Definition
|
|
Term
| what are 5 causes of erosive gastropathy |
|
Definition
NSAIDS
stress; burns, sepsis
prophylactic acid supression in ICU
alcohol
H. pylori |
|
|
Term
| how can you tell if someone has NSAID erosive gastropathytis |
|
Definition
| flea bitten appearance on endoscopy |
|
|
Term
| how can you tell if someone has H. pylori erosive gastropathy (4) |
|
Definition
pink nodules
prominent gastric rugae
shows on gemisa stain
gram negative pleonprphhic comma shaped rods in lumen |
|
|
Term
| how is erosive gastropathy diagnosed |
|
Definition
|
|
Term
| how is erosive gastropathy treated (6) |
|
Definition
pin point etiology
anti-helobacter
acid supression: antacid, H2 receptor antagonist, proton pump inhibitor
rare: volume expanders, electrocoagulation |
|
|
Term
| whais a esophageal varices or portal gastropathy |
|
Definition
|
|
Term
| what causes esophageal varices (2) |
|
Definition
chronic liver disease
cystic fibrosis |
|
|
Term
| what are 4 signs of esophageal varices |
|
Definition
splenomeagly
acetes
abnormal LFT
portal gastropathy looks red with spider webs on endoscopy |
|
|
Term
| how is esophageal varices treaed (7) |
|
Definition
volume resuscitation: prompt
vasopressin
somatostatin
TIPS
surgical porto caval shunt
liver transplant
viscereal scleropathy |
|
|
Term
| what is visceral scleropathy |
|
Definition
| injecting sclerosing agent to induce fibrosis to stop bleeding |
|
|
Term
| gastric and duodenal ulcers: who gets it, what are two causes |
|
Definition
rare in childhood
H. pylori, hypergastrinemia |
|
|
Term
| how are gastric and duodenal ulcers treated (6) |
|
Definition
stop bleed: thermocoagulation, epinepherine
acid supression: proton pump inhibitor, H2 receptor antagonist
carafate: promote healing
anti-helobacter |
|
|
Term
|
Definition
| local collection of puss that becomes painful, warm, and tender |
|
|
Term
| what are the aerobic causes of abscess (5), what is the prevelence |
|
Definition
50% aerobic
S. aureus 25%
GAS, strep, enterobacter, E. coli |
|
|
Term
| what are the anaerobic causes of abscess (2), what is the prevelence |
|
Definition
25% anaerobic
bacteroides, fusobacterium |
|
|
Term
| what is the prevelence of a mixed, aerobic and anaerobic, abscess |
|
Definition
|
|
Term
| what are the common causes of a perirectal abscess(4) and their prevelences |
|
Definition
85% anaerobes
35% S. aureus
E. coli, strep |
|
|
Term
| what are the ddx of abscess, why |
|
Definition
cellulitis: can progress to abscess
cyst: infected cyst is like an abscess |
|
|
Term
| what is lymphangitis, how can it be identified, what are the concerns |
|
Definition
streaks showing infection moving through the lymph vessels
can get into blood and cause bacteremia and systemic infection |
|
|
Term
| what is the treatment for abscesses (3) |
|
Definition
| antibiotics, incision, drainage |
|
|
Term
|
Definition
| painful, hot, swollen node |
|
|
Term
| what do you do if you suspect adenitis (4) |
|
Definition
look for source of the infection
if fluxcuant do aspiration
if purulent drain node
ultrasound may help determine |
|
|
Term
|
Definition
| abscess caused by chewing on hangnail |
|
|
Term
| what are the overall most common, cervical, axillary, inguinal, and systemic causes of adenitis |
|
Definition
overall tops: S. aureus, GAS
cervical: TB, influenza
Axillary: cat scratch, sporotrichosis
inguinal: anaerobes, enteric, plague
systemic: mono, toxoplasmosis, CMV, kawasaki, syphilis |
|
|
Term
| what are the two types of adenitis |
|
Definition
lymphadenitis
mycobacterium adenitis |
|
|
Term
| what are the 4 signs of lymphadenitis |
|
Definition
erythema
thin skin
fluctuance on palpation
central necrosis |
|
|
Term
| what are the 4 signs of mycobacterium adenitis |
|
Definition
gradual node enlargement
little warmpth and iflammation
thick, discolored, tense, adherent skin |
|
|
Term
| what is the treatment for adenitis (3) |
|
Definition
antibiotic trial
aspiration
drainage if fluctuant |
|
|
Term
| what do you do if the antibiotics for adenitis dont work |
|
Definition
| reactive adenitis would have resolved so consider persistant adenitis caused by Tb, cat scratch, mono, or malignancy |
|
|
Term
| what are the signs of bacteremia |
|
Definition
|
|
Term
| what do you do if you suspect bacteremia in a kid under 2 mo |
|
Definition
|
|
Term
| what do you do if you suspect bacteremia in a kid over 2 mo |
|
Definition
|
|
Term
| what are 5 causes of bacteremia and their prevelence |
|
Definition
S. pneumoniae (90%)
influenza (10%)
salmonella, E. coli, S. aureus |
|
|
Term
| what are the parts to a bacteremia work up (5) |
|
Definition
urinalysis
urine culture (males <6mo, females <2yo)
CXR
stool culture
blood culture with temp >39C |
|
|
Term
| what do you add to a bacteremia work up to make it a sepsis work up (3) |
|
Definition
urine culture at any age
spinal tap
CBC |
|
|
Term
| what is the qualification for a fever of unknown origin |
|
Definition
fever >100.4 at least twice a week for 3 weeks
at least one week of patient investigation without physical exam findings |
|
|
Term
| what is the initial work up for fever of unknown origiin (6) |
|
Definition
history and physical
CBC
urinalysis and culture
CXR
TB test
ANA titer (autoimmune testing, in older kids) |
|
|
Term
| what is the work up in a return vision for fever of unknown origin (10) |
|
Definition
CBC repeat
ESR
urinalysis and culture repeat
EBV screen
CXR review
blood culture
anti-streptolysin O
HIV antibody
Hep C antibody
twice daily temp recordings |
|
|
Term
| what is the initial work up for admitted fever of unknown origin (6) |
|
Definition
LP (if antibiotics were unsuccessful or it is an infant)
blood culture repeat
sinus radiographs
opthalmic exam for iridocyclitis
liver enzyme test
multiple serologies |
|
|
Term
| what serologies might you do for an admitted fever of unknown origin patient (9) |
|
Definition
CMV
toxoplasmosis
Hep A, B, C
tulaermia
brucellisis
leptospirosis
salmonellosis |
|
|
Term
| what is the work up for a inpatient fever of unknown origin after the first work up (7) |
|
Definition
abdominal ultrasound
abdominal CT
gallium or indium scan
upper GI x-ray (older kid)
marrow test (if CBC abnormal)
techenium bone scan |
|
|
Term
| what is the most common pediatric infection |
|
Definition
|
|
Term
| why is otitis media more common in kids (4) |
|
Definition
eustachian tube is more horizontal and shorter because the cranium isnt completely developed
immune system isnt fully developed
they sick on thinks causing negative pressure
feeding supine allows entry of food near the eustachian tube |
|
|
Term
| what are the 3 layers of the TM |
|
Definition
external epithelium
middle CT layer
inner respiratory ciliated epithelium |
|
|
Term
| contents of the middle ear and the boundries |
|
Definition
ossicles
anterior: eustachian tube opening
lateral: TM
medial: connection to middle ear, nerves
posterior: opening to mastoid
superior: petrous bone
inferior: base of skull |
|
|
Term
| what are the signs of a ear infection (4) |
|
Definition
| painful, fever, minor head cold, fussy |
|
|
Term
| why is an ear infection painful |
|
Definition
| many nerve cells in the TM so when it stretches it causes lots of pain |
|
|
Term
| what are the signs in the TM of an ear infection |
|
Definition
increased vasculature in pars flaxita that leats to erythemia
opaque
rirst retraction then bulging
reduced light reflex
landmarks obscured
mobility reduced due to fluid |
|
|
Term
| bullous otitis media: aka, define, 4 sings |
|
Definition
myringitis
Ear infection due to unusual pathogen of childhood
Inflammation of epithelial layers causes excruciating pain
Bullous bleb blister like lesion obscures much of TM
Can rupture all three TM layers due to increased pressure spontaneously causing relief from pain and release of purelent goo |
|
|
Term
| two common causes of bullous otitis media |
|
Definition
|
|
Term
| most common cause of otitis media in non-immunized older kids |
|
Definition
|
|
Term
| most ocmmon cause of otitis media in immunized younger kids |
|
Definition
|
|
Term
| 5 causes of otitis media common to least |
|
Definition
strep pneumo 32%
non-pathogen (virus, allergies) 25%
influenza
moraxella, GAS |
|
|
Term
| 5 complications of otitis media |
|
Definition
fibrosis
conductive hearing loss
mastoiditis which can lead to meningitis or brain abscess |
|
|
Term
| main antibiotic used to treat otitis media |
|
Definition
amoxicillin
TMP/SMX back up |
|
|
Term
| how do you determine to give antibiotics for otitis media |
|
Definition
<6 mo give antibiotic
2mo – 2yo use judgment
2yo + wait 48 hours and give decongestant and anti-inflammatory first
If child looks sick use judgment at any age |
|
|
Term
| 7 steps of otitis media treatment |
|
Definition
1. antibiotics
2. If symptomatic 48 hours later change antibiotic
3. At 3 weeks if there is still effusion recheck in 3 weeks
4. At 6 weeks if there is still effusion change antibiotics
5. At 9 weeks if there is still effusion do tympanogram aor audiological testing. Add prednisone and give antibiotic with B-lactaminase resistance for 21 days
6. At 12 weeks if there is still effusion diagnose chronic otitis media, do tympanogram and audiological tests, refer to EENT
7. Tympanoscopy tubes: vent middle ear, improve hearing, reduce infection for patients with chronic otitis media |
|
|
Term
| what is the most comon cause of abscess |
|
Definition
| aerobic causes especially S. aureus |
|
|
Term
| what is the most common cause of lymphadenitis in axillary region |
|
Definition
|
|
Term
| what is the most common cause of general lymphadenitis |
|
Definition
|
|
Term
| what are the two most common causes of bacteremia |
|
Definition
S. pneumonia 90%
influenza 10% |
|
|
Term
| what is the most common cause of ear infection |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 5 signs of acute sinusitis |
|
Definition
cough
nasal discharge
fever
facial pain
prolonged URI |
|
|
Term
|
Definition
strep pneumo
influenza
moraxella |
|
|
Term
| 5 complications of sinusitis |
|
Definition
cavernous sinus thrombosis
periorbital cellulitis
meningitis
maxillary osteomyelitis
brain abscess |
|
|
Term
| main cause of croup, 4 others |
|
Definition
parainfluenza
influenza, RSV, adenovirus, pertussis |
|
|
Term
|
Definition
|
|
Term
| what is the most common cause of upper airway obstruction in kids |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are 2 signs of croup |
|
Definition
strier at rest
critical airway obstruction possible - epiglottis stenosis |
|
|
Term
| what is the at home tx for croup (3) |
|
Definition
humidity
anti-pyretics
observation |
|
|
Term
| what is the hospital tx for croup (4) |
|
Definition
humidity
recemic epinepherine
O2
deaxmethazone via intubation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| main cause of broncholitis, 2 more |
|
Definition
main is RSV
adenovirus, parainfluenza |
|
|
Term
|
Definition
high TT
subcostal movement
wheeze |
|
|
Term
| 1 complication of broncholitis |
|
Definition
|
|
Term
|
Definition
bronchodilator B2 agonist (albuterol)
oxygen as needed |
|
|
Term
| 11 reasons to use ribivirin for RSV |
|
Definition
complicated congenital heart disease
congenital abnormalities
premature baby
under 6wks
bronchopulmonary displasia
cystic fibrosis
on ventilator
immune deficient
transplant patient
cancer patient
severly ill patient |
|
|
Term
|
Definition
2% of infants <1yo
4% of children 1-5yo |
|
|
Term
|
Definition
| inflammation and infection of alveola and pleura |
|
|
Term
|
Definition
chest pain on cough
wet cough
crackles |
|
|
Term
| when do you admit pneumonia patient (8) |
|
Definition
hypoxia, accessory muscle use, effusion
<3mo, <3yo with lobar, <5yo with multiple lobar
chronic diseasse
progression during treatment |
|
|
Term
| what are chronic diseases that you should admit the patient if you suspect pneumonia (8) |
|
Definition
CF
malignancy
anemia
diabetes
cardiac
pulmonary
renal
immune disorder |
|
|
Term
| what is the diagnostic test for pneumonia |
|
Definition
CXR confirms
can be treated off of clinical signs too (crackles) |
|
|
Term
| how is pneumonia treated in a pt <3mo, <20 wk, >5yo, 10-20yo |
|
Definition
<3mo: IV ampicillin, cephtriaxone
<20wks: add erythromycin (to cover chalmydia)
>5yo: amoxicillin, IV amoxicillin and cephtriaxone if serious
10-20: add macrolide (erythromycin) to cover mycoplasm walking pneumonia |
|
|
Term
|
Definition
girls are at higher risk
uncurcumsized boys
kids are at greater risk |
|
|
Term
| what is the general concept of the cause of UTI |
|
Definition
| inadequate wash oout and increased adherence of bacteria |
|
|
Term
| what are 9 risk factors for uti |
|
Definition
urothelial deficiency
hydronephrosis
obstruction
nephrolithiasis
vesicoureteral reflux
catheter or foreign body
non-retractable foreskin
fecal incontinence
poor hygiene |
|
|
Term
| what is the number one and 2 cause of uti |
|
Definition
|
|
Term
| what is the number 1 cause of uti in boys, why |
|
Definition
| poteus seen in 30% of boys under foreskin |
|
|
Term
| what is a common cause of uti in aldolecence |
|
Definition
|
|
Term
| what are 3 uncommon causes of uti |
|
Definition
pseudomonas
enterococcus
staph aureus |
|
|
Term
|
Definition
cystitis
foul smelling urine
fever
chills
accidents after potty training |
|
|
Term
|
Definition
| dysuria (pain), frequency, enuresis |
|
|
Term
| what is a complication of uti |
|
Definition
| develop renal scaring if they get more than 1 uti |
|
|
Term
| how is urine collected for a uti sample |
|
Definition
| pee in cup unless 2mo - 2yo then use suprapubic collection |
|
|
Term
| what do you need to remember when culturing for UTI |
|
Definition
| get repeat sample so asymptomati bacteriria can be detected |
|
|
Term
| what is tested for from a urine sample (7) |
|
Definition
WBC
leukocyte esterase
nitrite
bacteria
WBC casts
serum CRP |
|
|
Term
| how many WBC is too much in urine |
|
Definition
|
|
Term
| why might someone have a uti and not have nitrite |
|
Definition
| urine isnt concentrated enough, bacteria isnt the kind that makes it (like pseudomonas) |
|
|
Term
| how much bacteria is diagnostic for uti |
|
Definition
>50,000 CFU/mL to confirm
any bacteria in a urine aspiration |
|
|
Term
| what do casts in urine indicate |
|
Definition
if WBC: uti or pyelonephritis
PMN or tamm horsfall are ok becase they prevent bacterial adherence |
|
|
Term
| why do we check serum CRP in uti check |
|
Definition
| it can be increased in pyelonephritis |
|
|
Term
| first antibiotic for uti, 3 runner ups, how long is the perscription |
|
Definition
tmp/smx
amoxicillin, sulfisoxazole, cephalosporins
7-12d |
|
|
Term
| what group needs a different antibiotic redigmen for uti, why |
|
Definition
infants <60 days old
need to cover enterococci and liseria |
|
|
Term
| what is the concern with uti antibiotic tx |
|
Definition
| elimination of bacteria with low virulence can cause overgrowth and more agressive strains |
|
|
Term
| how do you treat someone long term uti with vesicureteral reflux |
|
Definition
if they do surgery do prophylaxis until resolution of the problem
if they dont do prophylaxis until 10 yo or until resolution |
|
|
Term
| how do you treat chronic uti in someone without vesicureteral reflux |
|
Definition
look into other GI problems
if you find something continue prophylaxis for 1year
if you dont continue for 6mo |
|
|
Term
| what GI problems can cause chronic uti without vesicureteral reflux (4) |
|
Definition
obstructive uropathy
neurigenic bladder
ureter duplication
calculi |
|
|
Term
| 5 signs of pyelonephritis |
|
Definition
high fever
flank pain
vomiting
elevated WBC and ESR |
|
|
Term
|
Definition
| cephalosporins (cephtriazone) |
|
|
Term
| what can cause uti symptoms without bacteria (11) |
|
Definition
Urethritis, vulvovaginitis, balanitis, pinworm
Metal irritation, topical irritants (soap, loation), vaginal foreign body
medication, emotional stress, trauma (sexual), daytime frequency syndrome |
|
|
Term
|
Definition
|
|
Term
| what can cause pyuria without bacteria |
|
Definition
• Urine with puss
• Febrile systemic illness
• Concentrated urine
• Catheter or instrument irritation
• Inflammation
• Calculi
• Glomerulonephritis
• Interstitial nephritis
• Nonbacterial infection: candidia, Mycobacterium TB, ureaplasma |
|
|
Term
| describe the 5 grades of vesicuoreteral reflux |
|
Definition
• Grade 1: cystourethrogram shows reflux only into ureter
• Grade 2: complete reflux into ureter, pelvis and calyces
• Grade 3: complete reflux and mild dilation of ureter and renal pelvis, only slight calyces
• Grade 4: reflux with moderate dilation of all parts, oblideration of sharp angle fornices
• Grade 5: dilation of all parts and oblideration of papillary impressions of calyces |
|
|
