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CMN 56 8 Unit 4 Test With
Complete Solution
When does malrotation occur? - ANSWER at about the 10th week of gestation
What is a malrotation? - ANSWER a congenital abnormality that occurs during the embryonic phase of development when the midgut retracts into the abdominal cavity. The midgut rotates counterclockwise
When do infants typically become symptomatic with a malrotation? - ANSWER at 3 weeks of life
What is the classic sign of a malrotation? - ANSWER bilious vomitting
How is a malrotation diagnosed? - ANSWER upper GI study
What are some radiologic findings that are indicative of a malrotation? - ANSWER corkscrew appearance with barium swallow; Signs of obstruction (air-fluid levels) may be present, along with an abnormal gas pattern at the stomach and duodenum.
What is pyloric stenosis? - ANSWER results from hypertrophy of the pyloric sphincter (muscle in the distal stomach), which leads to poor gastric emptying into the duodenum.
When does pyloric stenosis usually present? - ANSWER At 2-4 weeks of age
What are the symptoms of pyloric stenosis? - ANSWER vomiting that becomes projectile; typically occurs immediately after feeding, is nonbilious, and the infant is hungry after vomiting. The parents may also report
constipation, excessive crying and weight loss, or failure to gain weight
What can delay symptoms of pyloric stenosis? - ANSWER breastfeeding
What is pyloric stenosis usually mistaken for? - ANSWER reflux or formula intolerance
What is the hallmark finding of pyloric stenosis? - ANSWER an olive-shaped mass in RUQ
What are typical lab and radiologic findings of a baby with pyloric stenosis? - ANSWER hypochloremia, metabolic alkalosis, Hypokalemia. KUB imaging reveals a dilated gastric silhouette. An ultrasound typically reveals a thickened and elongated pylorus, measuring greater than 4 mm.
What is intussusception? - ANSWER involves the invagination of a section of the intestine into itself. The most frequent site is at the terminal ileum.
What is often a predisposing factor of intussusception? - ANSWER A recent viral illness, mesenteric lymphadenitis, Henoch-Schonlein purpura, and cystic fibrosis
What is the typical age of onset of idiopathic intussusception? - ANSWER 6 to 18 months, with an average age of 7 to 8 months
If intussusception occurs beyond 36 mths, it is typically due to a physical abnormality such as? - ANSWER meckel's diverticulum or polyps
Is intussusception more common in girls or boys? - ANSWER boys
What is the classic presentation of intussusception? - ANSWER colicky abdominal pain, recent viral illness with some vomiting and perhaps diarrhea. The child begins to have episodes of colicky abdominal pain, draws up the knees or stiffens the legs for a brief period, and then becomes quiet for
down
What findings would be indicative of an appendix rupture? - ANSWER peritoneal signs: decreased bowel sounds, a distended abdomen, and tenderness and guarding in all quadrants with palpation and percussion
What should you order if you suspect appendicitis, and what should you initiate? - ANSWER CBC, electrolytes, and a u/a. Aggressive IV hydration.
What difference is seen in the cbc of a child with appendicitis vs. a ruptured appendix? - ANSWER mildly elevated white blood count (WBC) with a left shift vs. a white count is often markedly elevated, with a left shift and an increased band count
What can often mimic appendicitis? - ANSWER ovarian torsion
The menstruating child will often be midcycle with an ovarian torsion? T/F - ANSWER T
What should you order if you suspect an ovarian torsion? - ANSWER A CT or U/S and surgery consult
What reflex will be absent in a testicular torsion? - ANSWER cremasteric
reflex
Any male child that presents with abdominal pain - ANSWER
A child who present to the ED with testicular pain requires what? - ANSWER u/a and u/s
If the manual reduction of an incarcerated inguinal hernia is unsuccessful and there is blood in the stool upon rectal exam, or if the hernia has been incarcerated for more than 12 hours, what should you do? - ANSWER order surgical consult
What are 2 serious causes of hematochezia? - ANSWER meckel's diverticulum and intussusception
The patient with Meckel's diverticulum often has no abdominal pain but may become profoundly __________? - ANSWER anemic
What labs should be ordered in a pt. with suspected meckel's diverticulum? - ANSWER H/H and type and crossmatch
What is the most useful method of detecting Meckel's diverticulum? - ANSWER technetium-99m pertechnetate scanning
In children, what is more accurate that the glidian IgA when testing for celiac? - ANSWER glidian IgG
In patients with severe protein deficiency, what is necessary to test for celiac disease? - ANSWER biopsy
What should a patient with positive serology and normal biopsies have done if celiac disease is suspected? - ANSWER be put on a gluten free diet trial
A person who tests neg. for serology and biopsy, but responds clinically to a gluten free diet may have what? - ANSWER gluten sensitivity
Epigastric pain or burning, early satiety, or post-prandial fullness are s/s of what? - ANSWER dyspepsia
What diagnostic procedure is warranted in patients with alarm features or in those older than 55? - ANSWER endoscopy
In patients without alarm features,<55 y/o, and s/s of dyspepsia, what should first be done? - ANSWER Testing for H. Pylori and a 4 week trial of PPI
What is the most common cause of chronic dyspepsia? - ANSWER functional dyspepsia
What is the typical profile of functional dyspepsia? - ANSWER younger, report a variety of abdominal and extraGI complaints, show signs of anxiety or depression, or has a hx. of psychotropic medication use
In patients older than 55 with c/o symptoms associated with dyspepsia, what lab tests should initially be done? - ANSWER CBC, electrolytes, liver enzymes, calcium, and thyroid tests, urea breath test (or other noninvasive tests for H. Pylori)
In most clinical settings, a test for what should initially be done in patients with c/o of dyspepsia? - ANSWER H. Pylori
What are 3 noninvasive tests for H. Pylori? - ANSWER urea breath test, fecal antigen, and IgG serology
What are "alarm features"? - ANSWER weight loss, dysphagia, recurrent vomiting, evidence of bleeding, or anemia
What is the study of choice to diagnose gastroduodenal ulcers, erosive esophagitis, or upper GI malignancies? - ANSWER upper endoscopy
what is warranted when symptoms of dyspepsia fail to respond to initial
obstruction, gastroparesis, intestinal dysmotility, psychogenic disorders, or CNS or systemic disorders
Vomiting that occurs in the morning suggests what? - ANSWER pregnancy, uremia, alcohol intake, and Increased ICP
What diagnostic tool is best used to determine the cause of gastric outlet obstruction? - ANSWER upper endoscopy
What diagnostic tool is best used to determine small intestinal obstruction? - ANSWER CT
A colonic transit time of what is considered significantly abnormal? - ANSWER 72 hours
What are "alarm" s/s of constipation? - ANSWER hematochezia, weight loss, anemia, or + occult blood tests
How is tx of constipation with laxatives usually initiated? - ANSWER with osmotic laxatives
Who should magnesium containing laxatives NOT be given to? - ANSWER patients with chronic renal insufficiency
What is the onset of action of osmotic agents? - ANSWER 24 hours
What is the onset of action of stimulant laxatives? - ANSWER orally 6- hours; rectally 15-60 min.
What medication is approved for the treatment of opioid induced constipation? - ANSWER methylnaltrexone
Diarrhea of less than 2 weeks duration is most commonly caused by what? - ANSWER invasive or noninvasive pathogens and their enterotoxins
What characteristics are associated with acute noninflammatory diarrhea? - ANSWER watery, nonbloody stools
Diagnostic evaluation is limited to patients with acute noninflammatory diarrhea that what? - ANSWER is severe or persists beyond 7 days
what characteristics are associated with acute inflammatory diarrhea? - ANSWER blood or pus and fever
what routine diagnostic evaluations are recommended in all patients
What med is used for empiric tx. of noninflammatory traveler's diarrhea? - ANSWER Rifazimin
How long should diarrhea persist to be considered as chronic diarrhea? - ANSWER longer than 4 weeks
What is the most common cause of chronic diarrhea in young adults? - ANSWER IBS
What stool appearance is indicative of a malabsorption disorder? - ANSWER greasy or malodorous
What stool appearance is indicative of an inflammatory disorder? - ANSWER containing blood or pus
What tests are recommended in the evaluation of most patients with chronic diarrhea and all patients with signs of malabsorption? - ANSWER serologic testing for celiac sprue with tTG test
What are the most common s/s of an acute upper GI bleed? - ANSWER hematemesis (bright red blood or coffee ground appearance) & melena (black tarry feces)
What is used to determine the severity of blood loss with an acute upper GI bleed? What is a poor early indicator of blood loss? - ANSWER volume status; hct
What is the initial step in the evaluation and tx. of an acute upper GI bleed? - ANSWER assessment of the hemodynamic status
What are the clinical predictors of increased risk of bleeding and death from an acute GI bleed? - ANSWER > 60 y/o, comorbidities, systolic bp < 100, HR
100, and bright red blood in ng aspirite or on rectal exam
What is the most common symptom of lower GI bleed? - ANSWER hematochezia
What is the main symptom of GERD, and what exacerbates it? - ANSWER heartburn; meals, bending, or recumbency 30-60 minutes after meals
Patients with typical symptoms of heartburn and regurgitation should be tx with what? - ANSWER PPI for 4-8 weeks
What condition occurs in which the squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet cells and
What is the name of the disorder in which food or environmental anitgens are thought to stimulate an inflammatory response? - ANSWER eosinophilic esophagitis
Most children with eosinophilic esophagitis have other coexisting _______________ ____________ - ANSWER atopic disorders
What does esophageal varices develop secondary to? - ANSWER portal htn
What condition is found in 50% of people with cirrhosis? - ANSWER esophageal varices
How is dx of esophageal varices established? - ANSWER by upper endoscopy
What is the most common cause of portal htn? - ANSWER cirrhosis
What is used to reduce the incidence of rebleeding in patients with esophageal varices? - ANSWER beta blockers and band ligation
What is achalasia? - ANSWER an idiopathic motility disorder characterized by loss of peristalsis in the smooth muscle
What are s/s of achalasia? - ANSWER gradual, progressive dysphagia for solids and liquids, regurgitation of undigested food
What may be seen on a barium esophagram in a patient with achalasia? - ANSWER "bird's beak" in the distal esophagus
What confirms the dx of achalasia? - ANSWER esophageal manometry
Who is gastropathy most commonly seen in? - ANSWER alcoholic or critically ill patients, or pts taking NSAIDs
Prior to testing for H. Pylori, what should be discontinued? - ANSWER PPIs for 7-14 days and abx for atleast 28 days
At what agesdoes duodenal ulcers most commonly occur? - ANSWER 30-
At what age does gastric ulcers most commonly occur? - ANSWER 55-
What are the 2 major causes of peptic ulcer disease? - ANSWER NSAIDS and chronic H pylori infection
What is the diagnostic procedure of choice in most patients with PUD? -
ANSWER urea breath test, fecal antigen test, or endoscopy with biopsy 4 weeks after completion of abx treatment and 1-2 weeks after PPI tx.
What is the most common cause of ulcer nonhealing? - ANSWER noncompliance
What is mandatory after 2-3 months of therapy in all nonhealed ulcers to look for malignancy or infection? - ANSWER repeat ulcer biopsy
What is the most sensitive and specific method for identifying Zollinger-Ellison syndrome? - ANSWER demonstration of an increased fasting serum gastrin concentration
What are atypical symptoms of celiac disease? - ANSWER dermatitis herpetiformis, iron deficiency anemia, and osteoporosis
Most patients with celiac disease also have what? - ANSWER lactose intolerance
How is diagnosis confirmed for lactase deficiency? - ANSWER hydrogen breath test
Smoking may lessen symptoms in what conditions? - ANSWER ulcerative
colitits
What is Murphy's sign and what condition is it seen in? - ANSWER pain in RUQ on inspiration, seen with inflammed gallbadder. can be illicited by palpating RUQ on inspiration
What is the most sensitive test for diagnosing acute abdominal pain? - ANSWER CT
What are alarm markers for herniations in infants? - ANSWER onset of colicky abd pain, N/V, and edema or discoloration at site
What are s/s of ulcerative colitis? - ANSWER bloody diarrhea, lower abd. cramps and fecal urgency, anemia, low albumin, neg. stool cx
What is the key to dx of ulcerative colitis? - ANSWER sigmoidoscopy
What condition inevitably causes colon cancer? - ANSWER familial adenomatous polyposis
Where is pain usually felt in patient with cholelithiasis (gallstones)? - ANSWER biliary pain characterized by infrequent episodes of steady severe pain in epigastrium or right upper quadrant with radiation to right scalpula
