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7feb 24 Flashcards

1
Q

Bloody stools , intermittent abd pain
HO viral infection

A

Intussusception

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2
Q

Pathogenesis and epidemiology of intussusception

A

Telescoping of one bowel segment into adj segment (ileocecal)

Bowel edema ➡️ ischemia & Necrosis

Age 6M to 3Y most common

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3
Q

RF of intussusception

A

Hypertrophy if peyer patches (recent viral illness

Pathological lead point (meckel diverticulum , HSP , Intestinal tumor )

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4
Q

CF of intussusception

A

🤮Sudden intermittent abd pain and vomiting
🤮bouts of pain are progressive

🤮symptom free between episodes

🤮Pt drawing legs up towards abdomen with pain (flexes hips and crying inconsolably)

🤮Emesis may follow pain initially non bilious and later bilious as obstruction persists.

🤮Sausage shaped mass in Rt abdomen
(Normally ileocecal junction is in RLQ but invagination of ileum into Colon causes mass to be found in Rt middle or upper abdomen)

🤮Currant jelly stools (from bowel wall ischemia )

🤮Lethargy or AMS

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5
Q

Dx and Ttt

A

USG : Target sign

Ttt:

Air (pneumatic) or saline enema

Surgical intervention for failed enema reduction or signs if peritonitus

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6
Q

Necrotizing enterocolitis pathogenesis

A

Gut mucosal wall invasion by gas producing bacteria

Intestinal inflammation , Necrosis

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7
Q

RF for Necrotizing enterocolitis

A

⚽️Prematurity

     Premature infants have dec bowel motility , inc intestinal permeability , immature host defenses

⚽️Very low birth wt. <1.5kg. 3lb 4oz

⚽️Enteral feeds (exposure to bacteria)

⚽️Infants with reduced mesenteric Oxygen delivery (cyanotic heart dx , hypotension)
Poor intestinal perfusion causes mucosal inf and necrosis and translocation of gas producing bacteria into bowel wall

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8
Q

CF of NE

A

Non specific :

    Apnea 
    Lethargy 
    Vital Sign instability 
    Leukocytosis
    Metabolic acidosis

GI :

   Abd distention
   Feeding intolerance , bilious emesis
   Bloody stools
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9
Q

Xray finding of NE

A

Pneumatosis intestinalis (air in bowel wall)
Pneumoperitoneum. (Free air under diaphragm)
Air in portal venous system

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10
Q

Complications of NE

A

Sepsis

DIC

Late : strictures , short bowel syndrome

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11
Q

Management if Necrotizing Enterocolitis
Immediate ttt

A

Discontinue enteral feeds
NG decompression
Blood cultures and empiric antibiotics
IV fluid repletion

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12
Q

Monitoring Of NE

A

Serial complete CBC , electrolytes
Serial abd exams and imaging

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13
Q

Indication for surgery in NE

A

Bowel perforation (pneumoperitoneum)

Clinical deterioration despite medical management (bowel necrosis)

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14
Q

Delayed passage of meconium cause s

A

Hirshsprung dx
Meconium ileus

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15
Q

Pathophys of hirshsprung dx

A

Failure of neural crest cell migration

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16
Q

Hirshsprung dx level of obs

A

Rectosigmoid

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17
Q

Rectal exam of hirshsprung

A

Inc rectal tone
Positive squirt

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18
Q

Meconium consistency in HD

A

Normal

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19
Q

Dx of HD

A

Plain Xray :
Dilated bowel loops
Absent rectal gas

Contrast enema :

🛞Dilated descending colon
🛞Abrupt transition (between dilated proximal colon and aganglionic segment )
🛞Narrow sigmoid colon

Biopsy :
Rectal suction biopsy (diagnostic) shows absence of ganglion cells

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20
Q

HD associations

A

Downs

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21
Q

Meconium ileus pathophys

A

Obstruction by inspisstaed stool

Ass with Cystic Fibrosis

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22
Q

Obstruction level of Meconium Ileus

A

Iluem

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23
Q

Rectal exam of MI

A

Normal tone
Negative squirt

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24
Q

Consistency of stool in MI

A

Inspissated

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25
Imaging of MI
Dilated small bowel Microcolon
26
Ttt of HD
Surgery
27
HD S/S
Neonates : Delayed passage of meconium Bilious vomiting Enterocolitis Children/ adolescents : Chronic constipation Failure to thrive
28
HD physical exam
🌻Distended abdomen 🌻Tight anal sphincter 🌻Absence of stool in rectal vault 🌻Forceful stool expulsion on rectal exam
29
STEC pathogenesis
🍀Ingestion of contaminated undercooked beef or contact with farm animals. 🍀 isolated cases without clear source very common. 🍀 invasion of intestinal epi cells 🍀production of shiga toxin
30
CF of Ecoli infection
🍔Watery ➡️ bloody diarrhea within 3 days 🍔No high fever (altho low grade fever <101.3 may occur) 🍔 presence of high grade fever suggests another dx
31
Dx of STEC
Multiplex stool PCR testing Stool shiga toxin assay Stool culture
32
Ttt of EColi infection
Supportive (aggressive fluid) Avoid antibiotics. And antidiarrheals (To prevent HUS)
33
Complication of STEC
HUS ( develops 1-2 weeks after diarrhea onset)
34
Pt with abd pain and watery loose stools and then blood streaked stools. Fever 101.8 Dx
Campylobacter
35
Infectious ileocecitis pathogenesis
Also called pseudoappendicitis Caused by yersinia and campylobacter Predilection for ileocecal area Periumb and RLQ pain (like appendix) May initially infect jejunum and then ileum and cecum. Watery , mucoid or bloody stools With Fever nausea vomiting
36
Campylobacter gastroenteritis CF
Fever , abd pain Mucoid/ watery or bloody diarrhea RLQ pain due to acute ileocecitis
37
Ttt of acute ileocecitis
Supportive self limiting (<7days) AB. Indications. ; Duration >7days Bloody stools High fevers Pregnant Immunocomp Elderly
38
Complications of Campylobacter gastro
GBS Reactive arthritis
39
Dx of campylobacter ileocecitis
🌹Imaging USG CT To show ileocecal inf with sparing of appendix 🌹Stool mutiplex PCR , Culture 🌹Surgery not req
40
Pathologic Pediatric constipation RF
Delayed meconium passage Down syndrome ( HD , intestinal atresia /stenosis)
41
Causes of functional constipation
Solid food introduction Toilet training School entry Hx:Absence of pathologic features Painful , infreq large caliber or pellet like stools Fecal soiling (encopresis)
42
Presentation of pathologic constipation in paeds
Poor weight gain Poor linear growth Narrow ribbon stools Blood mixed in stool Bilious vomiting or fever
43
Presentation of functional constipation in paeds
Absence of pathologic feature s Painful infreq large caliber or pellet like stools Fecal soiling (encopresis )
44
Examination findings of constipation
Functional: Absence of pathologic features Mild abd distention Anal fissure (rectal bleed) Pathological : Displaced anus , incr rectal tone or sacral anomalies (hair tuft) Abnormal lower extremity neurologic features (weakness) Severe abd distension
45
How to manage constipation
Pathologic : Workup for celiac dx , hypothyroidism HD , CF , spinal dysraphism Functional: Age appropriate toilet training Dietary changes (fiber , water) Laxatives (polyethylene glycol)
46
Jejunal atresia Causes
Poor fetal gut perfusion in utero due to use of vasoconstrictive medicines or substance use (cocaine) and tobacco. Necrosis and resorption of fetal intestine leaving behind blind proximal and distal ends of intestine. Can occur anywhere in GIT. Mostly ileum or jejunum Not ass with any chromosomal abnormalities.
47
Dx and ttt of jejunal atresia
Dx : Abd Xray Triple bubble sign (Gas trapping in stomach duodenum jejunum) Ttt: Resusitate stabilize Surgery
48
Most common GI anomaly of down syndrome
Duodenal atresia
49
Duodenal atresia CF
Bilious vomiting in first 2 days of life. No abd distension as gas cant move forward. H/O polyhydramnios Xray shows double bubble sign And no distal gas. Ttt: No Enteral feeds NG decompression Surgery.
50
Surveillance in Duodenal atresia
Echo For VSD or ASD (ass with downs )
51
Food protein induced allergic proctocolitis Presentation
Age <6Mo 1-4week after initial exposure to offending protein Painless bloody stools In a well appearing patient.
52
Cause of FPIAP
Cows milk (casein or whey ) Soy proteins
53
What is FPIAP?
Non IgE mediated reaction in which a protein in infants diet (breast milk or formula ) causes eosinophilic inf of distal colon or rectum.
54
Ttt of FPIAP
Formula fed babies : Switch to hydrolyzed formula Breast fed babies ; Restrict dairy (soy ) from maternal diet Pts tolerate products containing offending protein (milk , yogurt ) by age 1.
55
RF of FPIAP
Eczema FH of food allergies
56
Food protein induced enterocolitis syndrome presentation
Age <12 Mo Non IgE mediated Happens in hours. Profuse vomiting Diarrhea bloody or non bloody Dehydration Lethargy Ill appearing
57
IgE mediated food allergy in children
Anaphylaxis (In less than 1 hr)
58
Meconium ileus Pathophy
Inspissated stool causing obs at terminal ileum Related to CF
59
CF of meconium ileus
Failure to pass meconium within 24hr of birth Abd distension No stool in rectal vault Bilious emesis
60
DX of meconium ileus
Xray : Dilated bowel loops Contrast enema. : microcolon CF testing (sweat test
61
Ttt for meconium ileus
Hyperosmolar enema Surgery
62
Association of meconium ileus
🪵Chronic Rhinosinusitis 🪵Can occur as early as age 1 🪵Often ass with nasal polyps 🪵Due to thick viscous secretions and impaired mucociliary clearance in sinuses and resp tract
63
Straining infant how to approach
If ill appearing or red flags (Severe distension, abnormal rectal tone , sacral findings , delayed passage of meconium, failure to thrive) Look for : HD CF Spinal dysraphism Hypothyroidism If well appearing : 🌞loose stools (blood or mucus ) FPIAP 🌞normal consistency Normal infant dyschezia 🌞 hard pellet like stool Functional constipation (Anal fissure if blood)
64
Infant dyschezia CF and ttt
Straining and crying Turning red in face Straining fir greater than 10mins followed by passage of soft nonbloody stool Well appearing normal child Management: Resolves by 9mo Only reassure
65
Pathogenesis of infant dyschezia
Failure to coordinate Inc intraabd pressure with relaxation of pelvic floor muscles Inadequate abd muscle tone to produce an effective Valsalva maneuver
66
Imp CF to remember about hirschsprung Dx
🪴 dx severity correlates with length of non functional colon Pts with short aganglionic segment remain undiagnosed with chronic constipation for years 🪴 altho absence of stool in 48hrs of life is classic , passage of meconiun doesnt exclude HD 🪴 increased rectal tone and squir sign are classic SS 🪴 transition zone is characteristic
67
SS of HD in neonates and children
Neonates: Delayed passage of meconium Bilious vomit Enterocolitis Children/adolescents : Chronic constipation Failure to thrive
68
Congenital hypothyroidism CF
A/S at birth (rarely causes delayed meconium) After maternal thyroxine wanes (wks to Mo) Lethargy Poor feeding Enalrged fontanelle Protruding tongue puffy face umb hernia Constipation Prolonged jaundice Dry skin
69
How to determine degree of mild dehydration in babies. ?
Mild dehydration: 3-5% losses Dec intake Inc fluid loss No clinical symptoms
70
Moderate dehydration in babies signs
6-9% vol loss Decreased skin turgor Dry MM Tachycardia Irritability A delayed capillary refill (2-3 ) Dec urine output
71
Severe dehydration in babies signs :
10-15 volume loss Cool clammy skin Delayed cap refill >3sec Cracked lips Dry MM Sunken eyes Sunken fontanelle Tachycardia Lethargy Min to No urine output Hypotension or Shock
72
Ttt of dehydration
🌸Mild to moderate : Oral rehydration therapy 🌸Moderate to severe: IV crystalloids bolus Dextrose is given as maintenence (not used as initial fluid resuscitation)

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