Abdominal/GI Flashcards
Appy in peds
what labs to get, why
CRP, procal
some surgeons will take child to OR with elevated WBC, CRP, RLQ pain, and no imaging
Appy perf rate in children
33% of children, however >80% in <4years old!
Suspect appy: General protocol
- CRP, WBC, good hx and PE, then OR
- If above equivocal, get US
- if US equivocal, do MRI/CT
- MRI/CT neg, then admit for serial exams
Volvulus:
how good is upper GI series?
10-15% false pos
3-14% false neg
Not great test, transfer child early if necessary
Hirschsprung’s:
what to be concerned about, what to look for
High risk for Enterocolitis, even after surgery (up to 9%)
bloody stools, f/n/v, abd distention, high WBC
Tx: IVF, abx, rectal tube, colectomy
Also perineal abscess formation
HSP mnemonic for sxs
ARENA
abdominal pain
rash
edema
nephritis (check urine)
arthritis
Intussusception:
admit or not
low threshold for admission given recurrence often occurs in 24-48h
NEC
how to dx, what to do
pneumatosis intestinalis on KUB
tx: stop feeds, give NGT, give abx, IVF, surg consult for perf concern
neonatal jaundice:
when is normal to peak?
when abnormal
normal days 2-4 of life, east asians little bit later
first day is always abnormal (usu caught before baby sent home)
neonatal jaundice:
what is full set of labs if pt is sick?
Suspect infection, do anemic workup
CBC, CMP, cultures
retic count, LDH, coombs, blood smear
neonatal jaundice
tx options (3)
ivf for dehydration
phototherapy
exchange transfusion
neonatal jaundice
breast milk jaundice, when peaks
milk has liver enzyme inhibitors
enzymes peak at 2 weeks
suspect omphalitis
what if exam unclear if erythema is from diaper
observe child for short period of time to see if the erythema clears or progresses
pyloric stenosis
how to use NGT for dx?
use NGT aspiration: over 5cc residual is suspicious for pyloric stenosis (wait couple hours after feed to check for residual)
