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EOR Pediatrics > Chapter 9: Gastroenterology > Flashcards

Chapter 9: Gastroenterology Flashcards

1
Q

Definition of chronic abdominal pain

A

3 pouts of pain severe enough to affect activities over a period of at least 3 monnths

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2
Q

Functional Abdominal Pain Categories

A

1) Functional Dyspepsia
2) IBS
3) Abdominal Migraine

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3
Q

Rectal tags or fistulae suggest

A

Crohn’s disease

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4
Q

Cervical motion tenderness is consistent with

A

PID

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5
Q

Most common indication for abdominal surgery in childhood

A

Appendicitis

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6
Q

Most frequent age of appendicitis

A

10-15 y/o

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7
Q

When does appendicitis perforate?

A

about 36 hours after the pain begins

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8
Q

Treatment of appendicitis

A

Laparotomy and appendectomy should be performed before perforation
-If perforated: brood spectrum abx (ampicillin + gentamicin + metronidazole or piperacillin/tazobactam alone) to treat peritonitis

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9
Q

Most intussceptions are

A

ileocolic

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10
Q

Recognizable lead points in intussuception

A

1) meckel diverticulum
2) intestinal polyp
3) foreign body
Also associated with HSP but this is usually ileoileal

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11
Q

Clinical manifestations of Intussuception

A
  • violent episodes of irritability, colicky pain, emesis interspersed with relatively normal bleeding
  • rectal bleeding in 80%
  • palpable tubular mass in 80%
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12
Q

Treatment of intussecption

A

fluid resuscitation

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13
Q

Emesis shortly after feeding

A

Probably GER

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14
Q

Emesis that is projectile in infant 1-3 mo

A

Consider pyloric stenosis

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15
Q

Emesis and pharyngitis

A

Emesis is commonin in infectious pharyngitis

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16
Q

Who does pyloric stenosis occur in?

A
  • most common and 2-4 wks of life
  • occurs in 1:500 infants
  • male infants are affected 4:1 over females
  • *erythromycin therapy may cause pyloric stenosis
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17
Q

Clinical manifestations of pyloric stenosis

A

Cardinal feature = projectile non bilious vomiting

  • classic finding = olive sized, muscular, mobile, contender mass in the epigastric area (occurs in most but difficult to palpate)
  • String sign on upper GI study
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18
Q

Tx of pyloric stenosis

A

NG tube to decompress stomach
Correction of dehydration, alkalosis, electrolyte abnormalities (metabolic alkalosis common)
-pylorotomy after metabolic abnormalities are corrected

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19
Q

What is malrotation?

A

small intestines rotate abnormally in utero

  • results in malposition in abdomen and abnormal posterior fixation of the mesentery
  • puts patient at risk for volvulus in newborn period = surgical emergency
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20
Q

Clinical Manifestations of volvulus

A
  • bilious emesis
  • abdomianl distention and shock
  • blood stained emesis or stool
  • *unexplained lactic acidosis
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21
Q

Clinical manifestations of GERD in children

A
  • regurgitation
  • poor weight gain
  • dysphagia
  • abdominal or substernal pain
  • esophagitis
  • respiratory disorders

(uncomplicated GER = happy spitter)

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22
Q

Diagnostic eval of GERD

A
  • upper GI series is not sensitive or specific

- Impedence manometry is useful to establish reflux, and asses the adequacy of therapy

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23
Q

What is eosinophilic esophagitis?

A

reflux symptoms that do not respond to antacid therapy

-on endoscopy = furrowing and white exudate w/ >15 eosinophils per high-power field

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24
Q

Tx of GERD

A
  • less GER in prone than supine position but not worth SIDS risk
  • 1-2 week trail of a hypoallergenic formula in formula fed infants w /regurgitation
  • milk thickening products DO NOT improve reflux by pH monitoring but do decrease the number of episodes of vomiting
  • can do a brief trial of H2blockers and PPI (may increase risk of pneumonia and GI infections)
25
Most common cause of acute diarrheal illness throughout the world
-Viral gastroenteritis
26
What can cause diarrhea?
- apple - pears - antibiotics - chemo - c.diff (don't need to test for cure)
27
Diets for diarrhea
- regular diets are generally more effective than restricted or progressive diets (brat diet is unnecessarily restrictive) - most kids don't develop lactose intolerance and don't need to be milk restricted - offer child frequent small feedings every 10 to 60 min
28
Most common cause of constipation outside the neonatal period
Functional constipation (voluntary withholding)
29
Non organic causes of constipation=
- functional constipation (voluntary withholding) | - dysfunctional toilet training
30
Organic causes of constipation
- dietary (low fiber diet; inadequate fluid intake) - GI (functional ileus, hirschsprung, anal stenosis, abscess, fissure, NEC, collagen vascular disease) - Drugs or toxins (lead, narcotics, phenothiazines, vincristine, anticholinergics) - Neuromuscular (meningomyelocele, tethered spinal cord, infant botulinum, absent abdominal muscles) - metabolic (cystic fibrosis, hypokalemia, hypercalcemia) - endocrine (hypothyroidism)
31
If patient did not pass meconium in first 24-48 months of life consider
- CF | - Hirsprung dz
32
Tx of constipation
-Polyethylene glycol (PEG) is helpful for colonic clean out in children Others: mineral oil, magnesium hydroxide, lactulose, sorbitol (choice is based on safety, cost, practitioner experience)
33
Hirschsprung dz=
- congential aganglionic megacolon - three times more common among boys - often treated surgically in two stages
34
How long does it take for fresh blood to look like coffee groudns
5 min of exposure to gastric acid
35
What is upper/lower GI bleeding?
Upper = site proximal to ligament of treitz Lower = site distal to ligament of treitz **most GI bleeding in children is from the lower tract
36
Minor bleeding: stool streaked with blood
Usually caused by anal fissure or polyp
37
Earliest sign of GI bleeding
Increased heart rate
38
E.coli
bloody diarrhea after several days of non-bloody diarrhea | -leads to HUS in 10-15% of pts
39
Three common causes of GI bleeding
1) Meckel diverticulum (vestigial remnant of omphalomesenteric duct) 2) Ulcerative colitis 3) Crohn's disease
40
Presentation of meckel diverticulum
-PAINLESS rectal bleeding Dx: w/ meckel scan (technicium 99 pertechnetate scan) Tx: surgical excision
41
Ulcerative colitis
- diffuse superficial colonic ulceration | - involves rectum in 95%
42
Crohns Dz
- transmural skip lesions | - ileocolonic in 40%; small intestine in 30%; colon only in 20%
43
Common manifestations of crohns dz
- crampy abdominal pain - recurrent fever - weight loss
44
Common manifestations of ulcerative colitis dz
- bloody diarrhea w/ mucopus (100%) - abdominal pain (95%) - tenesmus (75%)
45
Risk of cancer w/ Crohns and UC
``` Crohns = increased UC = greatly increased ```
46
Extraintestinal sequlae of Crohns and UC
- polyarticular arthritis - ankylosing spondylitis - primary sclerosing cholangitis - chronic active hepatitis - sacroilitis - pyoderma gangrenosum - erythema nodosum - aphthous stomatitis - episcleritis - recurrent irits - uveitis
47
What enzymes are elevated in liver disease?
AST (aspartate aminotransferase) ALT (alanine aminotransferase) ***ALT is more specific for liver dz
48
DDX for mild to moderately elevated aminotransferases (<1000)
- alpha 1 antitrypsin deficiency - autoimmune hepatitis - chronic viral hepatitis - hemochromatosis - medications - toxins - steatosis - steatohepatitis - wilson's dz - celiac dz - hyperthyroidsims
49
DDX for more dramatic elevation of aminotransferases (>1000) w/ ALT >AST
- acute bile duct obstruction - acute Budd Chiari syndrome - Acute viral hepatitis - autoimmune hepatitis - ischemic hepattis (shock) - medications /toxins
50
What labs do you see in alcohol related liver injury?
AST > ALT
51
What is Wilson's Dz?
- rare autosomal recessive disease of copper metabolism - manifests as liver disease in children and teenagers - manifests as a neurpsychiatric illness in adults - Kaiser Fleischer rings * **dramatically increased hepatic copper is best evidence
52
Tx of Wilson's Dz
- Chelating agents (d-penicillamine, trientine, tetrathiomolybdate) - Zinc (interferse w/ uptake of copper and induces endogenous chelator) - Avoid foods high in copper
53
Alagille Syndrome AKA arteriohepatic dysplasia
-autosomal dominant disorder -bile duct paucity plus 3 of 5 clinical criteria (cholestasis, cardiac murmur or heart disease, skeletal anomalies, ocular findings, characteristic facial features)
54
Tx of arteriohepatic dysplasia
Adequate nutrition and high colure diet w/ high proportion of fat from medium-chain triglycerides is recommended in neonatal period
55
Most common cause of liver disease in childhood and adolescence
-NAFLD (non alcoholic fatty liver disease)
56
Most common factor associated w/ NAFLD
Obesity
57
Other factors that predispose to NAFLD
- Hispanic ethnicity - male sex - asian race
58
Clinical features of NAFLD
- most children are asymptomatic - acanthosis nigracans - elevated serum aminotransferases ALT >AST
59
Tx of NAFLD
-weight loss through lifestyle modification (diet and exercise)

EOR Pediatrics (16 decks)

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