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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
Q

Most common cause of acute diarrheal illness throughout the world

A

-Viral gastroenteritis

26
Q

What can cause diarrhea?

A
  • apple
  • pears
  • antibiotics
  • chemo
  • c.diff (don’t need to test for cure)
27
Q

Diets for diarrhea

A
  • 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
Q

Most common cause of constipation outside the neonatal period

A

Functional constipation (voluntary withholding)

29
Q

Non organic causes of constipation=

A
  • functional constipation (voluntary withholding)

- dysfunctional toilet training

30
Q

Organic causes of constipation

A
  • 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
Q

If patient did not pass meconium in first 24-48 months of life consider

A
  • CF

- Hirsprung dz

32
Q

Tx of constipation

A

-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
Q

Hirschsprung dz=

A
  • congential aganglionic megacolon
  • three times more common among boys
  • often treated surgically in two stages
34
Q

How long does it take for fresh blood to look like coffee groudns

A

5 min of exposure to gastric acid

35
Q

What is upper/lower GI bleeding?

A

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
Q

Minor bleeding: stool streaked with blood

A

Usually caused by anal fissure or polyp

37
Q

Earliest sign of GI bleeding

A

Increased heart rate

38
Q

E.coli

A

bloody diarrhea after several days of non-bloody diarrhea

-leads to HUS in 10-15% of pts

39
Q

Three common causes of GI bleeding

A

1) Meckel diverticulum (vestigial remnant of omphalomesenteric duct)
2) Ulcerative colitis
3) Crohn’s disease

40
Q

Presentation of meckel diverticulum

A

-PAINLESS rectal bleeding
Dx: w/ meckel scan (technicium 99 pertechnetate scan)
Tx: surgical excision

41
Q

Ulcerative colitis

A
  • diffuse superficial colonic ulceration

- involves rectum in 95%

42
Q

Crohns Dz

A
  • transmural skip lesions

- ileocolonic in 40%; small intestine in 30%; colon only in 20%

43
Q

Common manifestations of crohns dz

A
  • crampy abdominal pain
  • recurrent fever
  • weight loss
44
Q

Common manifestations of ulcerative colitis dz

A
  • bloody diarrhea w/ mucopus (100%)
  • abdominal pain (95%)
  • tenesmus (75%)
45
Q

Risk of cancer w/ Crohns and UC

A 
Crohns = increased
UC = greatly increased
46
Q

Extraintestinal sequlae of Crohns and UC

A
  • polyarticular arthritis
  • ankylosing spondylitis
  • primary sclerosing cholangitis
  • chronic active hepatitis
  • sacroilitis
  • pyoderma gangrenosum
  • erythema nodosum
  • aphthous stomatitis
  • episcleritis
  • recurrent irits
  • uveitis
47
Q

What enzymes are elevated in liver disease?

A

AST (aspartate aminotransferase)
ALT (alanine aminotransferase)
***ALT is more specific for liver dz

48
Q

DDX for mild to moderately elevated aminotransferases (<1000)

A
  • alpha 1 antitrypsin deficiency
  • autoimmune hepatitis
  • chronic viral hepatitis
  • hemochromatosis
  • medications
  • toxins
  • steatosis
  • steatohepatitis
  • wilson’s dz
  • celiac dz
  • hyperthyroidsims
49
Q

DDX for more dramatic elevation of aminotransferases (>1000) w/ ALT >AST

A
  • acute bile duct obstruction
  • acute Budd Chiari syndrome
  • Acute viral hepatitis
  • autoimmune hepatitis
  • ischemic hepattis (shock)
  • medications /toxins
50
Q

What labs do you see in alcohol related liver injury?

A

AST > ALT

51
Q

What is Wilson’s Dz?

A
  • 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
Q

Tx of Wilson’s Dz

A
  • Chelating agents (d-penicillamine, trientine, tetrathiomolybdate)
  • Zinc (interferse w/ uptake of copper and induces endogenous chelator)
  • Avoid foods high in copper
53
Q

Alagille Syndrome AKA arteriohepatic dysplasia

A

-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
Q

Tx of arteriohepatic dysplasia

A

Adequate nutrition and high colure diet w/ high proportion of fat from medium-chain triglycerides is recommended in neonatal period

55
Q

Most common cause of liver disease in childhood and adolescence

A

-NAFLD (non alcoholic fatty liver disease)

56
Q

Most common factor associated w/ NAFLD

A

Obesity

57
Q

Other factors that predispose to NAFLD

A
  • Hispanic ethnicity
  • male sex
  • asian race
58
Q

Clinical features of NAFLD

A
  • most children are asymptomatic
  • acanthosis nigracans
  • elevated serum aminotransferases ALT >AST
59
Q

Tx of NAFLD

A

-weight loss through lifestyle modification (diet and exercise)

EOR Pediatrics (16 decks)

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