Dr. Newman GI Pediatrics Flashcards
What is the most important study to quantify the severity of reflux in GERD pediatric patients?
24-hr esophageal pH and IMPEDANCE monitoring
- impedance measures DIRECTION of bolus movement by measuring changes in resistance to altering electrical current when a bolus passes by pair of metallic rings on catheter
Where does Intussusception commonly occur and what are 3 signs of disease? (RB/AP/SM)
What are two ways this condition can be treated? (AE/FR)
- commonly occurs at ILEOCECAL JUNCTION
S: rectal bleeding (“jelly-like”, less common), intermittent severe abdominal pain/emesis, RUQ “sausage-like” mass
- use air enema or FLUID RESUSCITATION
Who does Pyloric Stenosis occur in, what are two common signs, and what is its Classic Metabolic Triad?
- most common in boys 2-4 wks old
S: projectile vomit, palpable olive mass (epigastric)
T: hypocloremic, hypokalemic, metabolic alkalosis
What is Hirschsprung Disease, what are 3 symptoms (PS/ERV/H), and what is needed for definitive diagnosis?
- failure to pass meconium within 24-48 hrs of life due to ganglion cell migration failure
S: palpable stool in abdomen, empty rectal vault, history of never having unassisted stool
Dx: RECTAL BIOPSY IS REQUIRED
What is the difference between Direct and Indirect Coomb’s Tests?
Direct: performed on pts. RBCs (looks for Abs to RBCs)
- used where hyperbilirubinemia is hemolytic
- ABO incompatibility in newborns
Indirect: performed on serum (looks for Abs that could bind to certain RBCs)
Which babies are at greater risk for hyperbilirubinemia? (2)
What test would you do to test for these risks?
- those born to Type O moms or that are Rh negative
- do DIRECT Coomb’s Test on babys cord blood
What bilirubinemia is never NOT pathologic?
CONJUGATED HYPERBILIRUBINEMIA
What is the most common cause of CONJUGATED Hyperbilirubinemia in newborns and what are 3 symptoms of this condition? (CJ/H/AS)
- BILIARY ATRESIA
S: cholestatic jaundice, hepatomegaly, acholic stools
What causes Kernicterus and what is it also known as?
- free (not albumin bound) unconjugated bilirubin that crosses BBB and deposits in basal ganglia/brainstem causing permanent neurologic damage
aka: BIND (Bilirubin-induced Neurological Dysfunction)
What are Phase 1, Phase 2, and Phase 3 of Bilirubin Toxicity in Neonates?
P1: (1-2 days) - poor suck, yellow skin, high pitched cry
P2: (3-5 days) - muscle hypertonia, rigid arching (opsithotonus), retrocollis
P3: (7+ days) - hypertonia
What is the difference between Breast Feeding Jaundice and Breast-milk Jaundice?
BF: baby not nursing right and moms milk not coming in
- due to dehydration and inc. enterohepatic circulate
- dec. bilirubin excretion in stool
BM: breast milk inhibits bilirubin conjugation (3-6 wks)
- deconjugation enzymes in milk
What is the most common genetic cause of acute/chronic liver disease in kids?
alpha-1 antitrypsin deficiency
How does phototherapy help dec. bilirubin levels?
- ISOMERIZES unconjugated bilirubin making it water soluble
- does NOT conjugate, just makes bilirubin water soluble
