Dr. Newman's pediatric G.I./jaundice Flashcards
A 2 yr old comes into the pediatrician with the the main complaint of He has not being able to keep anything down and often refluxes. His mom is worried that he is developmentally delayed. The mother says that the baby is often fussy in arches his back. You’ve come to find out that he has a furrow White exudate with more than 10 is eosinophils on egd. You believe that he has to have surgery in order to correct his issue. But before the surgery what do you need to do first? What does the furrow white exudate have to do with his issue?
The white exudate is from eosinophil esophagitis from the reflux of acid stomach contents back up. The reason he is developmentally delayed is because he’s not getting enough nutrients from GERD, FOOD AVERSION.
Sloppiness of lower esophageal sphincter, not well developed
You must do a 24 hour into a esophageal PH and impedance monitoring to qualify the severity of the reflux. This allows you to measure the directions of the boss movement via measurement of changes in resistance to alternating electrical current when the bolus passes by a pair of metallic rings mounted on the catheter.
A eight-year-old girl comes in with sudden onset of intermittent severe abdominal pain and emesis. She states that she gets tired at random points during the day. She has been having current jelly stools. You palpate her abdomen and in the right upper quadrant there is a sausage like mass.
What does this little girl have?
Where is it most likely occurring?
What causes it?
What do you do to treat it?
Intussusception
Ileocecal junction
Hypertrophic Peyers patches, Meckel’s diverticulum, mesenteric notes, polyps, foreign body, cancer
Air enema
A three-wk-old boy projectile vomits after every time he eats. When his mom tried to feed him, you can feel his abdomen pulse as if his stomach is trying to grab the food. His mom states he is very pale in his urine is dark yellow. He is 2 pounds lighter than when he came in last.
You check his blood levels, And what do you see that is typical of this congenital anomaly?
What does this little boy have?
What do you see on ultrasound?
He is hyperchloremic hyperkalemic and has metabolic alkalosis.
Pyloric stenosis
string sign on ultrasound
A 1day old boy presents with bilious emesis. The nurse states he has failed to pass meconium since birth. You palpate his abdomen and fuel stool but when you check his rectal vault it is empty. What is the cause of his symptoms? How do you diagnose?
Hirschsprung’s disease,
failure of the ganglion cells to migrate down to the developing colon, most commonly limited to the rectosigmoid colon, normally inervated section remains contracted,
for definitive diagnosis you must do a rectal biopsy in which you will see an absence of gangilion cells
What is the difference between conjugated and unconjugated hyperbilirubinemia in a jaundice infant
Conjugated is from problems in the biliary tree
Unconjugated BiliRubin that is not bound to albumin, Is lipid soluble and can cross the blood brain barrier. It can be deposited in the basal ganglia and brain stem which can result in bilirubin induce neurologic dysfunction also known as kericterus
What is the difference between a direct and indirect Coombs test?
Direct coombs is used in ABO incompatibility in newborns. Specifically in situations where hyperbilirubinemia is resulted from hemolysis. This test looks for antibodies directly on the RBC of the baby.
Indirect looks at the blood sample for antibodies that combine to certain RBCs, leading to problems if blood mixing should occur
Babies are at high risk for hyperbilirubinemia when they are born to moms with what?
Moms who are type o blood or RH negative.
What are non-pathologic causes of unconjugated hyperbilirubinemia in a newborn baby?
Physiologic jaundice, from increase hemolysis of RBCs.
Breast-feeding or breastmilk jaundice
Prematurity
What are the pathologic causes of unconjugated hyperbilirubinemia in a newborn baby?
Conjugated bili is not normal. This is caused by increased Bilirubin production, deficiency of hepatic uptake, impaired conjugation of Bilirubin, and increase interhepatic circulation .
What is the MOA of Crigler Najjar type one and two in which one is worse?
Type one is worse and results in severe hyperbilirubinemia with high risk of BIND. It is from a UDPGT deficiency.
If you see elevated conjugated BiliRubin level in an event what should you automatically think?
Biliary atresia
A baby comes in with increased yellow skin tone, a large liver to palpation, and very pale stools. What does this baby have?
Conjugate hyperbili - cholestatic jaundice. It is from biliary atresia.
If a baby comes in with a high-pitched cry, Poor tone, yellow skin, Poor suck, listless, and BiliRubin is high enough to be a risk for a seizure, what phase is the neonates bili toxicity in?
Phase 1, first one to two days
A baby comes in with extremely tight extensor muscles, and rigid arching of his back, and retrocollis with a fever. What is the phase of the babies BiliRubin toxicity?
If they have hypertonia?
Phase 2, 3 to 5 days
Phase 3, end of the first week and beyond
My mom brings a baby and worried because its skin is yellow. She said the baby has issues nursing but she thinks it’s also due to her breastmilk not being produced enough. The baby is dehydrated. What causes jaundice?
Breast-feeding jaundice
Will fix overtime.
