Exam 1 Flashcards
when does physiologic reflux resolve
12-18 months
signs that reflux is pathological (GERD)
failure to thrive, food refusal, pain, GI bleeding, respiratory symptoms, Sandifer syndrome
risk factors for GERD in older children
CF, developmental delay, asthma, hiatal hernia, repaired tracheoesophageal fistula
most common foreign body ingestion
coins
initial imaging for foreign body ingestion
plain radiograph
imaging for ingestion of a nonradiopaque object
contrast esophagram
what foreign body should be removed immediately from esophagus
button battery
when should esophageal foreign bodies be removed
within 24 hours
esophageal food impaction raises concern for what
eosinophilic esophagitis
what to do if button battery has passed into stomach
consider endoscopic eval for larger batteries or younger children but otherwise it will likely pass
what to do about smooth objects in the stomach
may be monitored for several weeks
what to do about nails or screws in the stomach
will generally pass without incident but endoscopic removal may be considered on a case-by-case basis
what objects must be removed from stomach
double-sided sharp objects, multiple magnets, large and open safety pins, objects longer than 5 cm
how many ingested foreign bodies pass spontaneously
80-90%
symptoms of ingested foreign body
dysphagia, odynophagia, drooling, regurgitation, chest pain, abdominal pain, none, cough (if retained in esophagus > 1 week)
what is pyloric stenosis
pyloric muscular hypertrophy with gastric outlet obstruction
pyloric stenosis is more common in ___
boys
cause of pyloric stenosis
unknown, may be associated with neonatal use of erythromycin
pyloric stenosis presentation
projectile postprandial vomiting, hunger, postprandial upper abdominal distention, 5-15 mm oval mass in RUQ
pyloric stenosis age of onset
2-4 weeks (up to 12 weeks)
metabolic findings of pyloric stenosis
hypochloremic alkalosis with potassium depletion
imaging for pyloric stenosis
ultrasound
ultrasound findings of pyloric stenosis
hypoechoic muscle ring > 4mm thickness
barium upper GI series findings in pyloric stenosis
long, narrow pyloric channel with double track of barium
pyloric stenosis tx
manage dehydration and electrolyte abnormalities and then surgical repair (Ramstedt pyloromyotomy)
most common causes of gastric or duodenal ulcers
H. Pylori infection, NSAID use, underlying illness
most common symptoms of gastric/duodenal ulcers in peds < 6 y/o
vomiting, upper GI bleeding
most common symptoms of gastric/duodenal ulcers in older children
epigastric pain
diagnosis of gastric/duodenal ulcers
upper GI endoscopy with biopsy
triple therapy for H. Pylori
PPI, amoxicillin, clarithromycin for 7-10 days
quadruple therapy for H. Pylori
PPI, bismuth, metronidazole, tetracycline (doxycycline if < 8 y/o)
imaging for esophagitis
upper GI series and modified barium swallow study/esophagram
treatment for candida esophagitis
figure out cause, fluconazole
treatment for eosinophilic esophagitis
swallowed corticosteroid, PPI, refer for allergy testing and/or elimination diet
classic appearance of H pylori on EGD
nodular gastritis of stomach
what medication can be added to PPI for ulcer healing
sucralfate
when does hypertophy of muscle begin in pyloric stenosis
postnatally
predisposing conditions for mallory-weiss tears
portal hypertension, cirrhosis, severe GERD
typical location of mallory-weiss tear
gastroesophageal junction
etiology of mallory-weiss tear
longitudinal tears caused by elevated intrabdominal pressure
mallory weiss tears are more common in what age group
older children/adolescents, but can present at any age
mallory-weiss tear presentation
hematemesis (usually after several bouts of vomiting), melena, symptoms of volume depletion, abdominal pain (due to underlying cause of vomiting)
labs for mallory-weiss tear
CBC, coag studies
diagnosis of mallory-weiss tear
no specific imaging, generally diagnosed on EGD as one or more linear bleeding lesions at or just proximal gastroesophageal junction
when must endoscopy be performed for mallory-weiss tear
within 24 hours of bleeding
mallory-weiss tear treatment
determine underlying cause of vomiting, tears typically resolve spontaneously, but severe cases can be treated with systemic vasopressin or surgery (in extreme cases). No special diet is required
most common type of cholelithiasis < 10 y/o
black bile stones
most common type of cholelithiasis > 10 y/o
cholesterol stones
most common cause of cholecystitis in peds
cholelithiasis
GERD risk factors
preterm birth, chronic lung disease, cerebral palsy
when can gallstones start to form
in utero
gallstones ssx
acute/recurrent postprandial RUQ/epigastric pain radiating substernally, back, or right shoulder, N/V, +/- jaundice, fever
location of gallstone if jaundice present
common duct or ampulla hepatopancreatica
gallstones risk factors
hemolytic disease, females, obesity, rapid weight loss, portal vein thrombosis, “certain ethnic groups (Pima Indians/Hispanics)”, Crohns disease, CF, parenteral nutrition
labs for gallstones
CBC, gamma-glutamyltransferase (GGT), amylase, CMP
diagnostic criteria for acute pancreatitis
at least 2 of the following: upper abdominal pain, amylase/lipase > 3x upper limit, imaging consistent with acute pancreatitis
classic presentation of acute pancreatitis
epigastric pain radiating to the back, N/V; tender but not rigid abdomen, diminished bowel sounds, +/- ascites and left pleural effusion
most common causes of acute pancreatitis
idiopathic (20%), drugs, viral infections, systemic disease, abdominal trauma, obstruction of pancreatic flow
presentation of acute pancreatitis in infants and younger children
abdominal distention with classic symptoms less common
indicators of poor prognosis in acute pancreatitis
leukocytosis, hyperglycemia, falling hematocrit, rising BUN, hypoxemia, acidosis
initial imaging for acute pancreatitis
ultrasound followed by CT
treatment of acute pancreatitis
pain control, decompression of biliary system if obstructed, fluids (LR), enteral feeding, gastric decompression,
definition of cyclic vomiting syndrome
recurrent episodes of intense, unremitting nausea and paroxysmal vomiting with return to normal between episodes
prognosis of acute pancreatitis
good
associated symptoms in cyclic vomiting syndrome
mallory-weiss tear, autonomic symptoms (pallor, sweating, lethargy
cyclic vomiting syndrome is associated with what condition
migraines
cyclic vomiting syndrome treatment (acute)
avoid triggers, diphenhydramine/lorazepam to induce sleep, antimigraine medications, IV fluids
common population affected by cyclic vomiting syndrome
toddlers
when does colic occur
2-3 months
colic rule of 3s
cries for more than 3 hours per day, more than 3 days per week, for more than 3 weeks
causes of swallowing/feeding difficulties
oral-motor dysfunction (due to developmental delay or neuro problem), chronic conditions leading to fatigue, GI pain, emotional/social trauma, enteral/IV nutrition
prophylactic cyclic vomiting syndrome treatment
<5 y/o cyproheptadine, >5 y/o amitriptyline
dosing consideration for PPI
must take at least 30 minutes before eating
major risk factor for celiac disease
type I DM
triggers of celiac disease
wheat, rye, barley, some cross-reactivity with oats
GI manifestations of celiac (typical)
abdominal pain, diarrhea, vomiting, anorexia, distention, +/- constipation,
non-GI manifestations of celiac (atypical)
oral ulcers, dermatitis herpetiformis, growth/pubertal delay, IDA, arthritis, elevated LFTs, behavioral problems, migraines, electrolyte derangements
celiac age of onset
6-24 months
definition of food intolerance
non-immunologic adverse reaction, inability to digest/metabolize certain foods
2 classes of food allergies
immuno-related (IgE-mediated), non immuno-related (not IgE-mediated)
definition of adverse food reaction
untoward response to a food
valid immunologic tests
serum specific IgE, skin testing
valid non-immunologic tests
tTG-IgA/IgG, biopsies, lactose breath test
silent celiac disease is characterized by
intestinal damage and positive serology but no symptoms
pathophysiology of celiac disease
gluten triggers an inflammatory response leading to damaged microvilli and malabsorption
serologic testing for celiac disease
tTG-IgA + total IgA
initial testing for celiac disease
serology
when to use tTG-IgG + total IgG for celiac disease
if under 4 y/o
if celiac disease serology is positive
refer to GI
gold standard for celiac disease diagnosis
villous atrophy with intraepithelial lymphocytes on biopsy
celiac disease treatment
gluten-free diet, refer to dietician, regular follow up with labs q 4-12 months
lactose intolerance pathophys
no lactase to break down lactose into glucose and galactose, so it remains in the gut and gets fermented by bacteria, causing ssx
usual age of onset for primary lactose intolerance
around 5
causes of secondary lactose intolerance
celiac disease, crohn’s disease, prematurity
lactose intolerance diagnosis
hydrogen breath test
cow’s milk protein allergy presentation
healthy infant with slow onset of blood-streaked stools
who does cow’s milk protein allergy affect
more often males with history of atopy, resolves by 1 y/o
cow’s milk protein allergy treatment
supervised maternal elimination diet, hydrolyzed/hypoallergenic formula
testing to consider for cow’s milk protein allergy
abdominal x-ray, hemoglobin/hematocrit
most common outgrown IgE-mediated food allergies
milk, egg, soy, wheat
most common persistent IgE-mediated food allergies
peanuts, tree nuts
diagnosis of food allergies
clinical history, skin prick testing, IgE serum testing
cow’s milk protein allergy in older children
can be more severe, may cause eosinophilic gastroenteritis with protein-losing enteropathy, IDA, etc
diagnostic criteria for IBS
abdominal pain 1 day/week x 2 months with 2 or more criteria: related to defecation, change in stool frequency, change in stool form
medications for IBS
anti-diarrheals, laxatives, antispasmodics, antidepressants
IBS non-medication treatment
stress relief, peppermint, low-FODMAP diet
which SSRI is commonly used for functional GI disorders
citalopram
which tricyclic is commonly used for functional GI disorders
amitriptyline
what must be done prior to initiation of amitriptyline
get an EKG
what beta blocker is commonly used for functional GI disorders
propranolol
testing when evaluating for functional GI disorders
CBC w/ diff, UA, celiac panel, stool studies, thyroid, abdominal US, endoscopy
what stool study tests for inflammation
calprotectin
abdominal migraine presentation
episodic, incapacitating mid-abdominal pain lasting at least 1 hour with weeks-months in between episodes, with other migraine ssx (pallor, photophobia, N/V, HA)
functional abdominal pain presentation
episodic or constant abdominal pain not explained by another disorder, associated with stress
