Final lecture 9

Question 1

When can children swallow tablets and capsules

Answer 1

7-8 yo

Question 2

Compare GER and GERD

Answer 2

GER (gastroesophageal reflux)- is the passage of gastric contents into the esophagus
GERD(gastroesophageal reflux disease) gastric reflux causes troublesome symptoms or complications

Question 3

What is GER caused by

Answer 3

Relaxation of lower esophageal sphincter

Question 4

symptom difference between infants and Children older than 4

Answer 4

Infants with reflux may be happy spitters or may be fussy.
Children older than 4 yo have classic heartburn symptoms similar to adults

Question 5

GERD symptom in infants

Answer 5

1)Gastrointestinal
Regurgitation
feeding difficulties

2)Extra-intestinal
Irritability
back arching
persistent cough

Question 6

Symotims of GERD in children

Answer 6

Heartburn
vomiting
regurgitation
dysphagia
chest pain

Question 7

alarm symptoms for when to refer

Answer 7

Bilious or projectile emesis
GI bleeding/hematemesis
vomiting beginning after 6 months of age
difficulty swallowing
fever
diarrhea/constipation

Question 8

non-pcol therapy for infant patients

Answer 8

feeding changes- thickening of food, increasing caloric density of feeds while decreasing volume

Positioning therapy- Keep upright after feeds.
Elevate head of bed

Lifestyle changes
Frequent burping, weight reduction, smaller or more frequent feeding

Question 9

Treatment of GERD in older children

Answer 9

Diet/ positional modifications (same as infant)
Consider antacids for short term relief
Consider PPI for classic reflux symptoms

Question 10

When do we consider using pharmacologic therapy in infants

Answer 10

Lifestyle mods not improving symotoms

Question 11

What do we consider failure of lifestyle mods

Answer 11

no gain weight after 2-4 weeks

Question 12

What are some available agents for pcol therapy of infants

Answer 12

Acid suppressants (H2RAs) (PPIs)
prokinetics
Antacids
consider weining after 4-8 weeks. No stopping suddenly

Question 13

H2RA MOA

Answer 13

competitive inhibition of histamine at receptors on gastric parietal cells, results in decreased acid secretion

Question 14

available agents for H2RA

Answer 14

famotidine

Question 15

MOA of PPI

Answer 15

Irreversibly block gastric H/K/ATPase pumps
selectively inhibit H+ secretions

Question 16

PPI dosing

Answer 16

1 mg/kg/day QD

Question 17

4 main pathways that an trigger vomiting

Answer 17

Bloodborne toxins (medications)
Motion (vestibular pathway)
Mechanical (vagal))
Emotion (fear, anxiety)

Question 18

Fecal impaction

Answer 18

Large fecal mass that is unlikely to be passed on command

Question 19

Encopresis definition

Answer 19

Fecal incontinence

Question 20

Normal stooling patters in infants, toddlers and 4 yo

Answer 20

Infants- 3-4 stools per day
toddler- 2-3 stools per day
4 yo adult patterns

Question 21

treatment of constipation in infants

Answer 21

1st line- glycerin suppositories (do not use for more than 3 days and has an onset of 30 mins)

Question 22

Treatment of constipation in children

Answer 22

1 (dispemaction).

Oral PEG (miralax)
1-1.5 g/kg/day x 3-6 days

2. Maintainence
   PEG (miralax)

If no stool on mainatinence therapy, use Stimulants (senna, bisacodyl)

Question 23

Chronic diarrhea v diarrhea

Answer 23

Chronic is when lasting for more than 14 days
Diarrhea is 3 or more loose stools per day

Question 24

4 major categories of diarrhea in children

Answer 24

Secretory
osmotic
excretory
altered motility

Question 25

Most common infectious disease in childrens diarrhea

Answer 25

Viral

Question 26

Non infectious causes of diarrhea

Answer 26

Malabsorption
short gut
Allergic (lactose intolerance resolves by 12 mo)
Over feeding
medication

Question 27

Most common drug induced cause of diarrhea

Answer 27

Antibiotics

Question 28

if symptoms persist after antibiotics stopped consider______ as cause for infection

Answer 28

C. diff

Question 29

Name of drug that causes diarrhea

Answer 29

Amoxicillin/clauvulanate
Clauvulanate component causes diarrhea

Question 30

Name the standard dose and the high dose of Amoxicillin/clauvulanate

Answer 30

standard dose- 40-50 mg/kg/day of amoxicillin component

High dose- 80-90 mg/kg/day of amoxicillin component

Question 31

Why should we use 600mg-42.9mg/5mL of amoxicillin/clavulanate

Answer 31

Has the highest ratio of amoxicillin to clavulanate
we want to keep clavulanate less than 10 mg/kg/day

Question 32

How do you calculate fluid requirements based on weight

Answer 32

Up to 10 Kg: 100 mL/kg
10-20:1000 mL+ 50 mL/kg for every Kg greater than 10

> 20 kg: 1500 mL + 20 mL/kg for every kg greater than 20