Gastroenterology Flashcards
frequency of GI complaints in pediatrics
2nd MC after respiratory illnesses
type of exam required with GI complaints
complete abdominal
- visual inspection
- distention, discoloration, veins, jaundice, scars, ostomies
- auscultation
- normal, hypo/hyper, absent, high pitched
- palpation
- organomegaly, retained feces, masses
- rectal exam
- masses, fissures, abscesses, fistulas, rectal tone, content
abnormal visual exam of abdomen
- line of differentiation at ribs
- abnormal venous pattern
question to ask parent of child with frequent/persistent abdominal pain
Can you tell when the child is in pain,
or only if they tell you?
(child usually not functional if > 6/10 pain)
causes of acute vs. gradual pain
acute - obstruction, rupture
gradual - inflammatory: appendicitis, inflammed bowel
acute abdominal pain
labs
- CBC
- CRP
- ESR
- pregnancy
- UA
- AST/ALT/GGT, bilirubin
acute abdominal pain
imaging
- abdominal xray/series
- CT
- US
- endoscopy
- flouroscopy w/ contrast
non-surgical DDx of acute abdominal pain
- viral illness
- acute gastroenteritis
- food intollerance
- pneumonia
- gastritis (food related or post-infectious)
- constipation
- UTI
peak incidence ages of chronic abdominal pain
7-12
chronic abdominal pain
warning signs of underlying illness
- vomiting
- fever
- growth failure/weight loss
- blood in stool or emesis
- abnormal labs
- bilious emesis
- pain wakens child from sleep
- location other than periumbilicus
chronic abdominal pain
when to assess
anxious chid/parent, missed school
chronic abdominal pain
history to examine
- family Hx GI
- family Hx anxiety
- diet - too much of one, not enough of another
- lifestyle - sleep, meals, school, stressors
chronic abdominal pain
PE key check
sick vs. not sick
(determines urgency)
chronic abdominal pain
labs
- CBC
- ESR/CRP
- ALT/AST, GGT, bilirubin
- amylase/lipase
- UA
- address psych issues
2 common causes of chronic abdominal pain
- functional abdominal pain
- daily pain not assoc. w/ meals or BMs
- anxious/perfectionist
- “bounce back” after few min. of rest
- no warning signs of serious illness
- IBS
- alternating diarrhea and constipation
Tx of functional abdominal pain
- r/o possible causes first
- look at dietary intolerances
- do not treat as sick - avoid meds d/t placebo effect and subsequent need for more meds
these signs NOT okay in neonates
vomiting and diarrhea
(rarely typical cause, 24hrs gives significant dehydration)
causes of vomiting in neonate
- obstrutction - deadly
- stomach, sm. bowel, malrotation, imperforate anus
- metabolic disorder - deadly
- feeding intolerance
- ingestion of maternal blood
- blood from mom’s nipples benign
- NOT other
causes of diarrhea in neonate
*newborns normally have liquid, explosive stools
- protein allergy
- watery stools soaking diaper
- positive occult blood
- overfeeding
- malabsorption
causes of vomiting in infant/child
gastrointestinal virus
(accute onset, associated fever)
Sx of acute gastroenteritis
- abrupt onset of severe vomiting
- diarrhea follows quickly
- diarrhea watery w/out blood or mucus
Tx of acute gastroenteritis
- time and rehydration
- tablespoon fluid after 1hr without vomiting
- low sugar/artificial sweetner fluids w/ electrolytes
- oral anti-emetics (Ondansetron) if unremitting
acute gastroenteritis
when observation is not enough
- duration
- vomiting 24+ hours
- 10+ days diarrhea
- fever > 48 hours
- 5-10% weight loss or dehydration
- significant abdominal pain
- sick appearing
- blood in emesis
- blood or mucus in stool
“sick” AGE tests
- abdominal xray or US
- for obstruction, mass, intussusception, volvulus
- UA
- infection, glucose, electrolytes, metabolic function, WBCs (abdominal inflammation)
- Lytes, BUN, Creatinine, CBC, blood culture
- stool culture - rapid assay for pathogens
