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Peds Exam 1 (Lauren) > Gastroenterology đŸ§» > Flashcards

Gastroenterology đŸ§» Flashcards

1
Q

Name some diarrhea red flags

A

Fever

Blood in stool

Dehydration

Leukocytosis

Persistent symptoms

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2
Q

What is the big deal if a child holds their poop in

A

Stool may become impacted, and then encopresis may occur (poop builds up until it leaks out involuntarily)

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3
Q

What are the 2 main types of inflammatory bowel disease?

A

Crohn

Ulcerative colitis

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4
Q

What is the most common congenital anomaly of the GI tract?

A

Meckel’s diverticulum

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5
Q

How do you treat constipation?

A

Fluids

Gradual increase in fiber

Juice for infants

If encopresis, relieve impact ion if present

Constipation meds miralax, lactulose, enemas, suppositories, etc

Counseling and positive reinforcement

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6
Q

When is diarrhea considered “chronic”

A

If it goes on for more than 1 month

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7
Q

What is the fiber recommendation for a children under 2?

A

5g/day

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8
Q

What causes damage when someone has a meckel’s diverticulum?

A

Gastric acid is produced there and causes damage and bleeding

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9
Q

What is the most common cause of infectious diarrhea?

A

VIRAL ****

(Norovirus, rotavirus, adenovirus, calcivirus)****

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10
Q

Which imaging study is diagnostic AND therapeutic for intussusception?

A

Hydrostatic/pneumatic enema

Unfolds telescoping 90% of the time

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11
Q

What is the first line treatment for GERD?

A

Lifestyle modifications

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12
Q

How do you diagnose a Meckel’s diverticulum?

A

Technetium-99 scan (Meckel’s scan)**

Nuclear medicine scan identifies gastric mucosa in the places it’s NOT suppsed to be!

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13
Q

What is the clinical presentation of appendicitis?

A

Anorexia

Migrating abdominal pain (belly button to RLQ)

Pain increases with movement

Vomiting

Fever

Peritoneal signs- guarding, rebound tenderness, rovsing, obturator, iliopsoas signs

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14
Q

What will you see on ultrasound of a baby with pyloric stenosis?

A

Elongation and thickening of the pylorus

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15
Q

How old are babies that get infantile hypertrophic pyloric stenosis?

A

3-6 weeks old

VERY YOUNG

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16
Q

What are the clinical presentations of meckels diverticulum?

A

PAINLESS rectal bleeding ***

Obstruction (volvulus or intussusception)

Diverticulitis

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17
Q

What should you be thinking if the baby does not pass meconium

A

Bowel obstruction

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18
Q

What are the RED FLAGS for a patient with constipation?

A

Weight loss/ FTT

Anorexia

Fever

Hematochezia

Vomiting

History of delayed meconium passage

Acute onset

Failure to respond to conservative measures

(This was in red)

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19
Q

Who is more likely to be affected by Hirschsprung disease?

A

Males

Down syndrome pts

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20
Q

Where do you need to start with imaging if you suspect midgut malrotation?

A

Abdominal X-Ray -rule out bowel perforation

If not perforated, then you’re good to go ahead and get an upper GI contrast study - gold standard for mm

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21
Q

What is another name for Hirschsprung Disease?

A

Congenital Aganglionic Megacolon*******

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22
Q

What condition do “unhappy spitters” have?

A

GERD

Happy spitters have GER

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23
Q

Is reflux in babies common?

A

Yes common in infants 6 months and less

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24
Q

How do you diagnose Hirschsprung disease?

A

Contrast enema

Rectal biopsy- GOLD STANDARD

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25
Q

What will you see on an abdominal x ray if the baby has intestinal atresia in the jejunoileal/colonic areas

A

Dilated loops of bowel with air-fluid levels

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26
Q

What kind of a diet would cause a kid to develop functional constipation’/

A

No fiber

Too much dairy

Not enough water

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27
Q

Can congenital intestinal atresia be detected on ultrasound before the baby is born?

A

Yes

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28
Q

What is the initial test of choice when you suspect intestinal intussusception ?

A

Abdominal ultrasound

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29
Q

What are some of the complications of infantile hypertrophic pyloric stenosis that may occur as the disease progresses

A

FTT

Dehydration

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30
Q

What is the classic clinical presentation of midgut malrotation +/- volvulus

A

Vomiting- bilious green or fluorescent yellow

Abdominal pain

Hemodynamic instability

Hematochezia (sign of bowel ischemia)

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31
Q

How does smoking affect the risk for Crohn disease and UC?

A

2x increase risk for Crohn

50% decrease in risk of UC

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32
Q

What happens if your patient has intussusception and the hydrostatic enema didnt do anything

A

Must intervene surgically

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33
Q

Would you expect growth failure and delayed puberty to be signs of an inflammatory bowel disease?

A

Why yes you would

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34
Q

What will you see on the upper GI contrast study if the patient has midgut malrotation?

A

Corkscrew appearance of duodenum**

Duodenal obstruction

Displacement of the duodenum

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35
Q

What is the rule of 2’s regarding Meckel’s diverticulum?

A

2% of the population

2:1 M:F ratio

2% develop complications (usually before age 2)

2 feet from the ileocecal valve

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36
Q

What is a 2nd test you can order to diagnose pyloric stenosis if the ultrasound was non-diagnostic?

A

Upper GI Barium contrast study

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37
Q

What are you thinking:
-bile stained vomiting in first 48 hrs of life

  • Abdominal distention
  • failure to pass meconium
A

Congenital intestinal atresia

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38
Q

What will you find on physical exam on a baby with infantile hypertrophic pyloric stenosis

A

An “Olive like” mass in RUQ

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39
Q

What is the FIRST line treatment for relieving a fecal impaction for a constipated kid with encopresis?

A

Polyethylene glycol (Miralax)

**THIS HAD A BLUE STAR*****

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40
Q

What pat of the GI tract is affected by Crohn disease?

A

TRANSMURAL inflammation from your mouth to your asshole

The ~entire!~ GI tract may be affected

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41
Q

What are some possible causes of chronic diarrhea?

A

Celiac disease

Allergies

Malabsorption (ex Cystic fibrosis)

Toddlers diarrhea (fruit juice)

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42
Q

What kind of vomiting will a baby with infantile hypertrophic pyloric stenosis have?

A

Nonbilious (obstruction is before biliary grr)**

Projectile vomiting**

RIGHT AFTER eating**

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43
Q

What will you see on an abdominal x ray if a baby has intestinal atresia in the ~duodenum~?

A

Double Bubble Sign **

Due to gas and dilation in both stomach and duodenum

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44
Q

You’re working in the ER and a 12 year old rolls in and you take one look at him and say, “slam dunk its appendicitis”

Can you send him to surgery without even doing any imaging?

A

Yes

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45
Q

Do we do surgery for kids with IBD

A

Yes for refractory cases

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46
Q

When are kids most likely to start refusing to poop and causing themselves to get functional constipation?

A

Intro to solid foods or cows milk

Toilet training

Starting kindergarten

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47
Q

What is the surgical treatment for midgut malrotation?

A

Ladd procedure

Bowel is untwisted and repositioned in abdomen which creates “adhesions” that hold the bowel in place

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48
Q

What is the most common cause of intestinal emergency in kids under 2

A

Intussusception

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49
Q

What should you be worried about if a baby is irritable, has dystonic neck posturing, refusing feeding, FTT, respiratory complications and may have occult blood in stool?

A

GERD

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50
Q

What are some diarrhea red flags? (This might be more than something viral)

A

Fever

Severe abdominal pain

Blood in stool

Recent antibiotics

Persistent symptoms

Dehydration

Leukocytosis

Growth and development affected

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51
Q

Who are the “hungry vomiters”?

A

Babies with infantile hypertrophic pyloric stenosis

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52
Q

How do you diagnose celiac disease?

A

IgA antibodies to tissue transglutaminase

Small bowel biopsy

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53
Q

Leakage of retained stool seen commonly in kids with chronic constipation=?

A

Encopresis

54
Q

What is the definition of diarrhea?

A

> 3 loose watery stools/day

đŸ§»đŸšœđŸ’§

55
Q

What is the most common pediatric surgical emergency?

A

Appendicitis

56
Q

What would you see if you looked at the intestines of someone affected by Crohn disease?

A

Cobblestone appearance***

Skip lesions*

Perianal fissures/fistulas

57
Q

What are some of the medications that may be used for treating inflammatory bowel diseases?

A

Aminosalicylates: 5-ASA (Sulfasalazine, Mesalamine)

Immunomodulating agents (Mercaptopurine, azathioprine, methotrexate) or Biologics (Remicade, Inflixamad)

Steroids- especially in acute flare

+/- antibiotics

58
Q

Who is most likely to get infantile hypertrophic pyloric stenosis?

Males/females

First born/second born

A

First born males

59
Q

Is constipation a common problem for kids

A

Yes, it affects 30%of children

60
Q

What kind of tissue is in meckel’s diverticulum?

A

Intestinal epithelium

Gastric epithelium (WTF wait what you mean you have stomach tissue in your small intestine that is producing gastric acid in a totally inappropriate spot?!?!?!?!)

61
Q

What is the treatment for a meckels diverticulum?

A

Surgical resection (excellent prognosis)

62
Q

What are some possible causes for organic constipation (aka the kid isn’t holding it in on his own and its not his diet)

A

Anal stenosis

Hypothyroidism

Celiac disease

Hirschsprungs

HYPERkalemia

Cystic fibrosis

63
Q

What does encopresis mean?

A

SEEPING STOOL*****

64
Q

What will you find on physical exam of a pt with Hirschsprung disease?

A

Abdominal distention

TIGHT ANAL SPHINCTER*****

Postive squirt sign 👉

65
Q

Continuous, red, friability in rectum and large colon=

A

Ulcerative colitis

66
Q

What age group is most likely top get appendicitis?

A

10-20 yr olds

RARE before 5

67
Q

Is it possible for inflammatory bowel diseases like Crohn and UC to affect places other than the intestines?

A

Yes.

Mouth, skin, joints, liver, eye, etc

68
Q

TRANSMURAL inflammation from mouth to anus, skip lesions=

A

Crohn disease

69
Q

Embryonic remnant of the vitelline duct that can cause GI bleed=

A

Meckel’s diverticulum

70
Q

When are most cases of Hirschsprung disease discovered?

A

Before 6 weeks of age

71
Q

What is the prognosis for GERD?

A

Usually goes away in 9-12 months because the baby is sitting up when its fed

72
Q

What kind of vomiting will a bay with congenital intestinal atresia have?

A

Bile-stained within the first 48 hours of life

73
Q

Is the classic triad of intestinal intussusception seen in every patient?

A

No, less than 15% of patients with intussusception have the triad

74
Q

Why is bilious vomit an emergency?

A

It indicates an OBSTRUCTION

Malrotation, or congenital intestinal atresia

75
Q

Which one is an emergency:
Bloody vomit

Bilious vomit

A

Bilious

76
Q

What can cause midgut malrotation?

A

Incomplete rotation of the midget during embryonic development

77
Q

What the HELL is Hirschsprung disease?

A

There are NO ganglion cells in the colon which causes:

Spasm and abnormal motility

Colon does not relax= obstruction

Rectum and sigmoid colon are constricted

Areas behind the constriction get swollen

78
Q

What are skip lesions and what type of IBD are they associated with?

A

Areas in the intestine that look totally NORMAL (not really a lesion at all)

Associated with Crohn

79
Q

What kinds of lifestyle mods may be helpful for GERD?

A

UPRIGHT positioning for 30 min after feeding (sitting STRAIGHT up, not in a bouncer or whatever)

Hypoallergenic diet

Don’t overfeed

Avoid cigarette smoke

Thickened milk with cereal

80
Q

What will you see on contrast enema in Hirschsprung disease?

A

A “transition zone” where the narrowed aganglionic segment dilated to the proximal colon

81
Q

What will you see on rectal biopsy of Hirschsprung disease?

A

Absence of ganglion cells

82
Q

What causes the bleeding when someone has a meckels diverticulum?

A

Mucosal ulceration

83
Q

How do you manage congenital intestinal atresia?

A

Withhold feeding

Antibiotics

Surgery

84
Q

Are routine stool cultures recommended for most cases of diarrhea?

A

NO *****

85
Q

How do you treat acute diarrhea?

A

HDYRATION ALWAYS

Antibiotics sometimes

Anti-motility agents rarely

86
Q

What the F is a squirt sign?

A

If a finger is inserted into the rectum of a pt with hirschsprungs, the obstruction is relieved and there is an explosive release of gas and stool when the finger is removed đŸ„œ

87
Q

Periumbiuliucal pain, +rovsings, obturator, Psoas, McBurney’s point tenderness =

A

Appendicitis

88
Q

What is the recommended fiber intake for kids over 2?

A

(Childs age) + 5-10g

So a 10 year old should be getting 15-20g of fiber/day

89
Q

What is the classic presentation of Hirschsprung disease?

A

Newborn failing to pass meconium in first 48 hours of life*****

Bilious vomiting

Abdominal distention

90
Q

How do older children present with Hirschsprung disease?

A

Chronic constipation

FTT

(The later the diagnosis, the less severe the disease)

91
Q

One or more segments of bowel may be absent or obstructed at birth=?

A

Congenital intestinal atresia

92
Q

Is the treatment of inflammatory bowel diseases like crohn and UC a “one size fits all” approach?

A

NO
“Choice of treatment varies based on the severity of disease”

This was written twice in blue

93
Q

Which part of the bowel is most commonly affected by congenital intestinal atresia?

A

Duodenum

94
Q

What will you see on an UGI Barium contrast study in a baby with pyloric stenosis

A

“String sign”

Which is the narrowed lumen of the pylorus

95
Q

Should we give kids with diarrhea Imodium?

A

Not recommended

96
Q

What would you expect to see if you looked at the rectum and colon of someone with UC?

A

CONTINOUS (no skip lesions) edema, erythema, friability, and ulceration

97
Q

What are the thoughts on giving antibiotics to well-appearing children who have acute bloody diarrhea?

A

Should NOT be used unless a specific pathogen has been isolated (don’t want to induce HUS)

98
Q

What part of the GI tract is affected by ulcerative colitis?

A

Rectum and large colon

Mucosal layer ONLY

(Inflammation STARTS at the rectum and moves proximally into the colon)

99
Q

What is the gold standard test to detect midgut malrotation

A

Uppper GI contrast study

100
Q

What kids of findings suggest that constipation is from an organic cause and not functional?

A

Failure to pass meconium

FTT

Abdominal distention

Lumbosacral problems

Neurological abnormalities

Anteriorly placed anus ?

Occult blood in stool

101
Q

What is the DEFINITIVE MANAGEMENT of pyloric stenosis?

A

Surgery- “pyloromyotomy”

102
Q

What are you supposed to feed a baby that is allergic to milk or soy?

A

A hydrolyzed or free amino acid based formula (Ex: Nutramigen)

103
Q

Why don’t we pump kids with IBD full of steroids

A

Concern for bone density, growth and development

104
Q

What is the most common cause of a “lead point” that causes intestinal intussusception

A

Meckels diverticulum

105
Q

What is congenital intestinal atresia?

A

One or more segments of bowel are absent or obstructed at birth

106
Q

There is an association between infantile hypertrophic pyloric stenosis and ______________

A

Macrolide antibiotics during the first few weeks of life

Azithromycin, erythromycin, clarithromycin in case you forgot

107
Q

Which is bad:

GER or GERD

A

GERD is bad

GER is normal happy babies spitting up

108
Q

6 month old with abdominal pain and currant jelly stools=

A

Intussusception

109
Q

What will you see on ultrasound if patient has intussusception?

A

Target Sign

Coiled Spring

110
Q

What is the cause of 95% of pediatric constipation?

A

Functional constipation (psychological or diet reasons)

111
Q

How do you treat Hirschsprung disease?

A

Surgical resection of the aganglionic segment of colon.

Overall a good prognosis

112
Q

Abnormal position of the intestines in the abdomen that increase the risk of volvulus

A

Midgut malrotation

113
Q

What are some possible signs and symptoms that a kid might have celiac disease, other than diarrhea?

A

FTT*

Anemia

Foul smelling stools

114
Q

What is the classic triad of intestinal intussusception?

A

Abdominal pain

Abdominal mass (sausage shaped)

Currant jelly stools (blood + mucus)

****this was red and had a blue star

115
Q

What is a major risk of a malrotation?

A

Volvulus- where the small bowel twists around the superior mesenteric artery= HUGE RISK of small bowel ischemia!!!

EMERGENCY!!!!***

116
Q

What is this:

“Vitelline duct (embryonic remnant) leads to formation of a congenital outpouching of the small intestine”

A

Meckel’s diverticulum

117
Q

After surgery for midgut malrotation, is recurrence common?

A

No

118
Q

Which rotavirus vaccine was taken off the market due to a 22x risk of intussusception

A

Rotashield

🛡

119
Q

What kinds of things in a kid’s diet might cause diarrhea?

A

Fruit juice- Functional “Toddler’s” diarrhea

Milk/soy enteropathy (allergy)

120
Q

What kinds of medications are used for GERD in kids who don’t get better with lifestyle mods?

A

PPI (Omeprazole)

H2 blocker (Ranitidine)

121
Q

Congenital aganglionic megacolon, rectal biopsy is the gold standard=

A

Hirschsprung

122
Q

What is this:

“Immune mediated inflammatory disease of the small intestine caused by gluten sensitivity”

A

Celiac disease

123
Q

What should you do if your patient has GER?

A

Nothing, because it is a normal physiologic process that declines with age without ANY complications or consequences

124
Q

If you see a test question that has a 1st born 3 week old baby boy, who is always hungry, and projectile vomits immediately after eating, what is the answer

A

Infantile hypertrophic pyloric stenosis

125
Q

Intestinal atresia is more common in patients with these two conditions:

A

Cystic fibrosis

Down syndrome

126
Q

What causes intestinal intussusception?

A

Idiopathic 75% of the time

“Lead point” 25% - lesion/variation in the intestine gets dragged by peristalsis into a distal segment.

127
Q

What is the TEST OF CHOICE for diagnosing infantile hypertrophic pyloric stenosis?

A

Ultrasound

128
Q

How do you diagnose crohn disease

A

Colonoscopy*

129
Q

5 week old, hungry, with projectile vomiting=

A

Pyloric stenosis

130
Q

Is there an increased risk of colon cancer if you have UC?

A

Yes

131
Q

Whyyyyyyyyy do you need to evaluate a child with constipatin

A

You need to rule out an anatomic or biochemical cause

Peds Exam 1 (Lauren) (4 decks)

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