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X Pediatrics 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What might you think about bloody vomit?

A

Maternal ingestion, esophageal varices or foreign body

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2
Q

What might you think about bilious vomit?

A

Obstruction-urgent!!

malrotation with/without volvulus or congenital intestinal atresia

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3
Q

How do you differentiate between GER and GERD?

A

GER is a happy spitter while GERD is an unhappy spitter
GER: no complications/consequences, normal physiologic process, declines with age (reflux common <6 mos)– no tx
GERD: complications arise, fussy or irritable/feeding refusal, occult blood in stool

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4
Q

Why do sxs of GERD resolve by 9-12 mos?

A

That is when babies are fed more upright

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5
Q

How diagnosis GERD?

A

Usually made clinically
Use hemoccult to look for hidden blood in stool
Endoscopy, upper GI, with severe sxs

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6
Q

1st line tx for GERD

A

Lifestyle modification (upright positioning 30 min after feeding, hypoallergenic diet, not overfeeding, avoid tobacco smoke exposure, thickened feeds)

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7
Q

Roles of meds in GERD

A

Limited role
Consider in pt with refractory sxs or complicated disease
Use short term PPI (omeprazole) vs H2 blocker (ranitidine)

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8
Q

What might cause infantile hypertrophic pyloric stenosis?

A

Genetic predisposition and environmental factors
Associated with macrolide abx during first wks of life
M>F

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9
Q

Classic presentation of pyloric stenosis

A

3-6 wk old infant with forceful vomiting
Nonbilious, “projectile” emesis (immediately after feeding-postprandial)
“Hungry vomiter”
FTT may be later

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10
Q

What might be seen on a physical exam in pyloric stenosis?

A

Olive-like mass in RUQ (indicating hypertrophy)

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11
Q

Diagnosis of pyloric stenosis

A

U/s is test of choice (thickening of pylorus)

Upper GI barium contrast study (string sign showing narrowed lumen)-when u/s is non-diagnostic

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12
Q

Tx of pyloric stenosis

A

Definitive is surgery (pyloromyotomy, IV fluid and electrolyte resuscitation)
Excellent prognosis

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13
Q

Most commonly affected site of congenital intestinal atresia

A

Duodenum

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14
Q

When is intestinal atresia more common?

A

In pts with cystic fibrosis and down syndrome

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15
Q

What is congenital intestinal atresia?

A

One or more segments of bowel may be absent and/or obstructed at birth

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16
Q

When is congenital atresia usually diagnosed?

A

After birth at sx onset (prenatal u/s may provide)

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17
Q

Presentation of congenital atresia

A

Vomiting (may be bile stained-within 48 hrs)
Abdominal distention
Failure to pass meconium (always think bowel obstruction if this happens)

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18
Q

What might be seen on an Xray in congenital atresia?

A

Duodenal atresia: double bubble sign due to gas and dilation in both stomach and duodenum
Jejunoileal/colonic atresia: dilated loops of bowel with air fluid levels (air on top and everything settle to bottom)

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19
Q

Management of congenital atresia

A

Feedings withheld (IV fluids)
Broad spectrum abx to prevent post op infection
Surgical intervention
Good prognosis

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20
Q

What is midgut malrotation?

A

Abnormal positioning of the intestines (increases risk of volvulus)

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21
Q

What is volvulus?

A

Small bowel twists around superior mesenteric artery (risk of small bowel ischemia)

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22
Q

Classic clinical presentation of midgut malrotation and volvulus

A

Vomiting (typically bilious-green or fluorescent yellow)
Abdominal pain
Hemodynamic instability
+/- hematochezia (sign of bowel ischemia)

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23
Q

What is the gold standard test to detect malrotation +/- volvulus?

A

Upper GI fluoroscopic real time x-ray with contrast

Will see displacement of duodenum, obstruction and “corkscrew appearance” or duodenum

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24
Q

Tx of midgut malrotation +/- volvulus

A

Ladd procedure: bowel is untwisted and repositioned in abdomen which creates adhesions to hold bowel in place (prevent ischemia and recurrent sxs)
Resolution of sxs in 90%

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25
Q

What is intussusception?

A

Telescoping of intestine (from rotavirus vaccine)

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26
Q

What is the most common cause of abdominal emergency in kids < 2?

A

Intussusception

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27
Q

Presentation of intussusception

A 
Sudden, intermittent, severe abdominal pain
Abdominal mass (sausage shaped)`
Currant jelly stools
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28
Q

Etiology of intussusception

A

Most idiopathic
Others may be lead point (lesion/variation in intestine, dragged by peristalsis into distal segment)- Meckel’s diverticulum and others

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29
Q

Diagnostic studies for intussusception

A

Initial test of choice: abdominal u/s

Hydrostatic/pneumatic enema is diagnostic and therapeutic (choice if no perforation!)- opens up the telescope

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30
Q

What is the most common pediatric surgical emergency?

A

Appendicitis

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31
Q

Etiology of appendicitis

A

Obstruction of appendiceal lumen leading to inflammation (rare before 5)

32
Q

Clinical presentation of appendicitis

A

Anorexia
Migrating abdominal pain (periumbilical to RLQ)
Vomiting (after onset of pain)
Fever
Signs of peritoneal irritation (guarding, rebound tenderness, rovsing, obturator, iliopsoas)

33
Q

Treatment of choice for appendicitis

A

Appendectomy

34
Q

Definition of diarrhea

A

> 3 looser water stools/day usually for at least 5 days

35
Q

Etiology of most causes of diarrhea

A

Viral (rotavirus, adenovirus, calicivirus, norovirus)

Supportive care

36
Q

Most common cause of gastroenteritis

A

Viral

37
Q

Clinical manifestations of gastroenteritis

A

Diarrhea, vomiting, fever, anorexia, headache, abdominal cramps

38
Q

Red flags with presentation of diarrhea

A

Fever, severe abdominal pain, blood in stool, recent abx, persistent sxs, dehydration, leukocytosis, FTT

39
Q

Reasons for chronic diarrhea (>1 mo)

A

Celiac disease
Allergic
Malabsorption (cystic fibrosis)
Toddler’s diarrhea (6 mos-5 yrs, limit juice intake)

40
Q

How do you diagnose celiac disease?

A

Inflammatory disease of small intestine caused by gluten sensitivity
Diagnose with IgA antibodies to tissue transglutaminase and small bowel bx

41
Q

Are routine stool cultures recommended for diarrhea?

A

Not in most cases (because viral)

42
Q

Tx for acute diarrhea

A

Hydration (oral rehydration solution-pedialyte)
Sometimes abx
Rarely anti-motility agents

43
Q

Why are abx not routinely used in cases of acute diarrhea?

A

Don’t use for well-appearing kids with acute bloody diarrhea unless specific pathogen isolated for risk of HUS

44
Q

2 subtypes of inflammatory bowel disease

A

Crohns and ulcerative colitis

45
Q

Epidimiology of inflammatory bowel disease

A

Peak incidence 15-30

Genetic, environmental and immune factors

46
Q

Presentation of inflammatory bowel disease

A

Diarrhea, abdominal pain, hematochezia (maybe)
Growth failure, delayed puberty
Can have extraintestinal manifestations

47
Q

Presentation of Crohns disease

A

Transmural inflammation (from mouth to anus)
Skip lesions (some normal areas)
Cobblestone appearance
Perianal fissures, fistulas

48
Q

How do you diagnose Crohns disease?

A

Colonoscopy

49
Q

What is ulcerative colitis?

A

Rectum and large colon (mucosal layer only)
Inflammation starts at rectum and extends proximally into colon
Bloody diarrhea is common
Diffuse/continuous edema, erythema, friability, ulceration of colon
*increased risk of colon cancer

50
Q

How to treat inflammatory bowel disease

A

Accelerated step up therapy for most and top down therapy for high risk pts

51
Q

5 components of treatment for inflammatory bowel disease

A

Meds, surgery, nutritional rehab, behavioral health support, colorectal cancer screening for older pts

52
Q

What is the goal of tx for inflammatory bowel disease?

A

Clinical and laboratory remission with mucosal healing, not just symptomatic improvement

53
Q

Kinds of meds to treat inflammatory bowel disease

A

Aminosalicylates (decrease inflammation first line)- sulfasalazine
Immunomodulating agents or biologics
Steroids (primary therapy for acute flare)
Maybe abx

54
Q

Etiology of Meckel’s diverticulum

A

Vitelline duct (embryonic remnant) leads to formation of diverticulum (congenital outpouching of small intestine)

55
Q

When does bleeding occur in Meckel’s diverticulum?

A

From mucosal ulceration

56
Q

Rule of 2s in Meckel’s diverticulum

A

2% of population
2:1 M:F ratio
2% develop complication (before age 2)
2 ft from ileocecal valve

57
Q

Presentation of meckel’s diverticulum

A

Painless rectal bleeding

May see obstruction sxs or diverticulitis that mimics appendicitis

58
Q

Diagnostic studies for meckel’s diverticulum

A

Technetium-99 scan-nuclear med identifies ectopic gastric mucosa in diverticulum (lights up when misplaced gastric tissue)

59
Q

Treatment for meckel’s diverticulum

A

Surgical resection (good prognosis)

60
Q

What must you rule out in constipation?

A

Anatomic or biochemical cause

61
Q

Examples of functional constipation

A

95%
Psychological or psychosomatic
Diet

62
Q

Examples of organic constipation

A

Anal stenosis, hypothyroidism, celiac disease, hirschsprungs, hypercalcemia, cystic fibrosis

63
Q

What can occur when constipation is impacted?

A

Encopresis (seeping stool/incontinence)

64
Q

What is functional constipation?

A

Voluntary withholding of stool

65
Q

Periods when kids are more likely to develop constipation

A

Intro to solid foods or cows milk
Toilet training
Start of school (ages 5-6)

66
Q

Reasons for diet that lead to constipation

A

Lack of fiber
Dairy excess
Poor water intake

67
Q

What might suggest an organic cause for constipation?

A 
Failure to pass meconium
FTT
Abdominal distension or obstructive sxs
Lumbosacral problems, neurologic abnormalities
Anterior placed anus/other alterations
Occult blood in stool
68
Q

What kind of bowel sounds indicate impaction?

A

Hypoactive

69
Q

Red flags for constipation

A

Wt loss, poor weight gain/growth
Anorexia, fever, hematochezia, vomiting
History of delayed passing of meconium (cystic fibrosis)
Acute onset
Failure to respond to conservative measures

70
Q

Management of constipation

A 
Fluids
Gradual increase in daily fiber intake
Decrease dairy intake
Juice-apple, prune or pear
If encopresis, relieve impaction if present (polyethylene glycol/Miralax is first line)
71
Q

What is Hirschprung disease?

A

Congenital absence of ganglion cells in mucosal and muscular layers of colon (colon fails to relax and may lead to obstruction)

72
Q

Classic presentation of Hirschsprung disease

A

Failure to pass meconium in first 48 hrs of life (also may be bilious vomiting and abdominal distention)
Older kids may present with chronic constipation and FTT

73
Q

What is seen on a rectal exam with Hirschsprung disease?

A

Tight anal sphincter leads to squirt sign (explosive release of gas/stool when finger removed)- relieves obstruction temporarily

74
Q

What diagnostic studies are used in Hirschsprung disease?

A 
Contrast enema (localize transition zone of narrowed aganglionic segment to dilated proximal colon)
Rectal biopsy is gold standard for diagnosis (confirms absence of ganglion cells)
75
Q

Management of Hirschsprung disease

A

Surgical resection of aganglionic segment of colon (good prognosis but may have some abnormal bowel function)

X Pediatrics 2 (10 decks)

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