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Pediatrics > Gastroenterology II > Flashcards

Gastroenterology II Flashcards

1
Q

Bristol Stool - Type 1

A

separate hard lumps (like nuts)

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2
Q

Bristol Stool - Type 2

A

sausage-shaped but lumpy

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3
Q

Bristol Stool - Type 3

A

sausage like with cracks on surface

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4
Q

Bristol Stool - Type 4

A

smooth and soft sausage or snake

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5
Q

Bristol Stool - Type 5

A

soft blobs w/ clear-cut edges

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6
Q

Bristol Stool - Type 6

A

fluffy pieces w/ ragged edges - a mushy stool

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7
Q

Bristol Stool - Type 7

A

entirely liquid - no solid pieces

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8
Q

6 causes of diarrhea

A
  • abnorm. cell transport (dysentery)
  • decr. surface area- flat villi
  • incr. motility
  • incr. osmotically active molecules
  • incr. permeability (damage)
  • toxins or cytokines
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9
Q

causes of acute diarrhea

A
  • infection: viral, bacterial, parasite
  • antibiotics (loss of normal flora)
  • food allergen
  • toxin
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10
Q

MC age range for chronic nonspecific diarrhea

A

-MC 6mo - 2yr

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11
Q

s/s of chronic nonspecific diarrhea

A
  • 3-6 loose, often mucous per day

- not sick - still thriving

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12
Q

contributing factors to chronic nonspecific diarrhea

A
  • high carb, high juice diet

- high incident of functional bowel dz in family

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13
Q

tx of chronic nonspecific diarrhea

A

-dietary intervention:
high fat
lower carb
moderate fiber

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14
Q

diarrhea common after GI infection (post-infectious)

A

diarrhea of malnutrition or starvation

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15
Q

diarrhea of malnutrition or starvation secondary to this

A

malabsorption

  • changes in intestinal flora (give probiotics)
  • decreased disaccharidise activity
  • altered motility
  • diminished pancreas fx, bile acid production
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16
Q

causes of acute diarrhea w/ blood or mucus

A
  • bacterial enteritis (shiga toxin, salmonella, shigella, e coli)
  • intussusception
  • hemolytic uremic syndrome (HUS)
  • pseudomembranous colitis
  • IBD
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17
Q

clinical definition of constipation

A

2 or fewer stools/week or hard and pellet-like stools at least 2 weeks

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18
Q

DDx for constipation

A
  • functional constipation (MC & benign)
  • intestinal malformation
  • peripheral nerve problem
  • muscular (cerebral palsy, MD)
  • endocrine issue (altered fluid absorption in bowel)
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19
Q

functional constipation

A

passing stool uncomfortable - child withholds stool - infrequent passing of large stools - more withholding - encopresis

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20
Q

encopresis

A

large retained bulk of stool allowing passage of liquid stool only

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21
Q

Tx of functional constipation

A

clean from below, then above

  • mineral oil enema
  • oral osmotic agents/fiber
  • dietary change: limit dairy, processed foods; more whole foods and fiber
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22
Q

Hirshprung disease

A

failure of ganglion cells to migrate to distal bowel - segment dysfunctional w/ spasm or obstruction

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23
Q

when to suspect Hirshprung

A

stool not passed w/in first 24 hours of life or hx of reduced stool frequency

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24
Q

Dx of Hirshprung

A
  • anal manometry to diagnose

- rectal biopsy confirms

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25
Q

Tx of Hirshprung

A

surgical resection

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26
Q

pathologic causes of constipation

A
  • anorectal malformation: deformity of failure to pass meconium
  • cystic fibrosis: lack of normal pancreatic enzymes produces abnormal stool
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27
Q

anorectal malformation Tx

A

urgent colostomy then surgical reconstruction after 1 y/o

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28
Q

GI bleeding -

causes of blood in emesis

A

blood in stomach powerful emetic

  • maternal blood from breastfeeding
  • gastritis, food allergy, NSAIDs
  • AV malformation, esophageal varices
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29
Q

GI bleeding -

causes of rectal bleeding

A
  • ingested blood, rectal fissure
  • rectal fissure, food allergy, bacterial dysentery
  • rectal polyp, Meckel diverticulum, IBD
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30
Q

non-GI sources of ingested blood

A
  • oral cavity
  • pulmonary
  • nasal bleeding
  • pneumonia
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31
Q

how to confirm blood

A

hemoccult

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32
Q

Tx of GI bleeding

A
  • determine source of blood
  • diet change/PPI if gastritis suspected (food allergy)
  • Gastroenterologist if serious bleed suspected
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33
Q

when teething behavior and first tooth appear

A

behaviour: 4-7mo
tooth: 4-8mo

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34
Q

how to treat teeth present at birth

A

wiggle them out or see pediatric dentist

35
Q

Tx of teething pain

A

oral pain relievers better than topical

36
Q

when absence of teeth a concern

A

12mo - hypothyroidism, rickets, genetic disorder

37
Q

predictor of infant protective oral flora

A

maternal oral flora

38
Q

failure of midline facial structures to fuse

A

cleft lip and palate

39
Q

causes of cleft lip/palate

A
  • strong genetic component
  • EtOH and tobacco
  • medications
40
Q

Tx of cleft lip/palate

A

surgical intervention usually starting by 3mo of age

41
Q

common infection in young infants caused by candida albicans

A

oral thrush

42
Q

cause of oral thrush

A
  • muted B cell response to infection
  • typical in newborn/young infant
  • S/E of steroids
43
Q

oral thrush Tx

A
  • topical anti fungal - Nystatin or Clotrimazole

- oral anti fungal for persistent/severe infections

44
Q

when to Tx gastroesophageal reflux

A
  • increasing irritability
  • symptoms of aspiration
  • inadequate weight gain from loss of calories
  • age > 18 mo
45
Q

Tx of gastroesophageal reflux

A 
mild:
   - elevate head w/ feeding
   - sm. freq. feedings w/ freq. burping
   - thickened feedings
   - H2 blocker/PPI
aspiration or no weight gain:
   - oral meds
   - GI referral
   - surgical intervention
   - Nissen fundoplication (surgical tx)
46
Q

causes of GER in older children

A
  • reduced tone in LES
  • transient relaxation of LES
  • abnormal gastroesophageal junction
  • increased intra-abdominal pressure
47
Q

S/s of GER in older child

A

recurrent/persistent abdominal or retrosternal pain

48
Q

Dx of GER in older child

A
  • barium swallow
  • pH probe
  • endoscopy w/ biopsy
49
Q

acid related injury of esophagus, stomach, or duodenum

A

peptic disease

50
Q

risk factors of peptic disease

A
  • H. pylori (>50%)
  • NSIADs
  • IBD, pancreatitis, malrotation, biliary disease
51
Q

S/s fo peptic disease

A
  • epigastric and retrosternal pain

- often relieved by eating - but only for a short time

52
Q

Tx of peptic disease

A
  • PPI
  • treat H. pylori
  • endoscopy for non-responders
53
Q

VACTERL

A

esophageal atresia / tracheoesophageal fistula

assoc. syndromes
- vertebral anomalies
- anal
- cardiac
- tracheoesophageal fistula (TEF)
- renal
- limb

54
Q

clinical clue to esophageal atresia / tracheoesophageal fistula

A

single artery in umbilicus - choking w/ every feeding

55
Q

S/s of esophageal atresia / tracheoesophageal fistula

A
  • drooling infant
  • poor feeding
  • high aspiration risk
56
Q

Tx of esophageal atresia / tracheoesophageal fistula

A

surgery to repair TEF allows food to pass - poorly functioning esophagus

57
Q

hypertrophic gastric outlet muscle - progressive gastric obstruction

A

pyloric stenosis

58
Q

S/s of pyloric stenosis

A
  • forceful vomiting
  • severely hungry, irritable
  • dehydrated and hypoglycemic
59
Q

Dx of pyloric stenosis

A

abdominal US

60
Q

Tx of pyloric stenosis

A
  • hydrate and stabilize

- pyloromyotomy: surgery to reduce pyloric muscle

61
Q

malrotation of bowel during development leads to increased risk of this

A

midgut volvulus - twisting of small bowel

62
Q

S/s of volvulus

A

more common vomiting and abdominal pain

63
Q

Dx of volvulus

A
  • AXR shows obstruction

- UGI w/ barium shows absence of C-loop of duodenum

64
Q

Tx of volvulus

A

GI consult - surgical resection of any necrotic bowel

65
Q

one or more segments of bowel missing completely

A

intestinal atresia

66
Q

S/s of intestinal atresia

A
  • polyhydramnios in utero
  • abdominal distention
  • bilious vomiting as neonate
67
Q

Tx of intestinal atresia

A

surgical correction required

68
Q

abdominal wall defect - contents not covered by peritoneum and outside cavity

A

gastroschisis (assoc. w/ atresia)

69
Q

abdominal wall defect at umbilicus - bowel in umbilicus during development - contents covered w/ peritoneum and amniotic membranes

A

omphalocele (assoc. w/ Beckwith Widemann syndrome)

70
Q

abnormal or absent anal opening at birth

A

anorectal malformation

71
Q

anorectal malformation Tx

A

colostomy then later correction

72
Q

remnant of fetal emphalomesenteric duct - outpouching of distal ileum

A

Meckel Diverticulum

73
Q

S/s of Meckel Diverticulum

A

MASSIVE painless GI bleed d/t acid secretion by ectopic gastric mucosal tissue

74
Q

Dx of Meckel Diverticulum

A

Meckel scan - labeled technetium shows acid producing mucosa

75
Q

Tx of Meckel Diverticulum

A

resection of abnormal tissue

76
Q

telescoping bowel into downstream bowel

A

intussusception

77
Q

S/s of intussusception

A
  • sudden onset of severe crampy pain about every 15 min
  • pain becomes more constant
  • edematous bowel
78
Q

Dx of intussusception

A

abdominal US

79
Q

Tx of intussusception

A

air enema or surgical reduction/resection

80
Q

MC surgical emergency in childhood

A

appendicitis

81
Q

S/s of appendicitis

A
  1. periumbilical pain followed by NAV
  2. pain localizes to RLQ
  3. voluntary then involuntary guarding
82
Q

Tx of appendicitis

A

surgery

83
Q

failure of development of diaphragm - abdominal organs reside in chest leading to pulmonary hypoplasia

A

congenital diaphragmatic hernia

Pediatrics (13 decks)

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