Gastrointestinal Flashcards
1
Q
what is the capacity of a neonate’s stomach?
A
10-20 mL
2
Q
the neonate stomach can tolerate very small amounts of ___________
A
colostrum
3
Q
what is the capacity of an infant’s stomach?
A
30-300 mL
4
Q
why doesn’t reflux hurt infants?
A
low levels of HCl in gastric acid
5
Q
food remains in an infant’s stomach for ______________. Therefore, they eat ____________.
A
short period
eat more frequently
6
Q
breast milk is digested __________
A
quickly
7
Q
iron is digested _____________
A
slowly
8
Q
how are daily fluid requirements calculated?
A
first 10 kg = 100 mL/kg
second 10 kg = +50 mL/kg
> 20 kg = +20 mL/kg
9
Q
how are hourly fluid requirements calculated?
A
first 10 kg x 4 mL/kg
second 10 kg x +2 mL/kg
> 20 kg x +1 mL/kg
10
Q
infants are at very high risk for ___________
A
dehydration
11
Q
what are some signs of dehydration?
A
decreased output
tachycardia
decreased BP
increased RR
headache
thirst
decreased LOC
concentrated urine
< 6 wet diapers/day
8+ hours between voids
dry mucous membranes
sunken eyes
sunken fontanelles
decreased skin turgor
loss of appetite
high pitched cry
12
Q
what an early sign of dehydration?
A
tachycardia
13
Q
what is a late sign of dehydration? why is it late?
A
hypotension
good at compensating
14
Q
what is considered low urine output?
A
< 1 mL/kg/hr
15
Q
what is the treatment for dehydration?
A
mild = oral fluids
severe = IV bolus of NS
16
Q
how much IV fluid (NS) should be given for severe dehydration?
A
10-20 mL/kg
17
Q
what are some clinical manifestations of GI dysfunction?
A
growth failure
regurgitation/spitting up
nausea/vomiting
constipation
diarrhea
abnormal bowel sounds
abdominal distension
abdominal pain
GI bleeding
jaundice
dysphagia
fever
weight loss
18
Q
what are some signs of growth failure?
A
weight < 3rd percentile
BMI < 5th percentile
growth pattern decreased from baseline
19
Q
what are some signs of constipation?
A
bloody stool
abdominal pain
20
Q
what might cause abnormal bowel sounds?
A
inflammation
obstruction
21
Q
what might cause abdominal distension?
A
delayed gastric emptying
accumulation of gas/stool
inflammation
obstruction
22
Q
what are the 3 types of GI bleeds?
A
hematemesis
hematochezia
melena
23
Q
what is hematemesis?
A
bright red
bleeding in upper GI
24
Q
what is hematochezia?
A
bright red
bleeding in lower GI
25
what is melena?
dark tarry stool
bleeding in upper GI
26
jaundice is a sign of ____________
liver dysfunction
27
what are some characteristics of failure thrive?
weight < 2nd percentile
decreased velocity of weight gain
28
what is the Z score for failure to thrive?
-2 = weight < 2nd percentile
29
what are some causes of failure to thrive?
inadequate caloric intake
poor absorption
increased metabolism
decreased utilization
increased loss
30
what are some causes of inadequate caloric intake?
food insecurity
poor appetite
breast milk problems
restrictive eating disorders
neglect
incorrect formula preparation
31
what conditions might cause poor absorption leading to failure to thrive?
crohns
celiac
intestinal obstruction
32
what conditions might cause increased metabolism leading to failure to thrive?
cardiac defects
hypothyroid
33
how is failure to thrive diagnosed?
lab tests
- CBC
- ESR
- electrolytes
urinalysis + culture
34
why do we want CBC + ESR for failure to thrive?
possible immune disorder
inflammatory markers
35
why do we want a urinalysis + culture for failure to thrive?
protein in urine
UTI
36
how is failure to thrive managed?
feed them!
assess how they are feeding
if they don't gain weight --> investigate other causes
37
acute diarrhea
sudden increase in frequency and change in consistency of stools
38
chronic diarrhea
increase in frequency and water content of stools for 14+ days
39
what is the leading cause of illness in children < 5 years? why?
acute diarrhea
put everything in their mouths
poor hand hygiene
40
what are the consequences of gastroenteritis?
dehydration which can lead to shock
acid base imbalance
41
what are the causes of acute diarrhea?
GI infection
URT infection
UTI
antibiotics
laxatives
42
what are the viral causes of GI infections?
norovirus
rotavirus
43
what are the bacterial causes of GI infections?
salmonella
C. diff
E. coli
staphylococcus
44
what is considered acute diarrhea?
3+ watery stools in 24 hours
45
if left untreated, acute diarrhea should resolve in ___________, unless its ________________
14 days
unless its bacterial
46
what are the 2 risks associated with diarrhea?
dehydration
electrolyte imbalance
47
what conditions are associated with chronic diarrhea?
malabsorption
IBD
immunodeficiency
lactose intolerance
48
how is diarrhea managed?
oral rehydration therapy
reintroduce adequate diet
- breast feeding/formula/easily digestible foods
49
how much fluid should be given oral rehydration when managing diarrhea?
5-10 mL q1-5 min
50
what are some easily digestible foods to be reintroduced when managing diarrhea?
cereal
cooked vegetables
meat
51
what are some causes of vomiting?
meningitis
head injuries
surgical procedures
improper feeding technique
stress
infection
52
what is a concerning amount of vomiting for a neonate?
12+ hours
53
what is a concerning amount of vomiting for a child < 2 years?
24+ hours
54
what is a concerning amount of vomiting for children?
48+ hours
55
what are 2 concerning signs with vomiting?
dehydration
green/yellow colour
56
what does green/yellow vomit indicate?
bile
empty stomach
57
what is the management for vomiting?
medications
restore fluids
proper positioning
58
what are the medications for vomiting?
antiemetics
metoclopramide
promethazine
59
what are the 2 antiemetics?
ondansetron
trimethobenzamide
60
what is the MOA of metoclopramide?
increases peristalsis
61
what should be used to restore fluids for vomiting?
glucose-electrolyte solution
62
what is the appropriate positioning for vomiting?
lateral recovery
63
vomiting without nausea is a sign of ______________
brain tumor
64
what system assessments should be done for vomiting?
neurological
GI
65
what are some causes of dehydration?
inadequate intake
vomiting
diarrhea
diabetic ketoacidosis
burns
renal disease
66
what are the 2 compensatory mechanisms for dehydration?
intestinal fluid enters vasculature
vasoconstriction
67
how often should vitals be assessed with dehydration?
q15-30 min
68
how often should newborns be voiding in their first 24 hours?
once
69
how often should newborns be voiding in their first 2 days?
twice
70
how often should newborns be voiding in their 3rd-4th days of life?
3-4 times
71
how often should infants be voiding in their 5th day of life?
6 times
72
how often should infants < 1 year be voiding?
q1-2 hours
73
how often should toddlers be voiding?
q3 hours
74
what are the 3 types of causes of constipation?
secondary to other disorders
idiopathic
chronic
75
what are some other disorders that cause constipation?
strictures
ectopic anus
Hirschsprung disease
hypothyroidism
hypercalcemia
lead poisoning
76
what medications can cause constipation?
antacids
diuretics
antiepileptics
antihistamines
opioids
iron supplements
77
what causes constipation in newborns?
imperforated anus
78
when should a newborn pass their first meconium stool?
within first 24-36 hours of birth
79
what should be assessed if a newborn does not pass meconium stool?
intestinal stenosis
Hirschsprung's disease
hypothyroidism
meconium plugs
meconium ileus
80
what is a meconium plug?
meconium with low water content
81
what is meconium ileus?
obstruction of intestine due to abnormal meconium
82
meconium ileus is a manifestation of _____________
cystic fibrosis
83
what causes constipation in infants?
diet
84
constipation is more common in _____________ fed than _____________ fed. Why?
more common in bottle/formula fed than breast fed
breast fed have fewer and softer stools
85
constipation in formula fed infants is related to __________
iron
86
what are the causes of constipation in childhood?
environmental
(fear of using public washrooms)
normal development
(start holding it in)
painful
toilet training
87
what are the interventions for constipation?
fibre
fluids
stool softeners
prunes
88
what are some stool softeners?
docusate
lactulose
PEG 3350
89
what is encopresis?
involuntary passage of stool
stool sits in rectum and forms a hard rock
liquid stool leaks around causing incontinence
90
encopresis often occurs after ______________________
toilet training
91
encopresis is often seen in ______________
autism
92
with encopresis they don't ______________
sense the need to defecate
93
what are the 2 types of encopresis?
1. retentive*
2. nonretentive
94
what is retentive encopresis?
incontinence with underlying constipation
95
what is non retentive encopresis?
incontinence without constipation
96
non-retentive encopresis is often associated with __________________
psychological triggers
97
how is encopresis treated?
enema
fleets (bottom) + laxatives (top)
98
what is gastroesophageal reflux?
transfer of gastric contents into esophagus
99
when does GER resolve?
spontaneously within first year
100
when does GER become GERD?
when complications develop
101
what are some complications of GER that might cause GERD?
growth failure
bleeding
dysphagia
102
GERD is less common in _______________ infants
breast fed infants
103
GERD is common in _____________ infants
preterm
104
what causes GERD?
lower sphincter doesn't close
105
what are some clinical manifestations of GERD?
spitting up
vomiting
growth failure
coughing
wheezing
choking
heartburn
abdominal pain
dysphagia
106
how is GERD diagnosed?
anatomical abnormalities
- pyloric stenosis
- hernia
- esophageal stricture
24 hr esophageal pH monitoring
endoscopy
107
what are some anatomical abnormalities associated with GERD?
pyloric stenosis
hernia
esophageal strictures
108
what is the gold standard for GERD diagnosis?
24 hr intraesophageal pH monitoring
109
why is an endoscopy needed for GERD diagnosis?
strictures
esophagitis
rule out crohn's
110
what are the interventions for GER?
nothing if thriving and no complications
thicken feeds
upright positioning
NG feeds (if growth failure)
avoid tobacco smoke
surgery
111
what is the surgery for GER? when is it indicated?
nissen fundoplication
only if severe
112
what are the treatments for GERD?
prokinetics
PPIs
nissen fundoplication
113
what is Hirschsprung's disease?
mechanical obstruction caused by reduced intestinal motility
congenital aganglionic megacolon
114
Hirschsprung's disease is more common in __________ with _____________
males with Down syndrome
115
what is the leading cause of death with Hirschsprung's disease?
enterocolitis
116
Hirschsprung's disease is _____________ in childhood
more chronic
117
what are some clinical manifestations of HD in newborns?
failure to pass meconium
bilious vomiting
refusal to feed
abdominal distension
118
what are some clinical manifestations of HD in infancy?
constipation
fever
vomiting
enterocolitis
growth failure
diarrhea
119
how is Hirschsprung's disease diagnosed?
rectal biopsy to assess for lack of ganglion cells
120
____________ is required for most cases of Hirschsprung's disease
surgery
121
what is the treatment for Hirschsprung's disease?
surgery
(remove ganglionic portion)
relieve obstruction
restore motility
122
what is a complication associated with surgery for HD?
strictures
123
what are the 2 GI inflammatory disorders?
1. acute appendicitis
2. IBD
124
what is acute appendicitis?
inflammation of appendix
125
what is the most common cause of emergency abdominal surgery in childhood?
appendicitis
126
what is the common age range for appendicitis?
10-16 years
127
what causes acute appendicitis?
fecalith obstructs lumen of appendix causing inflammation
128
what are some clinical manifestations of acute appendicitis?
preumbiilical --> RLQ abdominal pain
fever
rigid abdomen
absent/hypoactive bowel sounds
vomiting
constipation
diarrhea
tachycardia
increased WBCs
129
what is the major complication of acute appendicitis?
rupture
130
patients are more __________ looking with ruptured appendix
septic
131
what happens to RLQ pain with a ruptured appendix?
disappears
132
how is acute appendicitis diagnosed?
CBC
urinalysis
serum hCG
CT scan
ultrasound
133
why is a CBC done for acute appendicitis?
increased WBC
increased CRP
134
why is a urinalysis done for acute appendicitis?
to rule out UTI
135
why is serum hCG needed for acute appendicitis?
to rule out ectopic pregnancy
136
how is acute appendicitis treated?
rehydration
antibiotics
surgical removal
137
what are the surgical procedure types for appendicitis?
laparoscopic (most cases)
open appendectomy (lots of pus)
138
what is a complication associated with appendix removal?
post-op ileus
139
what are the components of post-op care for ruptured appendix?
IV fluids
NPO + NG tube
suctioning
K+ supplements
sham clear fluids
perc drain
IV antibiotics
140
what is the discharge criteria post-appendix removal?
ambulating
no pain
no GI abnormalities
141
when can you shower after appendix removal?
24-48 hours post-op
142
when can you swim and bathe after appendix removal?
2 weeks post-op
143
what is IBD?
chronic intestinal inflammation
144
what is ulcerative colitis?
inflammation of rectum and colon
145
what is Crohn's disease?
inflammation of any part of GI
146
ulcerative colitis affects ___________ layers
mucosal and submucosal
147
Crohn's disease affects __________ layers
all
(transmural)
148
what are some characteristics and manifestations of ulcerative colitis?
rectal bleeding
diarrhea
less frequent pain
some weight loss
some joint pain
149
what are some characteristics of Crohn's disease?
diarrhea
abdominal pain
weight loss
anorexia
anal and perianal lesions
fistulas
strictures
150
how is IBD diagnosed?
lab tests
examine stools
upper GI series
151
what lab tests should be done for IBD?
CBC (anemia)
ESR ad CRP (inflammation)
152
what should we look for when examining stools for IBD diagnosis?
blood
leukocytes
infectious organisms
153
what is involved in an upper GI series for IBD?
endoscopy and colonoscopy with biopsies
CT and ultrasound
154
what should be assessed with CT and ultrasound for IBD diagnosis?
abscesses
inflammation
fistulas
155
what are fistulas?
lesions that pierce intestinal walls
form tracts between adjacent structures
156
how is IBD treated?
drug therapy
nutrition
surgery
157
what medications are involved in IBD treatment?
5-ASAs
corticosteroids
immunomodulators
antibiotics
biological therapies (TNF-alpha agents)
158
how does 5-ASA treat IBD?
induces and maintains remission
159
what corticosteroids are used for IBD?
prednisone
budesonide (IV)
160
what are some adverse effects of long-term corticosteroid use?
growth suppression
weight gain
decreased bone density
161
what is the benefit of budesonide for IBD treatment?
less adverse effects than prednisone
162
when are immunomodulators used for IBD treatment?
if steroid resistant or dependent
163
what are some adverse effects of immunomodulators?
infection
bone marrow toxicity
164
what diet is recommended for IBD?
high protein
high calorie
165
a colectomy is curative for ___________ but not _____________
cures UC, but not crohn's
166
what is the surgical procedure for ulcerative colitis?
colectomy
167
what is a cleft lip or palate?
facial malformation that occurs during embryonic development
168
when can a cleft lip or palate be first seen?
week 6-8 of pregnancy
169
cleft lips and palates are more common in __________
boys
170
what are the cases of a cleft lip or palate?
teratogens
171
how is a cleft lip diagnosed?
ultrasound
172
how is a cleft palate diagnosed?
gloved finger
173
what is the major complication with cleft lips and palates?
feeding difficulties
174
what are some feeding interventions for babies with a cleft lip or palate?
upright
Haberman special nipple
175
when can a cleft lip be repaired?
4 months
176
when can a cleft palate be repaired?
9-12 months
177
what are some considerations for cleft lip or palate?
pain management
speech therapy
avoid suctioning
178
what is a hernia?
protrusion of organ through abdominal wall
179
what is the mot common type of hernia?
inguinal
180
what are the 4 types of hernias?
umbilical
inguinal
ompahlocele
gastroschisis
181
what is an ompahlocele?
protrusion of organs at base of umbilical cord
covered by protective sac
182
what is gastrochisis?
protrusion of organs to right of umbilical cord
not covered by protective sac
183
what are the 2 obstructive disorders?
pyloric stenosis
intussusception
184
what is pyloric stenosis?
hypertrophic obstruction of pyloric sphincter
food doesn't empty from stomach into duodenum
185
what are some clinical manifestations of pyloric stenosis?
non-bilious vomiting
dehydration
irritable
abdominal pain
186
describe the vomiting that occurs with pyloric stenosis?
projectile
non-bilious
occurs immediately after feeding
(remain hungry)
187
how is pyloric stenosis diagnosed?
ultrasound
188
what is the treatment for pyloric stenosis?
pylomyrotomy
189
what is intussusception?
proximal bowel segment telescopes into distal
increased pressure top blood flow causing ischemia and leakage of blood and mucous into intestine
190
what is the mot common site for intussusception?
ileocecal valve
ileum invaginates into cecum and colon
191
what are some clinical manifestations of intussusception?
colicky abdominal pain
vomiting
red currant jelly-like stool
sausage shaped mass in RUQ
empty LRQ
192
how is intussusception diagnosed?
ultrasound
rectal exam
193
what is the treatment for intussusception?
push bowel out
pneumoenema reduction
hydrostatic reduction
surgery to manually reduce invagination
194
what is pneumoenema reduction?
air enema
195
what is hydrostatic reduction?
saline enema
196
what is the benefit of hydrostatic reduction vs pneumoenema reduction?
no radiation involved
197
how do you know when the intussusception is resolved?
pass normal brown stool
