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peds 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is Hirshprung’s Disease?

A

A mechanical obstruction caused by inadequate motility of part of the intestine.

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2
Q

Incidence of Hirshprung’s

A

1/4 of all neonatal obstructions: 1 in 5,000 births

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3
Q

Hirshprung’s: Male v Female

A

4x more likely in males

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4
Q

Pathophysiology of Hirshprung’s

A

Absence of ganglionoic cells in one or more segments of the colon –> absence of propulsive movement –> MEGACOLON

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5
Q

What is the leading cause of death in kids with Hirshprung’s?

A

Enterocolitis

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6
Q

Four signs and symptoms of Hirshprung’s in a newborn

A
  • Failure to pass meconium within 24 to 48 hours after birth
  • Reluctance to ingest fluids
  • Bile-stained vomitus
  • Abdominal distention
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7
Q

Five signs and symptoms of Hirshprung’s in an infant

A
  • Failure to thrive
  • Constipation
  • Abdominal distention (tender)
  • Episodes of diarrhea and vomiting
  • Explosive watery diarrhea, fever, severe exhaustion
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8
Q

Six signs and symptoms of Hirshprung’s in a child

A
  • Constipation
  • Ribbon-like, foul smelling stool
  • Abdominal distention (tender)
  • Visible peristalsis
  • Fecal masses easily palpable
  • Poorly nourished child and anemic
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9
Q

Four ways to diagnose Hirshprung’s

A
  • Rectal exam: Tight internal sphincter and absence of stool
  • Barium enema
  • Anorectal manometry: Inflate anal sphincter
  • Definitive diagnosis is rectal biopsy
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10
Q
  • How is an anorectal manometry performed? What is the normal finding? Abnormal?
A

Anorectal manometry: Inflate anal sphincter
• Normal: Relaxation of anal sphincter
• Harshprung’s: No relaxation

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11
Q

When do you close up the colostomy after Hirshprung’s surgery?

A

9k

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12
Q

Signs of a perforated bowel (5)

A
  • Vital signs: Watch for shock
  • Absent bowel sounds, distention and tenderness
  • Vomiting
  • Irritable, dyspnea and cyanosis
  • Fever
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13
Q

Six components of post-op care for an ostomy

A
  • Colostomy care
  • Prevent contamination of wound with urine
  • Impaired skin integrity due to incontinence
  • In infants, incontinence = continuously leaking stool.
  • NPO until bowel sounds return or flatus passed: IV fluids
  • Pain control
  • Strict I&Os
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14
Q

in Gastroesophageal reflux patients, their pH is much _____ than other patients.

A

Lower (acidic)

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15
Q

What is tracheal-esophageal atresia?

A

Low connection between esophagus and stomach

or a fistula between esophagus and trachea

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16
Q

What is Gastroesophageal reflux?

A

Dysfunction of Lower Esophageal Sphincter –> Delayed gastric emptying, poor clearance of esophageal acid

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17
Q

Two pharmacological risk factors of Gastroesophageal reflux

A

Theophylline (for asthma, apnea)

Caffiene (indicated for apnea)

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18
Q

Incidence of Gastroesophageal reflux

A

3% of all newborns

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19
Q

When does gastroesophageal reflux peak in infants? When does it resolve?

A

Between 1-4 months (Resolves by 6-12 mo)

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20
Q

Gastroesophageal reflux: Incidence in boys v girls

A

Boys affected 3x more than girls

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21
Q

How do you know that there is esophageal excoriation?

A

Heme positive stools

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22
Q

What is Sandifer’s Syndrome?

A

Behavioral symptom, when baby extends head and turns to one side to relieve reflux. Can almost mimic seizure.

23
Q

Three diagnostic tests for gastroesophageal reflux

A
  • Radionuclide tests
  • 24 hour esophageal pH monitoring via NG tube (gold standard)
  • Endoscopy and esophageal biopsy
24
Q

How would you manage gastroesophageal reflux in a thriving infant without respiratory complications (3)?

A
  • Small frequent feedings
  • Thickened with rice cereal (only time!)
  • Position w HOB elevated
25
Q

How would you manage gastroesophageal reflux in a FTT infant with severe reflux who failed to respond to medical therapy or who have anatomical abnormality?

A
  • NG Feedings

- Surgery (Nissen Fundoplication)

26
Q

Nissen Fundoplication

  • Indication
  • Potential complication
A

Surgery that inverts fundus a little - used in neurological patients with gastroesophageal reflux due to increased incidence of respirating, pneumonia

(Too tight –> Obstruction –> Gas bloat)

27
Q

Meds for Gastroesophageal reflux: Three categories

A
  • Proton pump inhibitors
  • Antacids or H2 blockers
  • Prokinetic
28
Q

Two proton pump inhibitors for gastroesophageal reflux

A
  • Omeprazole (Prilosec)

Iansoprazole (Prevacid) <– FIRST LINE!

29
Q

When should you administer prevacid?

  • Drug type
  • Indication
A

20-30 minutes before meal (AM)

  • Proton pump inhibitor
  • Gastroesophageal reflux
30
Q

Three Antacids / H2 blockers for gastroesophageal reflux (which are approved for infants?)

A
  • Cemetidine (Tagamet)
  • Ranitidine (Zantac) - PREFERRED UNDER ONE YEAR
  • Famotidine (Pepcid) - Approved under one year
31
Q

Two prokinetic drugs

A
  • Metoclopramide (Reglan) *20-30 min before AM meal

- Bethanecol (Urecholine)

32
Q

Pathophysiology of chrons

  • Where does it occur
  • What does it involve
A

Occurs in any part of GI tract from mouth to anus.
**Ilium, colon, rectum are most common
May be “skip areas”
Involves all 3 layers of mucosa – CHRONIC INFLAMMATORY DISEASE

33
Q

Chrons: Triggers (5)

A
  • Viral and infectious agents
  • Food allergies
  • Increased intestinal permeability
  • Immunological dysfunction
  • Stress
34
Q

Population affected by chrons

A
  • More common in whites
  • 3-6x more likely in Jewish people
    (Same incidence in men and women)
35
Q

What is erythema nosdosum?

A

Bruise-like rash that occurs with chrons disease

36
Q

Extraintestinal symptoms of chrons (7)

A
  • Erythema nosodosum
  • Large joint arthritis
  • Mouth ulcers
  • Liver disease
  • Renal calculi
  • Uveitis
  • Anema
37
Q

Lab data to diagnose chrons (10)

A 
CBC
ESR
CRP
Total protein
Albumin
Zinc
Magnesium
Vitamin B12
Fat soluble vitamins
pANCA
38
Q

What is in the stool of someone with chrons? (2)

A

Blood leukocytes

Infectious agents

39
Q

Four medical treatments for chrons: (categories)

A

1) Corticosteroids
2) Aminosalicyclates
3) Immunomodulators
4) Abx

40
Q

Role of Corticosteroids in treating chrons

A

Mediate and control inflammation

41
Q

Side effects of corticosteroids (7)

A
  • Moonface
  • Weight gain
  • Buffalo hump
  • Acne
  • Hersutism (hair)
  • Can affect bones
  • Can affect growth
42
Q

Patient teaching: Corticosteroids

A

Taper when stopping: You have to give patient time to start creating their own (negative feedback syndrome)

43
Q

Role of Aminosalicyclates in treating chrons

A

Anti-inflammatory

44
Q

Patient teaching: Aminosalicyclates

A

Can interfere with folic acid absorption

45
Q

Two aminosalicyclates indicated for chrons

A
  • Sulfasalizine (Azulfidine)

* Mesalamine (Asacol and Pentasa)

46
Q

Role of Imunomodulators in treating chrons

A

Enhance effect of steroids

47
Q

Precaution with immunomodulators

A

Can suppress your bone marrow production (do a CBC and differential)

48
Q

Four examples of immunomodulators

A
  • 6-mercaptopurine
  • Azathioprine
  • Methotraxate – Chemo drug
  • Cyclosporine
49
Q

Role of Anti-TNF in treating Chrons

Example

A

WHEN NOTHING ELSE WORKS

Infleximab (Remicade)

50
Q

Role of Interleuken 10 in tx chrons

A

Suppress Inflammation

51
Q

Role of Budesonide in treating chrons

A

Corticosteroid with fewer side-effects

52
Q

Role of zinc in treating chrons

A

Remove free-radicals that cause inflammation

53
Q

What is the primary component of chrons treatment?

A

NUTRITION

peds 1 (5 decks)

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