Gastrointestinal Flashcards
What are signs of dehydration in children
Low urine output Weight loss Dryness (tears and mouth) Sunken Fontanelle Increased pulse, decreased VP, skin turgor
Treatment for dehydration in children
Fluid Bolus 20mL/kg ASAP, followed by maintenance fluids once stable
What are common causes of Appendicitis
Idiopathic or Fecalith
Sx of Appendicitis
Periumbilical and RUQ pain
Nausea, Vomiting
Rovsing, Obturator, Psoas, McBurney’s Point Tenderness
Dx of Appendicitis
CT and US
Tx of Appendicitis
Appendectomy
What is Colic
Rule of 3’s: Healthy 3 month old who cries over 3 hours/day for over 3 weeks
Sx of Colic
Rule of 3’s: Healthy 3 month old who cries over 3 hours/day for over 3 weeks
Tx of Colic
Reassurance and parent education that baby is not sick. Eliminate cows milk from mother’s diet if breastfeeding
What is Gastroesophegal Reflux (GER)
Recurrent postprandial emesis that resolves spontaneously and is normal
What is Gastroesophageal Reflux Disease (GERD)
Persistent sx of GER or esophgeal Inflammation
Tx for GERD
Acid Suppression via H2 blockers or PPI like Zantac
Smaller more frequent feedings
Thicken milk with rice cereal
Antireflux surgery in severe cases
What is Chronic Constipation
Must have 2 or more: Fewer than 3 BM/week 1+ episodes of encopresis (involuntary pooping) Stool impaction in rectum Large stools that clog toilet Fecal Withholding Pain with Defacation
Treatment for Constipation
Dietary Fiber and Fluids
Stool Softener: MiriLax
Laxatives: Senokot, Ex Lax
What is Pyloric Stenosis
Hypertrophy and Hyperplasia of the muscular layer of the pylorus causing a functional outlet obstruction
Sx of Pyloric Stenosis
Nonbilous vomiting, Regurgitation, Projective Vomiting, Emesis after eating
Usually starts 2-4 wks of age
What is a Physical exam finding of Pyloric Stenosis
Mobile, firm, non-tender Olive Shape pylorus about 1-2cm in diameter to the right of the umbilicus
Tx for Pyloric Stenosis
Phyloromyotomy
Cimetidine (acid blocker)
What is Intussusception
When an intestinal segment invaginates into the adjoining intestinal lumen leading to bowel obstruction
Where does Intussusception usually happen
Ileocolic junction
Sx of Intussusception
Vomiting, Abdominal Pain, Currant Jelly Stools (mucous and bloody)
Cyclical crying pattern, Colicky pain
Dx of Intussusception
Ultrasound
Barium Contrast Enema
Tx of Intussusception
Air or Barium Enema
IV Fluids, Surgery
What is Hirschsprung’s Disease
Congenital absence of Meissner’s and Auerbach’s Autonomic plexus
Where does Hirschsprung’s Disease usually occur
Retrosigmoid
Sx of Hirschsprung’s Disease
Newborn fails to pass meconium
Constipation, Vomiting, Failure to Thrive
Dx of Hirschsprugn’s Disease
Anal Monometry, Rectal Biopsy
Tx of Hirschsprung’s Disease
Surgical Resection
Sx of a foreign body
Dysphagia, Odynophagia, Drooling, Regurgitation, Chest/Abdominal Pain, Cough
Tx of foreign body removal
Endoscopic or Miralax
What is Encopresis
Repeated passage of stools in underwear, usually after 4 yrs of age
What causes Encopresis
Constipation
Tx for Encopresis
Support and Education, Establish good bowe habits
What is Acute Bilirubin Encephalopathy
Lethargy, Poor Feeding, Irritable, High Pitched Cry, Arched Neck
What is Kernicterus
Injury to the basal ganglia and brainstem due to severe hyperbilirubinemia
Sx of Kernicterus
Movement disorder, strange gaze, auditory disturbances
What is Gilbert’s Syndrome
Persistent jaundice without other abnormalities
What is Breastfeeding Jaundice
Appears within first few weeks of life when baby is not getting adequate milk supply
What is Crigler-Najjar Syndrome
Rare disease that presents a few days after birth and persists
Sx of Crigler-Najjar Syndrome
Problem with UDPGT which makes bilirubin water-soluble for clearance. Jaundice
What is Biliary Atresia
An obstruction of extrahepatic biliary system
Presents from birth-8wks
Sx of Biliary Atresia
Jaundice, dark urine, hepatosplenomegaly, acholic stools
What is Duodenal Atresia
Congenital duodenal obstruction. There is an absence of closure of a portion of duodenum
Sx of Duodenal Atresia
Bilous vomiting within a few hours after birth
Normal meconium
Dx of Duodenal Atresia
X-Ray: Double bubble sign
US: Can see prenatally with polyhydramnios
Tx for Duodenal Atresia
Stomach decompression and electrolyte correction/fluids and surgery
What is a non-communicating Inguinal Hernia
Peritoneal fluid is trapped. The intestine goes through the inguinal ring when the processes vaginallus fails to obliterate.
What is a communicating Inguinal Hernia
When the processus remains open and bowel contents and fluids may be forced inside
What is an Umbilical Hernia
Associated with congential hypothyroidism in neonates. Common in full term infants, African American
Tx for Umbilical Hernia
Surgical Repair when over 4 yrs old. Most regress spontaneously
Where do we get Niacin (B3). A diet rich in what is associated with Niacin Deficiency?
Tryptophans. Diet rich in corn is associated with Niacin deficiency
Niacin Deficiency leads to what disorder
Pellagra: 4 D’s
Diarrhea, Dementia, Dermatitis (stocking/glove pattern), Death
What is Vitamin A good for
Vision, Immune Function
Vitamin A Deficiency leads to what
Vision Loss, Night Blindness ,Bitot Spots, Xerophthalmia (dry eye), Squamous Metaplasia
Vitamin C Deficiency leads to what disorder
Scurvy: 3H’s
Hyperkeratosis, Hemorrhage (gum, skin, joints), Hematologic (anemia)
Where do we get Vitamin C
Raw Citrus and Green Veggies
Vitamin D Deficiency leads to what disorder
Rickets: Softening of the bones, Bowing deformity, fractures, muscle weakness
What is the intervention for Foreign Body Ingestion
80-90% pass spontaneously. Can help move things along with polyethylene glycol solution (Miralax).
If dangerous object (battery): Endoscopic removal
Dx for Intussusception
Abdominal Ultrasound is #1
Barium Contrast Enema (can be dx and tx)
Dx for Hirschsprung Disease
Anal Monometry (no relaxation of sphincter) Rectal Biopsy (no nerves)
Tx for Constipation
Dietary fiber and fluids Osmotic Stool Softeners: Miralax Laxatives: Sneokot or Ex Lax Encorporesis: Disimpaction with phosphate, saline enemas, or mineral oil + regular stool softners Stretch anal sphincter to loosen
Tx for Gastroesophageal Reflux
GER: Normal
GERD: Trial of H2 blockers or PPI
Smaller, more frequent meals or thicken formula/milk with rice, rice cereal
Keep baby upright
Antireflux Surgery (Nissen Fundoplication) for refractory cases
