Gastrointestinal Flashcards
If a child has gastroenteritis, when can they return back to daycare?
after they have 2 negative stool cultures
are antimotility drugs choice of medication?
No they should be used judiciously
What is the 1st drug of choice for gastroenteritis considered when the patient has 8-10 stools per day (test does not abbreviate)
trimethoprim/ sulfamethoxazole (TMP/SMZ)
[bactrim]
what is the choice for salmonella?
nothing! salmonella is not very responsive to antibiotics.
which virus is the cause of 50% of viral gastroenteritis?
rotavirus
Which class of GERD would you see weight loss?
physiologic
functional
pathologic
pahologic only
first line treatment for GERD?
H2 blockers ranitidine then PPI (omeprazole, prilosec)
after trying smaller feeds, burping frequently, rice cereal or oat to thicken, elevating head after feeding
what is one side of effective of a PPI to be aware of?
gynecomastia
also anemia
time frame for pyloric stenosis?
3wks to 4 months
would you expect to see bilious or non bilious emesis for pyloric stenosis. Why?
NON bilious
bile would indicate a problem further down (intestines)
no bile= closer to stomach, so pyloris stomach or esophageal.
what conditions would you expect to see bilious emesis for?
intussusception and hirschsprung, small bowel obstruction, volvulus, malrotation.
what is a positive obturator sign, +psoas sign?
psoas- pain with right thigh extension (straight leg up and pain with pressure on leg)
obturator- with internal rotation of right thigh (bend knee twist thigh inwards)
What are some clinical signs for appendicitis? PROM?
Psoas sign- leg extension
Rrebound tenderness- pressing on one side that moves to another with release of pressure
Obturator sign- pain with internal rotation
Mcburneys point tenderness- point closer to iliac crest between umbilicus
s/s concerning for appendicitis?
PROM, pain worse with cough, nausea, low grade fever.
an 18 mo comes in with chronic diarrhea, abd pain, fatigue, cheilosis, foul stool. What is one of your main differentials?
Malabsorption disease
also IBD, chronic diarrea, maybe hepatic disease, gastro
lactose and sucrose breath hydrogen testing is done to test for what disorder?
H. pylori
sweat chloride is done for suspicion of what disorder?
cystic fibrosis
what are some examples of malabsorption disorders?
CF, celiac disease, gluten intolerance, abnormality of intestinal mucosa
What foods do you avoid for celiac disease?
what can they eat?
BAD: gluten, wheat, oats, barley, rye (bread, crackers, beer, whiskey)
GOOD: rice, soy, dairy
refer to gastro as needed
what do CF patients require for management?
enzymes and fat soluble vitamins (A, D, E, K) & refer to gastro
[reminder: CF patients have trouble absorbing fats, and some vitamins need fat to be absorbed)
neuroblastoma (wilms tumor) is most common before what age? what is often the first sign? where does this cancer usually originate?
age 5
first sign: lump/ swelling/ mass in abdomen or neck
orginate often: adrenal glands (from immature nerve cells called neuroblasts)
Which of the following labs would indicate a recovery from Hep B?
a) IgM
b) anti-HBc
c) igG
d) anti-HBsAg
extra credit, what would be looked at when drawing Hep B titers?
D) anti-HBsAg = antibody to Hep B surface antigen
this is only ever seen if you have Hep B and have recover.
e.c. Anti-HBs this shows the pt has seroconverted
(similar to above that shows recover minus the antigen portion b/c pt was never infected)
Which lab shows you have hep A and have not yet recovered?
a) anti-HAV
b) IgM
c) IgG
B- IgM (immediate) means it is still present
IgG means it is GONE, anti-HAV is present in active and recovered hep A
hint: think you are a mother before grandmother so IgM first then IgG
what is the management for oral rehydration therapies for moderate and severe dehydration?
moderate= 50ml/ hr severe= 100ml/hr
what are the main difference between moderate and severe dehydration?
moderate= tachycardia, normal BP normal cap refill, decreased skin turgor, slightly sunken in fontanels
severe= normal/ low BP, decreased HR, prolonged cap refill, sunken fontanel
s/s: failure to pass meconium, bilious vomiting, explosive bowel movements, tight anal sphincter, Failure to thrive
what do you suspect? how do you diagnose
Hirschsprung
XR, rectal biopsy= definitive
1 mo vomiting, non bilious, projectile emesis, poor weight gain what do you suspect? how do you diagnose?
pyloric stenosis
US
15 mo, possibly bilious emesis, intermittent fussiness, lethargic. What is in your diff?
what diagnostics would you consider?
intuss.
US
3 year old comes in with fatigue, weight loss, tachycardia, sweating, enlarged abdomen. What is in your differential? what diagnostics are you considering?
neuroblastoma (wilms tumor)
US, CBC, urine catecholamines (b/c of likely adrenal gland involvement) abd CT
what are the percentages of wt loss with the associated levels of dehydration for:
mild:
moderate:
severe:
mild: 3-5%
moderate: 6-9%
severe: >10%
what are the rehydration levels for moderate and severe dehydration?
(6%-9%)moderate= 50ml/r
(>10%) severe= 100ml/hr
an 18 mo old has has v/d and presents with sunken fontanels, increased HR, dry mucous membranes, moderately increase thirst, and delayed cap refill. what level of dehydration would you consider this to be, how many ml/hr would you expect to rehydrate the pt at?
moderate
50ml/hr
wha clinical sign would you expect for severe dehydration? A-normal cap refill B-normal fontanel C-cool, mottled skin D-dry mucous membranes
C- cool mottled skin
in the US most common parasitic gastro is caused by? enterobius vermicularis entamoeba histolytica giardia lamblia cryptosporidium parvum
Giardia`
which of the following serological findings indicates chronic HBV? HBsAg neg for 6 mo anti-HBc + and HBsAg + IgM and anti-HBc + anti-HBs +
B= anti-HBc + and HBsAg +
T/F
kids with Hepatitis (A, B, C) do not often have icteric skin/ sclera.
true
Hep A especially
