Gastrointestinal Issues and Disorders Flashcards
What causes gastroenteritis?
viruses are the majority--especially during the winter:
rotavirus (50% of viral cases)
adenovirus
Bacterial:
salmonella
camylobacter (odorous stool)
shigella
e. coli (mild loose stools)
giardia (from swimming pools)
parasitic
Inorganic food contents
emotional stressWhat symptoms are indicative of shigella?
fever spikes, bloody stools, febrile seizures
Signs/symptoms of gastroenteritis?
N/V/D (watery) hyperactive bowel sounds general sick feeling--fever when septic anorexia cramping abdominal pain distention
Explain mild dehydration
3-5%
everything is normal, except urine output is slightly decreased
Explain moderation dehydration
6-9% abnormals are: increased pulse/hr decreased skin turgor fontanel slightly sunken urine output decreased (
Explain severe dehydration
>/= 10% bp: normal or decreased pulse/hr: severe, decreased prolonged cap refill decreased skin turgor sunken fontanel urine output
Explain daycare exclusion with gastroenteritis
if you have rotavirus, e. coli or shigella, need to stay home–if have e. coli and shigella, need 2 negative stool cultures to return to daycare
What is moderate and severe oral rehydration therapy?
moderate: 50 ml/hr
severe: 100 ml/hr
What is the first antibiotic of choice if gastroenteritis is needed to be treated with meds?
bactrim (trimethroprim/sulfamethoxazole)
antibiotics considered with pt has more than 8-10 stools daily and indicated when an organism is isolated or symptoms are not resolved
What organism that causes gastroenteritis is not very responsive to antibiotics?
salmonella
Name the 3 classes of GERD
- physiological: infrequent, episodic vomiting (specific cause and effect)
- functional: painless effortless vomiting with no physical sequelae (wet burps, happy spitter)
- pathological: frequent vomiting with alteration in physical functioning such as failure to thrive and aspiration pneumonia (irritable)
How common is GERD and when does it typically resolve?
85% of premature infants and infants with low birth weight
Typically resolves by 18 months
Signs and symptoms of GERD
choking, coughing, wheezing and weight loss (need work up for these symptoms) irritability recurrent vomiting heartburn painful belching/ab pain stool changes sore throat pharyngitis otitis media dental erosions
What medications can be used to treat GERD?
Histamine H2-recpetor anatgonist (H2RA) to inhibit gastric acid secretion caused by histamine–ex) ranitidine, famotidine
Proton Pump Inhibitors (PPIs) to block gastric acid secretion caused by histamine, acetylcholine or gastrin–ex) omeprazole
What is pyloric stenosis?
obstruction resulting from thickening of the circular muscle of the pylorus
How common is pyloric stenosis?
1:500, more common in males and caucasians
What delays presentation of pyloric stenosis?
breast feeding
What are the signs and symptoms of pyloric stenosis?
projectile non-bilious vomiting after eating
hungry after vomiting
poor weight gain or weight loss
eventually becomes dehydrated
visible peristaltic waves
palpable mass (pyloric olive) after vomiting
When does pyloric stenosis typically present?
from 3 weeks to 4 months
What are diagnostic tests of pyloric stenosis?
abdominal US (more accurate) If US is not diagnostic, GI imaging--commonly shows a string sign
What is intussusception?
acute prolapse of one part of the intestine into another adjacent segment of the intestine
What virus is suspected to link to intussusception?
adenovirus
What are other suspected causes of intussusception?
CF, celiac disease
Who does intussusception typically occur in?
males, before the age of 2
What are signs and symptoms of intussusception?
previously healthy infant develops acute colicky pain
bilious vomiting
progressive lethargy
currant jelly stool (dark red seedy) **LATE SIGN
sausage shaped mass in the right upper quadrant
progressive distention, tenderness
if not reduced, perforation and shock may occur
What does bilious vomiting indicate?
an obstruction below the ampulla of water (union of pancreatic duct and common bile duct)
How common is Hirschsprungs Disease (ganglionic megacolon)?
1:5000 births, more common in boys in girls
may present in infancy or older children
What are the signs and symptoms of hirschsprung’s disease?
failure to pass meconium bilious vomiting jaundice infrequent explosive bowel mmt progressive ab distension **tight anal sphincter with an empty rectum failure to thrive malnutrition
What would an abdominal X-ray likely show in someone with hirschsprungs?
large colon
If an appendicitis in untreated what can it lead to?
gangrene in perforation may develop within 36 hours
Who are appendicitis most common in?
males ages 10-30 years old
What are the most common signs of appendicitis?
colicky umbilical pain
after several hours–pain shifts to RLQ
rebound tenderness
pain worsens and localizes with cough
Nausea with 1-2 episodes of vomiting (more indicates another condition)
sense of constipation (infrequently diarrhea)
fever (low grade)
If you have an appendicitis you can’t go to the _______.
PROM
P: psoas sign: pain with R thigh extension
R: rebound tenderness
O: obturator sign–pain with internal rotation of the thigh
M: McBurney’s point tenderness
What labs/tests would indicate an appendicitis?
WBC: 10000 to 20000, ESR elevated
US or CT is diagnostic
What are signs and symptoms of malabsorption?
FTT severe, chronic diarrhea bulky, foul stool (steatorrhea) vomiting ab pain protuberant abdomen Also--associated with vitamin deficiency or malabsorption: pallor, fatigue, hair/derm abnormalities, cheilosis, peripheral neuropathy
What tests would you do for someone with suspected malabsorption?
stool: culture, hemoccult, and ova/parasite exam
serum calcium, phosphorous, alkaline phosphatase, total protein, ferritin, folate, and liver function test
bone age
lactose/sucrose breath hydrogen testing
sweat chloride cystic fibrosis test
What vitamins for cystic fibrosis pt?
fat soluble vitamins (A, D, E, K)
What is a neuroblastoma?
tumor arising from neural tissue, frequently from adrenal gland (on top of kidney) and can spread to bone marrow, liver, lymph nodes, skin, and orbits of eyes
When does neuroblastoma most commonly occur?
before the age of 5
What are the signs/symptoms of neuroblastoma?
FTT
enlarged abdominal mass
profuse sweating
tachycardia
What tests should you do for suspected neuroblastoma?
urine catecholamines,
abdominal US or CT
What are the most common types of hepatitis in pediatrics?
A, B, C
Hepatitis A
an enteral virus, transmitted via the oral-fecal route
What are Hep A outbreaks typically caused by?
contaminated food/water–lots of flooding in areas can lead to outbreaks
do not give sushi to children
When do symptoms of Hep A typically manifest?
2-6 weeks after infection
blood/stools are infectious during the 2-26 week incubation period
HEP A HAS THE SHORTEST INCUBATION PERIOD
Do children with Hep A have jaundice?
most children are not anicteric (jaundiced) with Hep A so infections frequently go unnoticed
What is the serology of active hep A?
Anti-HAV, IgM (IgM=active disease)
What is the serology of recovered hep A?
Anti-HAV, IgG (disease is gone)
Does chronic carrier state exist for hep A?
NO–and mortality rate is low and fulminant hepatitis A (occurs suddenly/quickly) is rare
Hepatitis B
a blood-borne virus present in saliva, semen, vaginal secretions and all body fluids which is transmitted via blood, blood products, sexual activity, and mother to fetus
What is the incubation period of Hep B?
6 weeks- 6 months longest incubation period
What makes Hep B and Hep A different?
Hep B has a more insidious or gradual onset
Is there a risk for fulminant hep B?
Yes, but
What is the serology for active hep B?
HbsAg, HBeAg, Anti-HBc, IgM
What is the serology for chronic hep B?
HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG
What is recovered hepatitis B?
Anti-HBc, anti-HBsAg, IgG
With Hep B vaccine–serologically converted, what will the serology most look like?
recovered hep B
Hepatitis C
traditionally associated with blood transfusion
50% of cases are related to IV drug use
Risk of sexual transmission is small, and maternal transmission to newborn is rare
What is the incubation period of hep C?
4-12 weeks
What is the serology of acute hep C?
Anti-HCV, HCV RNA
What is the serology of chronic hep C?
Anti-HCV, HCV RNA
Is there a cure for hep C?
NO so acute and chronic hep c serology look exact same
What are pre-icteric signs and symptoms of hepatitis?
Before jaundiced: fatigue, malaise, anorexia, N/V, headache and aversion ot second-hand smoke and alcohol odors
What are icteric signs and symptoms of hepatitis?
weight loss, jaundice, pruritus, RUQ ab pain
What are other symptoms of hepatitis?
clay, colored stools dark urine low grade fever hepatosplenomegaly diffuse abdominal pain tenderness over liver dark urine and light colored stool
What are lab tests you would want in someone with suspected hepatitis?
CBC
UA: proteinuria, bilirubinuria
AST, ALT (elevated 500-2000)
LDH, bilirubin, alkaline phosphate, and PT are normal or slightly elevated
What happens to AST and ALT tests in someone with hepatitis?
AST and ALT rise prior to onset of jaundice and will fall after jaundice presents
What is the management of hepatitis?
generally supportive–rest during active phase
increase fluids
vitamin K for prolonged PT >15 sec
avoid alcohol and meds detoxified by the liver
little to no protein diet
What should you increase fluids to in someone with hepatitis?
3,000 to 4,000 ML/day
What may be prescribed for hep C?
rebetron (interferon and ribavirin)
