Gastrointestinal Issues and disorders Flashcards
A nonspecific term applied to a syndrome of acute nausea, vomiting, and diarrhea as the result of an acute irritation/inflammation of the gastric mucosa
Gastroenteritis
Children attending ___ ___ are at increased risk of gastroenteritis
daycare
Cause of gastroenteritis:
a)
b)
a) Virus
b) bacteria
Cause of viral with gastroenteritis include:
a) _____ is 50% of viral cases
b) Adenovirus
a) Rotavirus
Cause of bacterial gastroenteritis include:
a) ______
b) Campylobacter
c) Shigella
d) E. Coli
e) Parasite
f) ____
g) emtional stress
a) Salmonella
f) Inorganic food contents
This bacteria is associated with an odorous stool?
Campylobacter
The bacteria is associated with gastroenteritis with fever spikes, bloody stools, febrile seizures?
Shigella
The bacteria is associated with gastroenteritis mild loose stools?
E. Coli
Signs and symptoms of gastroenteritis:
a) _____
b) vomiting
c) hyperactive bowel sounds
d) watery diarrhea
e) general “sick” feeling (fever when septic)
f) anorexia
g) cramping abdominal pain and or abdominal distention
Nausea
This is associated with ______ dehydration
a) 3 to 5 %
b) blood pressure: normal
c) heart rate: normal
d) CAP refill: WNL
e) Skin turgor: normal
f) Fontanel: normal
g) Urine: slightly decreased
Mild
This is associated with _____ dehydration
a) > 10%
b) blood pressure: normal to decreased
c) hear rate: severe, decreased
d) CAP refill: Prolonged > 3 seconds
e) Skin turgor: decreased
f) fontanel: sunken
g) Urine: < 1 ml/kg/ hour
Severe
This is associated with _____ dehydration
a) blood pressure: normal
b) heart rate: increased
c) CAP refill: WNL
d) skin turgor: decreased
e) fontanel: sunken (slightly)
f) urine: < 1 ml/kg/ hour
g) 6 to 9%
Moderate
Diagnostic test for dehydration include
a) _____ indicated unless symptoms persist more than 72 hours or bloody stool is present
b) stool guaiac may be positive with bacterial infections
c) Stool with white blood cells
d) stool culture
e) stool for ova and parasites
a) None
Daycare exclusion: Rotavirus, E. coli, and shigella; only E. coli and shigella require ____ negative stool cultures prior to return to daycare with gastroenteritis.
two
Management of dehydration involves usually frequent _____ therapy.
supportive
_____ and formula should continue with dehydration.
Breastfeeding
Oral rehydration therapy
a) ______: 50 ml/hr
b) Severe: 100 ml/hr
Moderate
A regular diet gradually resumes after the patient is ______ (BRAT - Banana, rice, applesauce, toast diet not necessary)
rehydrated
Diagnostic tests for dehydration are ____ indicated unless symptoms persist more than ___ hours or bloody stool is present.
none
72 hours
Stool _____ may be positive with bacterial infection with dehydration.
guaiac
Diagnostic/test stool for _____ with dehydration?
White blood cells
Stool _____ for dehydration
stool
With dehydration check stool for ova and ______?
parasites
Daycare exclusion: Rotavirus, E. Coli, and Shigella; only this and Shigella require _____ negative stool cultures prior to return to daycare.
two
Frequent ______ therapy is often all that is needed
supportive
With dehydration ______ and formula should continue.
breastfeeding
Oral rehydration therapy:
Moderate is ___ ml/hr
50 ml/hr
Oral rehydration therapy:
Severe ____ ml/hr
100 ml/hr
Dehydration:
A ____ diet gradually resumes after the patient is rehydrated (BRAT)
regular
Dehydration:
BRAT stands for?
Banana, Rice, Applesauce, and toast
Dehydration:
___________ drugs shuld be used judiciously
a. Not usually indicated in mild forms of disease
b. May prolong the illness
c. Should not be used in patients with fever and /or
bloody stools
Anti-motility
Antibiotic therapy for dehydration:
a. Considered when the patient experiences more than ______ to ____ stools daily
8 to 10
Antibiotic therapy for dehydration:
First dose of Choice is?
Trimethoprim/sulfamethoxazole (TMP/SMZ)
Antibiotic therapy for dehydration:
Indicated when an organism: (except ________, which is not very responsive to antibiotics) is isolated or symptoms are not resolved
Salmonella
A condition in which gastric contents pass into the esophagus from the stomach through the lower esophageal sphincter (LES)
GERD
The three classes of gastroesophageal reflux are:
a. ______: Infrequent, episodic vomiting
Physiological
The three classes of gastroesophageal reflux are:
b. _____: Painless, effortless vomiting with no physical sequelae
Functional
The three classes of gastroesophageal reflux are:
c. ________: Frequent vomiting with alteration in physical functioning such as failure to thrive (FTT) and aspiration pneumonia
Pathological
Signs and symptoms of Gastroesophageal reflux disease (GERD)
- _____, coughing, wheezing
- Weight loss
- irritability
- Recurrent vomiting
- ____________
- Painful belching/ abdominal pain
- Stool pattern changes
- Other: Sore throat, pharyngitis, otitis media, dental erosions
- Choking
5. Heartburn
Lab for GERD include:
- ____
- Urinalysis and urine culture
- Stool for occult blood
- Abdominal ______ to rule out pyloric stenosis (if age appropriate)
- CBC
4. ultrasonography
Management of GERD is
a) Small frequent _____
b) ____ frequently during feeding
c) Continue breastfeeding; avoid formal changes
d) Weighted formula or use AT formula; One tablespoon of rice very per ounce of formula
e) Elevate head after feeding
f) Medications
g) Follow up frequently to monitor growth parameters; parent education
h) Consider referral to GI specialist
a) feedings
b) Burp
Histamine H2- receptor antagonists to inhibit gastric acid secretion caused by histamine
Ranitidine (Zantac) and Famotidine (Pepcid)
Proton pump inhibitors (PPIs) to block gastric acid secretion caused by histamine, acetylcholine, or gastrin [_________ (______)]- may cause gynecolmastia
Omeprazole (Prilosec)
Obstruction resulting grom thickening of the circular muscle of the pylorus, occurring in 1: 500 infants
Pyloric Stenosis
_____ _____ the
a) cause is unclear; maybe familiar predisposition
b) Males more often affected
c) most common in Caucasians
d) breastfeeding delays presentation
Pyloric Stenosis
Pyloric Stenosis signs and symptoms include:
a) presentation is usually from ___ weeks to 4 months of age
b) Projectile non-bilious vomiting after eating
c) Hungry after vomiting
d) poor weight gain or weight loss
e) eventually becomes dehydrated
f) visible peristaltic waves
g) palpable mass (pyloric olive) after vomiting
3
Laboratory for Pyloric Stenosis include
a) Abdominal ______
b) Upper gastrointestinal imaging (GI) if ultrasound is not diagnostic. Commonly show “string sign” (narrowed pyloric channel)
Ultrasound
Management of Pyloric stenosis includes?
Surgical referral; prognosis excellent
Acute prolapse (telescoping) of one part of the intestine into another adjacent segment of the intestine
Intussusception
_____________
1) Cause of this is unknown but may be due to adenovirus
2) Other proposed causes include celiac disease, cystic fibrosis
3) More common in males
4) Most cases occur before two years of age
Intussusception
Signs and symptoms:
a) previously healthy infant develops acute colicky pain
b) bilious vs. non-bilious vomiting
c) progressive lethargy
d) currant jelly stool: Late presentation
e) Sausage shaped mass in the right upper quadrant
f) progressive distention/tenderness
g) if not reduced, perforation and shock may occur
Intussusception
Laboratory/ diagnosis for Intussusception:
a) ________ to clarify diagnosis
b) Barium enema: Diagnotic and produces reduction
Radiograph
Management of Intussusception:
a) _____ reduction as above
b) may require emergency surgery
c) fatal if not treated urgently
a) Barium reduction
It can be multi-factorial, familial, or develop spontaneously, IF untreated, may develop enterocolitis, which can be fatal.
Hirschsprung’s Disease (Aganglionic Megacolon)
Cuse of Hirschsprung’s Disease:
a) May present in ______ or in older children
b) Incidence in 1: 5000 births
c) More common in boys than girls
a) infancy
Signs/ symptoms of this include:
a) failure to pass meconium
b) bilious vomiting
c) jaundice
d) infrequent, explosive bowel movements
e) progressive abdominal distention
f) tight anal sphincter with an empty rectum
g) failure to thrive
h) malnutrition
Hirschsprung’s Disease
Laboratory/diagnostics for Hirschsprung’s Disease include:
a) ______ _____
b) barium enema
c) rectl/ colon biopsy
a) abdominal x-ray
Management of Hirschsprung’s disease include:
Referral to GI specialist/surgery
Inflammation of the appendix, precipitated by obstruction due to feces, a foreign body, inflammation or neoplasm
Appendicitis
_______ if untreated, gangrene and perforation may develop within 36 hours.
Appendicitis
Cause/Incidence of this occurs most:
a) most common in males 10 to 30 years old
b) affects approximately 10% of the population
appendicitis
Signs and symptoms of appendicitis include:
a) begins with vague, _____ umbilical pain
b) after several hours, pain shifts to right lower quadrant of the abdomen (RLQ)
c) Psoas sign
d) Rebound tenderness
e) Obturator sign
f) McBurney’s point tenderness
g) pain worsens and localized with cough
h) nausea with one or two episodes ob vomiting ( more vomiting suggest another diagnosis)
i) Sense of constipation; infrequently diarrhea
j) Fever (low grade)
a) colicky
c) Psoas
This is pain with right thigh extension
Psoas sign
Pain with internal rotation of the right thigh
Obturator sign
One- third the distance from the anterior superior iliac spine to the umbilicus
McBurney’s point tenderness
Laboratory/Diagnostics: Appendicitis
a) Elevated white blood cells _____ to _____/ul; EST elvated
b) Ultrasound or computerd tomography (CT) is diagnostic
a) 10,000 to 20,000 uL
Management of Appendicitis is:
a) _____ treatment with wound healing. Prognosis is typically very good.
b) Pain management
Surgical
Impairment intestinal absorption of essential nutrients and electrolytes caused by enzymatic deficiencies (e.g., cystic fibrosis), celiac disease (sprue), gluten intolerance, infectious agents, and abnormality of the intestinal mucosa
Malabsorption
Signs and symptoms of __________ include:
a) failure to thrive
b) severe, chronic diarrhea
c) bulk, foul stool (steatorrhea)
d) vomiting
e) abdominal pain
f) protuberant abdomen
g) associated with vitamin deficiency or malabsorption
1) pallor
2) fatigue
3) hair and dermatological abnormalities
4) cheilosis
5) peripheral neuropathy
Malabsorption
Laboratory/ diagnostics: malabsorption
a) stool: culture, Hemoccult, and ova and _____ exam (O&P)
b) serum calcium, phosphorus, alkaline phosphatase, total protein, ferritin, folate, and liver function test
c) bone age
d) lactose and sucrose breath hydrogen testing
e) sweat chloride tet if clinical suspicion of cystic fibrosis
a) parasite
Differential diagnosis: malabsorption
a) failure to thrive
b) short ______
c) cystic fibrosis
d) immune deficiency
e) Hepatic disease
f) inflammatory bowel disease
g) Chronic diarrhea/celiac disease
stature
Management: malabsorption
a) Treat persistent enteric infection
b) _______ modifications
1) celiac disease
2) cystic fibrosis
c) refer to gastroenterology
Dietary
No wheat, oats, rye, barley
Celiac disease
Pancreatic enzyme replacement; fat soluble vitamins (A,D,E, K)
Cystic fibrosis
A tumor arising from neural tissue; frequently from the adrenal glands and can spread to bone marrow, liver, lymph nodes, skin, and orbits of the eyes
Neuroblastoma
Cuse of this include:
a) Most common before the age of five
Neuroblastoma
Signs and symptoms neuroblastoma;
a) failure to thrive
b) enlarge abdominal mass
c) ____ _____
d) tachycardia
profuse sweating
Laboratory findings for neuroblastoma include:
a) abdominal _________
b) refer to CT
c) urine catecholamines
ultrasound
Management of neuroblastoma include:
a) referral to pediatric ________
oncologist
Inflammation of the liver with resultant liver dysfunction
Hepatitis
Manifestation fo symptoms may be either mild and self-limited, or profound and life ______
threatening
______ caused by any variety of viral subtypes (hepatitis A, B, C, D, E, and G); the most common types in pediatrics are A, B, and C.
Hepatitis
An enteral virus, transmitted via the oral-fecal route
Hepatitis A
Hepatitis A:
a) Common source outbreaks result in form contaminated ____ or food
b) Shellfish, such as raw oysters, clams and mussels, are a frequent source of infection
c) Symptoms manifest _____ weeks after infection
d) Blood and stools are infectious during the two to a six-week incubation period
e) Most children are anicteric, so infections frequently go unnoticed
f) A chronic carrier state does not exist; the mortality rate is very low, and fulminant hepatitis A is rare
water
A blood-borne virus present in saliva, semen, vaginal secretions, and all body fluids
a) Transmitted via blood and blood products, sexual activity, and mother to fetus
b) Incubation is six weeks to six months
c) Clinical features of hepatitis A and V are similar, but B tends to have a more insidious onset
d) The risk of fulminate hepatitis is < 1%, but when it occur, mortality is approximately 60%
Hepatitis B
Hepatitis C:
a) Traditonally associated with blood transfusion
b) ____ % of cases are related to IV drug use
c) The risk os sexual transmission is small and maternal -neonatal transmission is rare
d) The incubation period is variable, ranging from about four to 12 weeks
50%
This is fatigue, malaise, anorexia, N/V, headache, aversion to second-hand smoke and alcohol odors
Pre-icteric
Weight loss, jaundice, pruritus, right upper quadrant abdominal pain (RUQ pain), clay-colored stool, dark urine
Icteric
Hepatitis:
a) ____ grade fever may be present
b) Hepatosplenomegaly may be present
c) Diffuse abdominal pain, tenderness over the liver area
d) Dark urine and light-colored stool
a) Low
Laboratory for Hepatitis include:
a) ____
b) Urinalysis: Proteinuria, bilirubinuria
c) Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (500 to 2,000 IU/L)
d) AST and ALT rise prior to ______ of jaundice and will fall after jaundice presents
e) Lactate dehydrogenase (LDH), bilirubin, alkaline phosphate, and prothrombin time test (PT) are normal or slightly elevated
CBC
Serology Anti- HAV, IgM
Active hepatitis A
Serology Anti- HAV, IgG
Recovered hepatitis A
Serology HBsAg, HBcAg, Anti-HBc, IgM
Active Hepatitis B
Serology HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG
Chronic hepatitis B
Serology Anti-HBc, Anti-HBsAg
Recovered hepatitis B
Serology Anti-HCV, HCV RNA
Acure hepatitis C
Serology Anti-HCV, HCV RNA
Chronic hepatitis C
Management of hepatitis include:
a) generally supportive: rest during the ____ phase
b) increase fluid to 3,000 to 4,000 milliliters/day
c) Vitamin K for prolonged PT (>15 seconds)
d) Avoid alcohol and medications detoxified by the liver
e) little to no protein diet
acute
_____ (interferon and ribavirin) may be prescribed for hepatitis C
Rebetron
