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DRT > Gastrointestinal Issues & Disorders > Flashcards

Gastrointestinal Issues & Disorders Flashcards

1
Q

Peds GI - Gastroenteritis - Overview

A

-Acute nausea, vomiting, and diarrhea - copious and ongoing - explosive water diarrhea - “A lot coming out of both ends”
-Children attending daycare are at high risk

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2
Q

Peds GI - Gastroenteritis - Causes

A

-Viruses: most common
*Rotavirus - more common
*Norovirus (cruise-ships) - more common
*Adenovirus

-Bacterial
*E. coli - loose stools
*Salmonella - no distinctive symptoms
*Campylobacter - foul smelling stools
*Shigella - fever with febrile seizures, and bloody stools

-Stress
-Parasites
-Inorganic food contents - kids with pica eating dirt/soil

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3
Q

Peds GI - Gastroenteritis - S/S

A

-Nausea
-Copious vomiting and diarrhea
-Hyperactive bowel sounds
-Dehydration
-Decreased urinary output (1st sign)
-“Sick” feeling
-Anorexia
-Cramping or distention

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4
Q

Peds GI - Gastroenteritis - Assessment of Dehydration

A

-Decreased urinary output is usually the 1st sign of dehydration
-HR is affected before BP

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5
Q

Peds GI - Gastroenteritis - Diagnostic Tests

A

-No diagnostic tests indicated unless s/s persist for more than 72 hours or pts have bloody stool
-Stool guaiac may be positive if bacterial infection is cause
-Stool culture for WBCs, parasites, ova

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6
Q

Peds GI - Gastroenteritis - Management

A

-Daycare exclusion: Children cannot go back to daycare until 2 stool cultures, 24 hours apart, come back negative (only for e.coli or shigella)
-Continue breastfeeding/formula
-Oral rehydration therapy (water, Pedialyte for older kids) - no Gatorade, juice, soda, as they have limited electrolyte concentrations and are high in carbs
-Resume regular diet gradually - for kids with a lot of diarrhea, you can do BRAT diet: Banana, Rice, Applesauce, Toast
-Do not use anti-motility drugs - you want the patient to get rid of whatever is affecting them - definitely don’t use if blood in the stool or patients with fever
-Antibiotics - only give if bacterial infection is cause

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7
Q

Peds GI - GERD - Overview

A

-Gastric contents pass into the esophagus through the lower esophageal sphincter

-3 classes:
*Physiological: “Nothing major”, infrequent
*Functional: “Happy spitter”, painless, effortless vomiting, no physical sequelae
*Pathological: Frequent vomiting, alteration in physical functioning, FTT, aspiration PNA, frequent OM

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8
Q

Peds GI - GERD - S/S

A

-Weight loss
-Recurrent vomiting
-Heartburn (older kids)
-Painful burping
-Sore throat
-Dental erosion

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9
Q

Peds GI - GERD - Management

A

-Small frequent feeds
-Burp frequently during feeds
-Continue breastfeeding
-Avoid formula changes, rather do weighted formula (rice-cereal)
-Elevate head after feeding - do not sit up, it puts pressure on esophageal sphincter and can cause vomiting

-Medications:
*Histamine H2-receptor antagonist - inhibits gastric acid secretion - famotidine
*Proton pump inhibitor (PPI) - blocks gastric acid secretion - pantoprazole, lansoprazole

**Both of these meds can cause gynecomastia - even if meds are discontinued, the gynecomastia does not resolve

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10
Q

Peds GI - Constipation

A

-S/S:
*Abdominal pain
*Decreased appetite
*Painful stooling

-Labs/Diagnostics:
*Clinical dx, made by history and physical exam
*Abdominal XR will show stool

-Management:
*High-fiber diet
*Stool softeners (Miralax works well)
*Increases water intake

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11
Q

Peds GI - Pyloric Stenosis - Overview

A

-Obstruction resulting from thickening of circular muscle of the pylorus
-Cause is unclear
-Males more affected
-More common in Caucasian
-Breastfeeding delays presentation

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12
Q

Peds GI - Pyloric Stenosis - S/S

A

-Children between 3 weeks-4 months
-Projectile non-bilious vomiting after eating - it is non-bilious because contents do not make it to the intestines
-Hungry after vomiting3
-Poor weight gain, weight loss
-Dehydration
-Palpable mass (pyloric olive) after vomiting

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13
Q

Peds GI - Pyloric Stenosis - Labs & Management

A

-Labs:
*US
*Upper GI imaging - US - shows “string sign” (narrowed pyloric channel)

-Management
*Surgical referral

-Overall good prognosis

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14
Q

Peds GI - Intussusception - Overview

A

-Telescoping of one part of the intestine into another part of the intestine
-Cause unknown, however, may be due to adenovirus, and has been debated if linked to celiac disease or cystic fibrosis
-Children between 3 months-6 years
-More common in males

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15
Q

Peds GI - Intussusception - S/S

A

-Previously healthy baby develops sudden colicky pain
-High-pitched, sudden loud crying
-Bilious or non-bilious vomiting - depending where in the intestines the telescoping is
-Progressive lethargy
-Currant jelly stools **
-Sausage-shaped mass in RUQ **
-Necrosis where telescoping

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16
Q

Peds GI - Intussusception - Management

A

-Send to ER
-Fatal if not treated urgently
-Fluid or air enema for reduction
-Surgery

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17
Q

Peds GI - Hirschsprung’s Disease (Aganglionic Megacolon) - Overview

A

-Nerve cells are missing at the end of the bowel, causing blockages in bowel
-More common in boys
-Can happen in infancy or older children

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18
Q

Peds GI - Hirschsprung’s Disease (Aganglionic Megacolon) - S/S

A

-Failure to pass meconium *** Hallmark sign
-Bilious vomiting
-Abdominal distention
-Tight anal sphincter with empty rectum
-FTT
-Malnutrition

19
Q

Peds GI - Hirschsprung’s Disease (Aganglionic Megacolon) - Labs/Diagnostics

A

-Gold standard for dx is BIOPSY

20
Q

Peds GI - Hirschsprung’s Disease (Aganglionic Megacolon) - Management

A

-Surgery
-If untreated, enterocolitis may develop, which can be fatal

21
Q

Peds GI - Volvulus

A

-Torsion of GI tract, leading to bowel obstruction
-Causes: can be caused by chronic constipation
-May be the first sign in Hirschsprung’s disease

-S/S:
*Insidious, progressive abdominal pain
*Constipation
*Abdominal distention
*N/V

-Labs/Diagnostic:
*CBC, BMP
*XR
*CT

-Management:
*Refer to GI
*Endoscopic detorsion
*Surgery

22
Q

Peds GI - Celiac Disease - Overview

A

-Immune reaction to eating gluten (found in wheat, barley, and rye)
-Genetic
-Female more affected than males
-First appear in infants

23
Q

Peds GI - Celiac Disease - S/S

A

-GI findings suggestive of malabsorption
*Diarrhea (greasy, foul-smelling)
*Flatus
*Weight loss
*Stomach pain

24
Q

Peds GI - Celiac Disease - Labs/Diagnostic & Management

A

-Labs/Diagnostic
*Gold standard: intestinal biopsy via endoscopy
*Antibody testing

-Management
*Referral to GI
*Gluten-free diet
*Daily multivitamin if vitamin deficient
*Corticosteroids

25
Q

Peds GI - Ulcerative Colitis

A

-Idiopathic, inflammatory condition affecting most commonly small bowel and colon
-Peak onset in late adolescent
-More common in males

-S/S:
*Possible growth failure
*Prolonged diarrhea
*RLQ or periumbilical pain relieved by defecation
*Low-grade fever
*Weight loss
*Bloody stools (if colon is involved)

-Labs/Diagnostics:
*Colonoscopy for dx
*Serologic testing can differentiate between Crohn’s and UC

-Management: Step-Up Approach
*Mild: Oral 5-ASA (mesalamine), abx, nutrition
*Moderate: Corticosteroids, 5-ASA, immunomodulary agents
*Severe: Biologics, combination of mild and moderate

26
Q

Peds GI - Irritable Bowel Syndrome

A

-Group of symptoms: abdominal pain, diarrhea, constipation, or a combination
-More common amongst females

-S/S:
*Abdominal cramping
*Diarrhea
*Constipation
Rectal tenesmus ** hallmark sign

-Diagnostic:
*Stool sample
*Lactose breath hydrogen test
*XR, US
*Endoscopy/colonoscopy

-Management:
*Symptomatic
*Fiber
*Antidiarrheals
*Stool softeners for constipation

27
Q

Peds GI - Malabsorption Syndrome - Overview

A

-Group of disorders where the small intestine is unable to absorb enough nutrients

-Causes:
*Celiac disease
*Crohn’s disease
*Cystic fibrosis

28
Q

Peds GI - Malabsorption Syndrome - S/S

A

-FTT
-Fatigue - vitamin deficiency
-Severe, chronic diarrhea
-Bulky, foul stool (steatorrhea)
-Vomiting
-Abdominal distention - associated with vitamin deficiency or malabsorption - pallor, fatigue, hair and derm abnormalities, cheilosis, peripheral neuropathy

29
Q

Peds GI - Malabsorption Syndrome - Labs/Diagnostic & Management

A

-Labs/Dx:
*Stool: culture, hem occult, ova and parasite exam
*Bone age (assess for delayed bone age)

-Diff Diagnosis:
*FTT
*Short stature
*Cystic fibrosis
*Hepatic disease
*IBD
*Celiac disease

-Management: treat underlying cause
*Refer to pediatric GI
*Dietary modifications - celiac disease, no wheat, rye, oats, or barley - cystic fibrosis, pancreatic enzyme replacement, fat soluble vitamins (ADEK)

30
Q

Peds GI - Neuroblastoma

A

-Cancerous tumor of neuroblasts
-Most commonly found in the adrenal gland
-Most common before there age of 5
-Most common cancer in infants

-S/S:
*Lump or pain where tumor is growing

-Labs/Dx:
*CT/MRI
*Bone marrow aspirate or biopsy
*PET
*Urine catecholamines
*Tissue biopsy

-Management:
*Refer to pediatric oncology
*Surgery
*Chemo
*Radiation

31
Q

Peds GI - Hepatitis - Overview

A

-Inflammation of the liver resulting in liver dysfunction
-Most common types (A, B, and C)

32
Q

Peds GI - Hepatitis - Hep A

A

-Transmitted oral-fecal route
-Contaminated water and food
-Foods, especially shellfish (raw foods, oysters, clams, mussels)
-S/S manifest 2-6 weeks after infection

33
Q

Peds GI - Hepatitis - Hep B

A

-Blood-borne (saliva, semen, vaginal secretions - body fluids
-Can also be transmitted mother to fetus
-Incubation: 6 weeks-6 months

34
Q

Peds GI - Hepatitis - Hep C

A

-Typically associated with blood transfusions, however in the US, blood is now screened for it
-Most cases related to IV drug use
-Incubation: 4-12 weeks

35
Q

Peds GI - Hepatitis - S/S

A

-Pre-icteric: flu-like symptoms
-Icteric: weight loss, jaundice, pruritus, RUQ pain, clay colored stools, dark urine
-Hepatosplenomegaly

36
Q

Peds GI - Hepatitis - Labs/Dx & Management

A

-Labs/Dx:
*US
*AST, ALT
*BIlirubin

-Management:
*Supportive care
*Postexposure prophylaxis to contact: HAV vaccine or IG as soon as possible, but no later than 2 weeks after exposure

37
Q

Peds GI - Hepatitis - Serology tests

A

-Active Hep A
*Anti-HAV, IgM - in the moment

-Recovered Hep A
*Anti-HAV, IgG - gone

-Active Hep B
*HBsAG (antigen), HBeAG (e in the middle - middle of a fight), Anti-HBc, IgM (in the moment)

-Chronic Hep B
*HBsAG, Anti-HBc, Anti-Hbe (e at the end - almost done, chronic), IgM, IgG (gone)

-Recovered Hep B
*Anti-HBc, Anti-HBs

-Acute Hep C & Chronic Hep C
*Anti-HCV, HCV RNA - a quantitative test tells you if virus is active or not depending on #s

38
Q

Peds GI - Appendicitis - Overview

A

-Inflammation of the appendix
-Can be due to obstruction due to feces, foreign body, inflammation, neoplasm
-If left untreated, gangrene or perforation can happen within 36 hours
-More common in males 10-30 years

39
Q

Peds GI - Appendicitis - S/S

A

-Begins with vague, colicky pain
-After several hours, pain shifts to RLQ
-McBurney’s & Rovsing’s - pain on palpation
-Psoas & obturator - pain with leg manipulation
-Pain worsens with cough
-Nausea (only 1-2 episodes)
-Low-grade fever

40
Q

Peds GI - Appendicitis - McBurney’s Point Tenderness

A

-One third the distance from the anterior superior iliac spine to the umbilicus - pain on palpation

41
Q

Peds GI - Appendicitis - Rovsing’s Sign

A

-RLQ pain when pressure is applied to LLQ

42
Q

Peds GI - Appendicitis - Psoas Sign

A

-Pain with right thigh extension

43
Q

Peds GI - Appendicitis - Obturator Sign

A

-Pain with internal rotation of the flexed right thigh

44
Q

Peds GI - Appendicitis - Labs/Dx & Management

A

-Labs/Dx:
*Elevated WBCs (10k-20k)
*Elevated ESR and CRP
*US or CT is diagnostic (US first)

-Management
*Surgical treatment - good prognosis
*Pain management

DRT (11 decks)

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