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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
Peds GI - Ulcerative Colitis
-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
Peds GI - Irritable Bowel Syndrome
-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
Peds GI - Malabsorption Syndrome - Overview
-Group of disorders where the small intestine is unable to absorb enough nutrients -Causes: *Celiac disease *Crohn's disease *Cystic fibrosis
28
Peds GI - Malabsorption Syndrome - S/S
-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
Peds GI - Malabsorption Syndrome - Labs/Diagnostic & Management
-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
Peds GI - Neuroblastoma
-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
Peds GI - Hepatitis - Overview
-Inflammation of the liver resulting in liver dysfunction -Most common types (A, B, and C)
32
Peds GI - Hepatitis - Hep 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
Peds GI - Hepatitis - Hep B
-Blood-borne (saliva, semen, vaginal secretions - body fluids -Can also be transmitted mother to fetus -Incubation: 6 weeks-6 months
34
Peds GI - Hepatitis - Hep C
-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
Peds GI - Hepatitis - S/S
-Pre-icteric: flu-like symptoms -Icteric: weight loss, jaundice, pruritus, RUQ pain, clay colored stools, dark urine -Hepatosplenomegaly
36
Peds GI - Hepatitis - Labs/Dx & Management
-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
Peds GI - Hepatitis - Serology tests
-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
Peds GI - Appendicitis - Overview
-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
Peds GI - Appendicitis - S/S
-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
Peds GI - Appendicitis - McBurney's Point Tenderness
-One third the distance from the anterior superior iliac spine to the umbilicus - pain on palpation
41
Peds GI - Appendicitis - Rovsing's Sign
-RLQ pain when pressure is applied to LLQ
42
Peds GI - Appendicitis - Psoas Sign
-Pain with right thigh extension
43
Peds GI - Appendicitis - Obturator Sign
-Pain with internal rotation of the flexed right thigh
44
Peds GI - Appendicitis - Labs/Dx & Management
-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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