Gastrointestinal/Nutritional System Flashcards
1
Q
rotavirus
A
- 3-15 mos old, winter, transmitted fecal-oral, incubation 1-3d, MCC gastroenteritis in children <2yo
- sxs: vomiting, diarrhea (watery, non-bloody, nonmucous), low grade fever, nasal sxs + coryza precede GI sxs
- signs: met acidosis from bicarb loss in stool, ketosis from poor intake, lactic acidemia from hypotension/perfusion
- dx: hypo/hypernatremia with dehydration, PCR of stool
- tx: supportive (pedialyte), reduced fat intake to dec N/V, antidiarrheal ineffective
- health maint: vaccinate at 2, 4, 6 mo
2
Q
dehydration
A
- loss of plasma free water compared to loss of electrolytes
- RF: higher incidence with gastroenteritis (V/D), fever, burns, young children unable to communicate needs
- etiology: large number wet diapers, V, bleeding, oliguria/anuria, D, sick contacts, diuretic tx, diabetes insipidus, glycosuria, fever, burns, volume depletion is measured by change in weight from baseline
- sxs: hx increased thirst, dec UOP, lethargy, irritable
- signs: volume depletion - change form baseling weight 2kg (= 2L), inc pulse or resp, low BP, dec skin turgor, delayed cap refill
- dx: hypernatremia, HCO3 <17 indicates moderate to severe hypovolemia or met acidosis, urine sodium <25 and osmolality >450; severe: BMP, VBG, lactic acid, CBC, glucose, HCO3
3
Q
calculating maintenance fluids
A
- 4-2-1 rule: 4mL/kg per hr first 10kg, 2mL/kg per hour next 10kg, 1mL/kg
4
Q
appendicitis
A
- lumen obstructed by hyperplasia of lymphoid tissue, fecalith, or foreign body - leads to bacterial growth and inflammation - distention leads to ischemia, infarction, and necrosis
- peak incidence = mid 20s
- sxs: abd pain (epigastric → umbilicus → RLQ), anorexia, N/V, McBurney pnt (RLQ tendernes), rebound tenderness, guarding, decreased bowel sounds, low fever, Rovsing sign (LLQ TTP →RLQ referred pain), psoas sign (LQ pain w/ hip plexed against resistance or extended while lying on L side), obturator sign (LQ pain when hip and kne flexxed and hip internally rotated)
- dx: CLINICAL DX, CBC - neutrophilia (supportive), ANC elevated, CRP elevated, UA to ro UTI, imaging if atypical presentation (CT, US)
- tx: appendectomy (lap), IVF, broad spectrum abx (cefoxitin, ceftriaxone, flagyl), NPO, pain mngmt
5
Q
pyloric stenosis
A
- foreceful vomiting caused by hypertrophy and spasm of pylorus
- MCC obstruction in neonate
- MC: 3-6wk of life, mostly males
- common presentation: hungry infant that wants feeding after vomiting, constipation
- sxs: blood streaked, non-bilious projectile vom, weight loss, anorexia steady periumbilical pain (moves to RLQ), N/V, low fever
- signs: L-R peristaltic waves in LUQ after feeding, palpable olive shaped mass superior to right of umbilicus in midepigastrium, dehydration
- dx: Ultrasound (initial) thickened, enlarged pylorus, antral nipple sign, cervix signs, +peritoneal signs, UGI (string sign - long narrow pyloric lumen) REQUIRED FOR DX, venous pH (hypochloremic alkalosis), lab findings = hypochloremia, hypokalemia, metabolic alkalosis
- tx: IVF, surg (pyloromyotomy)
6
Q
intussusception
A
- males, MC abd emergency in early childhood
- MCC: intestinal obst in first 2y of life
- etiology: 75% idiopathic, MC location is ileocolic, adhesions in adults
- infant: paroxysmal abd pain, bilious V, D progressing to bloody stool, inconsolable crying, draws legs toward abdomen
- child: follows viral illness, sudden onset, intermittent, severe, colicky abd pain, pain leads to vomiting, becomes bilious with time, current jelly stool (blood and mucous)
- signs: palpable sausage shaped mass in RUQ
- dx: abd US (target/bull’s eye/coiled spring sign), CT scan (target lesion representing layers of intussuscepted segment
- tx: barium/air enema: diagnostic and tx, NPO, IVF, NG, ABX, manual reduction or resection with primary anastomosis
7
Q
hirschsprung dz
A
- MC: short segment of distal colon (transition zone in rectosigmoid), M>F, FH or genetic mutations
- associated: trisomy 21, kidney or urinary tract anomalies, congenital absence of Meissner and Auerbach autonomic plexus - functional obstruction
- sxs infant: failure to pass meconium in first 24h, bilious V, distention
- sxs older child: chronic constipation (acute enterocolitis), foul-smelling stool that is ribbon like
- signs: distended abd with veins, pencil-like stools
- dx: DRE (squirt sign), KUB (transition zone), barium enema w XR (cone shaped transition zone, narrowed dist colon w proximal dilation), full-thickness rectal bx (no ganglion cells)
- acute enterocolitis: bowel stasis and bact overgrowth, sepsis-like (F, V/D, distention) - toxic megacolon
- chronic const: pencil-like stools, no fecal incont, FTT, distention
- tx: acute (NPO, IVF, NG, ABX, surgery - diverting colostomy or ileostomy)
- colonic lavage: mech irrigation with large bore rectal tube and large colume irrigant
- surg: diverting colostomy
- chronic: stimulant laxatives, osmotic laxative, enema, rectal irrigation, anal botox
8
Q
duodenal atresia
A
- congen absence or complete closure of portion of lumen of duodenum
- associated with trisomy 21
- hx: polyhydramnios during preg, bilious vomiting first day of life, lethargy
- signs: upper abd distention, resp difficulty
- dx: XR (double bubble sign)
- tx: IVF, NG tube, duodeno- duodenostomy, not urgent
9
Q
infantile colic
A
- 2wk to 3-4mo, M=F, unkown etiology, may be related to bad feeding technique (under/overfeed, infreq burping), cows milk/lactose intol, GI immaturity, intest hypermot, alt in fecal microflora
- persistent or excessive crying during infancy, benign, self-limiting condition that resolves with time
- sxs: rule of threes (cries for 3+h/d, 3+d/wk, for at least 3wk)
- loud, high pitched, screaming > crying, unable to console
- occurs suddenly in late evening, otherwise healthy and well fed
- aggravators: hungry, hurt, sick, too hot or cold, tired; allergy to formula or breastmilk
- signs: hypertonia, flushing, circumoral pallor, tense and distended abdomen, knees drawn up, fists clenched, stiffening and tightening of arms, arching back
10
Q
intantile colic dx and tx
A
- dx: clinical dx
- tx: soothing techniques (rub abdomen, provide white noise), change feeding habit (dont rush eating, give time to burp, bottle fed in vertical position), if refractory: trial of changing feedings, eliminate cow’s milk
- prognosis: resolves by age 3-4mo
- health maint: normal for infants to cry up to 2h/d especially in first 3mo of life, simethicone, herbal teas and probiotics not proven to help, do not treat with dicyclomine and phenobarb
11
Q
constipation
A
- 95% functional, no pathology
- MCC: painful BM with voluntary withholding of feces
- triggers: toilet training, changes in routine/diet, stress, illness, unavailable toilets, too busy
- most nonorganic causes: toilet phobia, avoidance, excessive parental intervention, developmental, genetics, reduced stool volume/dryness
- sxs: 2 or more of the following for 2mo (<3BMs per wk, more than one ep of encopresis per week), impaction of the rectum with stool, passage of stool so large it obstructs the toilet, retentic posturing and fecal withholding, pain with defecation - painless rectal bleeding
- tx:
- infants (<1y): glycerin suppository
- children: rapid disempaction (enemas, mineral oil, normal saline, milk and molasses)
- slower disimpaction: HD mineral oil, PO senna, PO mg citrate
- adults: dietery fiber + fluids, osmotic stool softener (milk of mag, lactulose, miralax), stimulants (senna)
12
Q
encopresis
A
- males 3-6x more common, age 5-6y, constipation (90%), retention, colon dilation, overflow
- sxs: repeated voluntary/involuntary passage of feces in inappropriate places (soiling), 1 event per mo, at least 3mo, at least 4yo
- signs: dark, foul smelling, liquid stool
- dx: T4/TSH, IgA TG abs, Ca and lead, KUB
- tx: evacuation behavior strategies (sit on toilet after meals to stimulate gastrocolic reflex, inc fluid intake), <1yo = osmostic laxative, glycerin suppos, enema; >1y = osmotic laxative, lubricants, stimulants, enema
13
Q
jaundice
A
- RF: birth weight <2500g, breast feeding, gest age <37wk, sibing with prev phototx, cephalohematoma or bruising, east asian
- sxs: yellow face, sclera
- signs: splenomegaly with hereditary spherocytosis
- dx: bhutani nomogram, hyperbilirubinemia >35wk gest is TB >95% on nomogram (if extends below umbilicus, measure total bili (TB), at risk if TB >25mg/dL (kernicterus with encephalopathy))
14
Q
types of jaundice
A
- ABO incomp: first 24h after birth, coombs +, retic high, H&H low, tx with transfusion or phototx
- RH isoimmun: first 24h after birth, coombs +, H&H low, tx with transfusion or phototx
- Hereditary spherocytosis: first 24h after birth, coombs -, retic high, spherocytes on periph smear, tx with transfusion or phototx
- G6PD def: first 24h after birth, coombs -, tx with phototx
- physiologic: after 24h, peaks 3-5d, bili inc by <5mg/dL/day, tx with phototx if >15 or not descending
- breastfeeding: peaks 2-3d, bili inc and persists 6-8wks, tx by supplementing breast milk, feed q2h, phototx if >15
15
Q
inguinal hernia
A
- processus vaginalis remains open and peritoneal fluid or abd structure forced into it (INDIRECT), M>F, preterm male = 5%, males <1000g = 30%
- sxs: painless inguinal swelling (retracts when cold, active, frightened or agitatied
- +/- V, abd distention
- signs: inginal fullness with coughing or long periods of standing, or presence of firm, globular, tender swelling
- tx: manual reduction of incarcerated hernias attempted AFTER infant sedated and placed in Trendelenburg position
