Gastrointestinal (Peds) Flashcards
Acute Diarrhea:
- Inflammatory: bloody + fever + abdominal pain
- Non Inflammatory: watery + vomiting + crampy pain
- MCC acute diarrhea in infancy: Rotavirus
- MCC bloody diarrhea:
Campylobacter, Amoeba, Shigella, E.coli, Salmonella
Acute diarrhea - Best initial test:
- Stool cultures with blood, leukocytes (H.U.S.)
- C. diff toxin if recent h/o antibiotics
- Ovum & parasites
- Enzyme immunoassays for viruses
Acute diarrhea - Best initial therapy:
Tx: Hydration; fluid/electrolyte replacement
- no antidiarrheals in children; rarely antibiotics
Tx if pt is not dehydrated and tolerating oral intake:
normal-age appropriate diet, limit fats, limit sugar
(makes diarrhea worse)
Shigella:
TMP-SMX
Campylobacter:
Self limited. Erythromycin may speed up recovery - use in severe disease or dysentery.
Salmonella:
Tx if < 3 months old who are:
Toxic, have disseminated disease, or who have S. typhi
C.difficile:
Metronidazole or PO vancomycin; discontinue other abx
E. histolytica or Giardia:
Metronidazole
Cryptosporidium:
Antiparascitics.
Hemolytic Uremic Syndrome (HUS)
- complication of acute invasive (bloody) diarrhea
- mcc: e.coli 0157: H7
H/P: 5-10 days after infection
- pallor, weakness, oliguria, ARF
- mcc ARF in young children
HUS: dx
microangiopathic hemolytic anemia: helmet cells, burr cells, fragmented cells; (-) coombs; low platelets; hematuria
HUS: tx
supportive care, tx of hypertension,
aggressive nutrition, early dialysis
Chronic Diarrhea:
-nonspecific; normal wt, normal ht; no fat in stool
- h/o excessive intake of fruit juice, carbonated fluids,
low fat intake - if wt loss or stool with fat - screen for malabsorption
Fat Malabsorption:
Best initial: Sudan black stain
Confirmatory: 72 hour stool for fecal fat (gold standard)
To assess pancreatic function: Serum trypsinogen
Carbohydrate Malabsorption:
Best initial: Clinitest (measures reducing substances)
Specific: Breath hydrogen test
Protein Malabsorption: cannot be evaluated directly
Initial: spot stool alpha-1-antitrypsin level
Vitamins/Minerals:
Measure Fe, folate, Ca, Zn, Mg, vits B12, D, A
Celiac:
-chronic diarrhea, FTT, anorexia, growth retardation
initial: antiendomysial and antigliadin antibodies
specific: histology on biopsy
Celiac: Tx & Risks
Tx: Lifelong strictly gluten-free diet
Risks: Increased risk T cell lymphoma, Osteoporosis
GERD: nonbilous vomiting but maintains normal weight
1st step: Upright positioning, thicken formula with rice
2nd (if 1st fails): H2-receptor antagonist (ranitidine, cimetidine) because of its safety profile
Pyloric Stenosis: presentation
- associated with erythromycin
h/p: < 6 wks; post-prandial nonbilous projectile vomiting;
child is hungry immediately after eating
Pyloric Stenosis: dx & tx
initial: Abdominal U/S (thickened pyloric sphincter;
1”-mass “olive-sign”) Tx: 1) IVF, correct electrolytes;
2) NGT to decompress bowel 3) Pylorectomy
Malrotation and Volvulus: h/p & tx
h/p: Bilious emesis, recurrent abdominal pain w/ vomiting
tx: surgery
Malrotation and Volvulus: initial
Initial: abdominal U/S (inversion of SMA and vein and duodenal obstruction) or barium enema (cecum not in RLQ; duodenum misplaced)
Meckel’s (hematochezia): h/p
- only true diverticulum
h/p: painless rectal bleeding; iron def anemia + massive BRBPR due to gastric acid secretion by ectopic tissue
-ectopic gastric and/or pancreatic tissue
Meckel’s: dx and tx
Dx: Tc-99m pertechnetate scan detects gastric mucosa
Tx: Surgical removal
Intussusception:
- telescoping of bowel; classically occurs in < 2 yrs
- following URI; meckel’s; polyp; viral; lymphoma; stool
h/p: sudden paroxysms of colicky abdominal pain in lethargic child + bilious vomiting + shock + fever + palpable sausage-shaped mass + black currant jelly stool (ischemia)
Intussusception: testing
best initial: plain film of abdomen to r/o obstruction
U/S: “doughnut sign,” “target sign”
-concentric alternating mucosa/submucosa
Intussusception: diagnosis and curative
Air enema: diagnostic and curative
-if radiographic reduction not successful:
emergent surgical intervention to prevent necrosis
