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Peds > GI > Flashcards

GI Flashcards

1
Q

A concerned parent brings her child to you complaining that he has 2 loose stools /day. Would you Dx diarrhea?

A

maybe not… it should be >3 LOOSE WATERY stools/day per definition of diarrhea.

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2
Q

a child comes in with diarrhea. what are some of your DDx?

A

1.infectious 2. diet related 3. IBS 4. inflammatory bowel dz 5. meds (abx), 6. celiac dz 7. intussusception 8. appendicitis

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3
Q

what is infectious diarrhea due to?

A

viral, bacterial, systemic

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4
Q

what is the common cause of viral diarrhea?

A

Rota virus

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5
Q

what are two possible causes of diet related diarrhea?

A

1.toddler’s diarrhea 2. cows/soy milk intolerance

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6
Q

what do you focus on first for Tx of diarrhea?

A

focus on hydration PO vs IV

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7
Q

what is constipation?

A

regular passage of firm or hard stools, or the infrequent passage of stools

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8
Q

what are 2 types of constipation?

A

functional vs. organic

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9
Q

a child comes in with constipation but you find no anatomical biochemical abnormality. What kind of etiology do you suspect for this constipation?

A

functional constipation

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10
Q

what is organic constipation due to?

A

anatomic or biochemical cause

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11
Q

what is functional constipation?

A

voluntary holding of stool –there is no anatomical biochemical abnormality–

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12
Q

why do some kids voluntarily hold their stool?

A

neg experience, painful…this may result in stool incontinence (encopresis)

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13
Q

when does constipation most likely happen… in kids of course?

A

intro to solid food, toilet training, start of school

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14
Q

What PE do you do for constipation?

A

abdominal and anus/rectal

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15
Q

why do you do abd exam for constipation?

A

decreases bowel sound and distention may be concerning for obstruction

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16
Q

why do you do anus/rectal exam for constipation?

A

looking for anal fissure, anatomic placement, r/o fecal impaction

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17
Q

when you have a pt with constipation, what Dx study do you do to r/o impaction?

A

plain film of abdomen

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18
Q

what do you recommend for management of constipation?

A

fluids, gradual increase in daily fiber intake, decrease dairy, relieve impaction, laxative, counseling and reward program

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19
Q

what should you ALWAYS do for a pt with vomiting?

A

obtain a reliable history and description of vomits

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20
Q

what do you do to check volume status in pt with vomiting when suspecting dehydration?

A

check mucous membranes, skin turgor, sunken fontanelle, urine output

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21
Q

what are some infections that cause vomiting?

A

gastroenteritis, UTI, Pharyngitis

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22
Q

what is GERD?

A

effortless regurgitation of stomach contents

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23
Q

Is GERD always bad?

A

no…there are some happy spitters

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24
Q

How do you know if your pt with vomiting is a happy spitter?

A

vomit in happy spitters is not forceful

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25
Q

if you see hoarseness, dysphagia, respiratory complications with vomiting, is it a happy spitter case?

A

Nope!

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26
Q

if symptoms of vomiting are severe what do you do?

A

UGI or endoscopy

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27
Q

what is Tx for GERD?

A

H2 blocker or/and PPI therapy

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28
Q

what is pyloric stenosis?

A

increase in size of pylorus muscle causing stenosis of the channel

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29
Q

Pyloric stenosis is most common in:

a. males
b. females
c. second born children
d. first born children

A

D. poor first born children.

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30
Q

what are clinical presentation of Pyloric Stenosis?

A

PROJECTILE vomiting after feeding, non-bilious, HUNGRY VOMITER

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31
Q

what might you find in PE exam suspecting Pyloric Stenosis?

A
  1. upper abd may be distended
  2. prominent peristaltic waves moving from L to R
  3. Olive sized mass in RUQ
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32
Q

you finish your abd exam and you find an Olive sized mass in RUQ . what does this indicate…most likely?

A

pyloric stenosis from HYPERTROPHY

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33
Q

Is a mass always palpable in pyloric stenosis with hypertrophy?

A

no…due to early presentation, abd fat, or of course skills of examiner a mass might not be palpable.

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34
Q

What is the test of choice for pyloric stenosis?

A

Ultrasound

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35
Q

What can you see in ultrasound of a pt with pyloric stenosis?

A

elongation and thickening of the pylorus

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36
Q

What do you have to look for on UGI of a pt with possible pyloric stenosis?

A

the string sign on UGI

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37
Q

What is the management of pyloric stenosis?

A
  1. IV fluid and electrolyte resuscitation
  2. pyloromyotomy
  3. wait for the EXCELLENT prognosis
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38
Q

What is a pyloromyotomy anyway?

A

incision down to the mucosa and fully across the length of the pylorus

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39
Q

what is congenital atresia?

A

one or more segments of bowel may be missing and/or obstructed

40
Q

what are three types of congenital atresia?

A

Duodenal, jejunoileal,colonic

41
Q

what type of congenital atresia is a/w congenital abnl such as down syndrome?

A

duodenal

42
Q

what is the common etiology of congenital atresia?

A

it is common with prenatal hx of polyhydramnios

43
Q

what is the most important clinical presentation of congenital atresia?

A

bile-stained vomiting begings within first 24 hrs.

44
Q

A new born has failed to pass meconium. what is your first thought for DX?

A

congenital atresia

45
Q

What dx studies do you order when suspecting congenital atresia?

A

first abd plain film and upper GI series/contrast enema to confirm or identify the exact area.

46
Q

You see a DOUBLE BUBBLE sign on abd xray of a pt. what is your dx?

A

duodenal congenital atresia: due to gas and dilation in both stomach and duodenum

47
Q

You see adilated loops of bowel and air fluid levels on abd xray of a pt. what is your dx?

A

jejunoileal/colonic congenital atresia: dilated loops of bowel and air fluid levels

48
Q

what would ultimately resolve the congenital atresia?

A

you manage via iv fluid to correct electrolytes but surgery intervention is the ultimate.

49
Q

what is prognosis for surgery intervention for congenital atresia?

A

> 90% survival

50
Q

what is a complication of midgut malrotation?

A

volvulus: narrow mesenteric base increase small bowel mobility

51
Q

what is volvulus?

A

small intestine twists around SMA causing vascular compromise

52
Q

midgut malrotation is not an emergency. is it?

A

Yes!!!! it is a surgical emergency because it can lead to necrosis, perforation, peritonitis, sepsis, and you being sued!

53
Q

a 14 day old pt comes in with BILIOUS vomiting, abd pain and HEMATOCHEZIA what are you thinking of?

A

midgut malrotation w/wo volvulus

54
Q

you do an abd exam on a week old infant and you see abd distention and VISIBLE PERSITALSIS. what are you thinking of for Dx?

A

midgut malrotation …at least

55
Q

what dx studies do you do when suspecting midgut rotation and why?

A

UGI to see obstruction and displacement of duodenojejeunal jxn to the RIGHT of the spine

56
Q

why would you order barium enema for dx of midgut malrotation?

A

if DX in question or to confirm dx (cecum in RUQ)

57
Q

what is tx of midgut malrotation?

A

surgery with a good prognosis in 90% of pts

58
Q

what is intussusception?

A

invagination of one portion of intestine into another usually PROXIMAL to ILEOCECAL VALVE.

59
Q

what is the most frequent cause of intestinal obstruction in the first 2 years of life?

A

intussusception. Remember it is rare in newborns.

60
Q

a 1.5 yo pt comes in for abd cramp where he draws his legs to the chest. his mom also reports vomiting, not feeding, and currant jelly stools. what is your DX?

A

intussusception

61
Q

what are you looking to find in abd exam when suspecting intussusception?

A

tender/distended abd and a sausage shaped mass in upper mid abd secondary to swollen bowel

62
Q

what dx studies when suspecting intussusception?

A
  1. abd ultrasound
  2. Barium enema (dx and therapeutic ~90%)
  3. air enema ( to avoid risk a/w perforation)
63
Q

how do you manage intussusception?

A
  1. IV fluid
  2. emergent surgical consult
  3. reduction w/barium enema
  4. SURGERY if BE unsuccessful
64
Q

Can you skip reduction in managing intussusception?

A

NOPE! if reduction not performed, can be fatal

65
Q

what is meckel’s diverticulum?

A

embroyonic remnant of the omphalomesenteric duct or Vitelline duct

66
Q

what does an abnormal pouch/opening from small intestine called?

A

Meckel’s diverticulum

67
Q

where do you expect to fine Meckel’s diverticulum?

A

usually located mid to distal ileum

68
Q

what is the dz of 2’s?

A

meckel’s diverticulum

69
Q

what does the dz of 2’s mean?

A

2% of population
2:1 M:F
2% become symptomatic
<2yo more symptomatic

70
Q

what are some clinical presentation of meckel’s diverticulum?

A

painLESS rectal bleeding
obstruction (volvulus or intussusception)
DiverticulITIS (may look like Appendicitis)

71
Q

What dx studies do you order when suspecting meckel’s diverticulum?

A

Technetium-99 scan (meckel’s scan)

72
Q

You are about to dx a pt with Meckel’s diverticulum but you are also thinking of something else. what is that dx?

A

acute appendicitis

73
Q

You have dx a patient with Meckel’s dovertoculum. what’s next?

A

Surgical resection of the diverticula and the omphalomesenteric remnant.

74
Q

you just sent a pt for surgery b/c of meckel’s diverticulum. the family asks you about the prognosis. what do you say?

A

prognosis is excellent!!

75
Q

what is hirschsprung dz?

A

congenital aganglionic megacolon

76
Q

hirschsprung dz occurs secondary to what?

A

absence of ganglion cells in mucosal and muscular layers of colon and begins in DISTAL bowel usually RECTOSIGMOID

77
Q

in hirschsprung dz pt does not have ganglion cells in parts of colon. So what?

A

peristalitic waves cannot extend beyond this zone of denervation and the bowel may become obstructed

78
Q

what kind of obstruction is a/w hirschsprung dz?

A 
functional obstruction
(REMEMBER  hirschsprung dz is ORGANIC CONSTIPATION)
79
Q

SPASM and abnl motility in affected portion of the colon is a/w what?

A

hirschsprung dz

80
Q

what is most common cause of LOWER bowel obstruction in neonates?

A

hirschsprung dz

81
Q

hirschsprung dz has concurrence with which of the chromosomal abnormalities?

A

down syndrome

82
Q

a new born fails to pass meconium within the first 24 hr, followed by bilious vomiting, abd distention, reluctance to feed. there is no hematochezia and visible persitalsis. abd xray does not show double bubble. What is your dx?

A

hirschsprung dz

83
Q

Can you dx hirschsprung dz if pt has passed meconium?

A

YES!! new born may passes meconium with symptoms developing later. pt may present with progressive constipation and partial obstruction.

84
Q

what are PE findings when suspecting hirschsprung dz?

A

abd distention
anal canal may feel narrow on rectal exam
anal canal and rectum devoid of fecal material–>gush of stool when finger removed

85
Q

gush of stool when finger removed on rectal exam is a/w what?

A

hirschsprung dz

86
Q

what dx studies when suspecting hirschsprung dz?

A

rectal bx–confirms absence of ganglion cells

87
Q

how do you manage hirschsprung dz?

A
  1. resection of aganglionic segment

2. colostomy

88
Q

what do you need to consider when thinking of colostomy for hirschsprung dz?

A
  1. allow pt to recover before reparative surgery

2. colorectal anastomosis performed later

89
Q

what is inflammatory bowel dz?

A

immune mediated inflammation of GI including ulcerative colitis and crohn’s

90
Q

cobblestone appearance is a/w what dz?

A

crohn’s dz

91
Q

erythematous and friable mucosa with small erosions is a/w what dz?

A

ulcerative colitis

92
Q

how do you treat inflammatory bowel dz?

A

dz maintenance

  1. 5-ASA (sulfasalazine, asacol)
  2. immunimodulating agents (6-MP)
  3. biologics (remicade)
  4. steroids
93
Q

when do you use steroids for inflammatory bowel dz?

A

during flares

94
Q

what are the concerns for using steroids for inflammatory bowel dz?

A

bone density and growth and development

95
Q

What often results from functional constipation in children?

A

stool incontinence (encopresis) often results from functional constipation

96
Q

Corkscrew sign on Xray is a/w ?

A

Volvulus

Peds (8 decks)

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