GI Flashcards
externalized intestines, not in a pouch
gastroschesis
Complications of gastrochesis
infection
hypothermia
necrosis of the intestines
immediate tx of gastrochesis
sterile saline and gauze to wrap intestines
wrap saran warp to keep moisture and heat in
problems that has sx without pathologic correlation. Lab tests/ work up are negative
Functional
sx caused by an distinct pathological entity.
organic problem
what does a Chem 7 look at?
basic electrolytes
kidney function
what can strep throat depend on?
Headache and stomachache
Most common sources of acute abdominal pain in young children?
Malrotation
intussusception
incarcerated hernia
congential anomalies
Most common source of acute abdominal pain in older children
Appendicitis
pouch on the wall of the lower part of the intestine that is present at birth
Merckel’s diverticulum
what are 2 function chronic abdominal pains
constipation
IBS
common organic problems of abdominal pain
gastritis/ ulcer
lactose intolerance
parasites
gallbaldder dz
bloating, transitioning b/w constipation and diarrhea.
IBS
tx for functional abdominal pain
reassurance and explanation of functional pain (fluids, diet, activity, sleep, emotions)
most common cause of vomiting in childhood?
Viral gastroenteritis
what can forceful or projectile vomiting indicate?
Pyloric stenosis, obstruction
what causes billious (green/yellow) vomiting?
Beyond ampulla of vater (means there is a problem beyond that point)
what can cause bloody vomiting?
mallory weis tear
gastric
peptic ulcer
problems associated with projectile vomiting in neonates
obstruction
duodenal atresia/ stenosis
malrotation/ volvulus
pyloric stenosis
What is forceful vomiting that is non-billious and forceful and projectile. Will present with FTT
Pyloric stenosis
Most common cause of vomiting in older children?
Viral illness
Vomiting first thing in the morning associated with headaches. Not associated w/ nausea or abdominal pain.
CNS problem
what is the origin of acute diarrhea usually?
Infectious
Tx for acute diarrhea
Fluids, Na, K
oral rehydration
what part of the GI system does rotavirus affect?
Small intestine
what presents with volumous watery diarrhea without leukocytes or blood. Will first have vomiting then followed by a low fever.
Rotavirus
what age groups is roatvirus common in?
3-15 months, peak in winter
who are enteroviruses more common in
Toddlers and school aged
What is a potential cause of traveler’s diarrhea?
Norovirus (winter vomiting syndrome)
How do you tx diarrhea?
No antidiarrheal medications because they are ineffective and possibly worsen the illness
What should you suspect if there is blood in the stool?
Colitis, bacterial cause
Patients with shigella often also have what?
a high fever
when can abx be harmful with diarrhea?
Shigella, can cause hemolytic uremic syndrome
what are the only indications for abx in bacterial diarrhea
C. Diff or
salmonella or campylobacter with risk of further infection
What conditions can cause malabsorption diarrhea?
Lactose inteolerance
celiac disease
cystic fibrosis
steatorrhea
Pt. presents with fever, tenesmus, abdominal pain with diarrhea and hx of being on abx.
pseudomembranous colitis by C. Diff
what causes toddler’s diarrhea
too much fat, not enough protein
most common reason for constipation in children.
Functional
Think of with a constipated infant. Stool isn’t moving due to lack of innervation.
Hirschsprung disease
causes of organic constipation
cystic fibrosis
hypothyroidism
anorectal malformation
Chronic constipation with dilatation of rectal ampulla and fecal soiling
Encopresis
Tx for consptiation
increase fiber, avoid dairy increased fluids
toilet training exercising after eating
Signs of an organic cause of constpation
No massage of meconium w/i 2 days of birth hard, infrequent stooling poor growth/ development distended abdomen abnormally placed anus
Medical tx for constipation
osmotic laxative- polyethylene glycol
Causes of signifiant GI bleeding in kids
PUD
Meckel’s diverticulum
colitis
intussusception
Causes of minor GI bleeding in kids
Anal fissure
mallory-Weiss tear
swallowed nasopharyngeal blood
outpouching of the small intestines
Meckel’s diverticulum
most common cause of rectal bleeding in infants
colitis from allergies (milk allergy) or anal fissue
common causes of GI bleeding in odler children
IBS
meckel’s diverticulum
tx you can do for Mecke’s diverticulum
Meckel scan (nuclear med test)
Is a paralytic ileus functional or organic?
Functional
Is disordered peristalsis functional or organic?
Functional
Is a septic ileus functional or organic?
Functional
For an ______ you have pain that is out of proportion to the physical exam. will hear hypertympanic bowel sounds.
obstruction
sill be sitting still
peritonitis
if pain is increasing in frequency or severity what does it suggest
Ischemia
what is the major cause of small bowel obstruction
surgery (due to surgery)
what can show an obstruction
x-ray (KUB) do supine and upright to look for air/fluid levels
A Blueish hue in infants can indiacte what?
Perforation
what does increased bowel sounds indicate (high pitched)?
obstruction
gastroenteritis
what usually cause decreased bowel sounds?
paralytic ileus
obstruction
ischemia
exposure of the esophagus to gastric contents. It is a physiologic problem
GE reflux
Casues of reflux
Increased frequency of sphincter relaxation
Decreased lower esophageal sphincter resting tone
Poor esophageal clearance of refluxed material
Slow gastric emptying
when is spitting up a problem
Pain
FTT
aversion to eating
Pulmonary complications of reflux
Aspiration pneumonia
Broncho-pulmonary disease
Asthma/reactive airway disease
Apnea and bradycardia
irritation of the esophagus
Esophagitis
meds for GERD in kids
H2 antagonists (zantac, pepcid) PPIs (prilosec, prevacid, nexium)
what is a surgery that tightens the esophagus and is for severe reflux.
Nissen fundoplication
will present with copious oral secretions,choking aspiration,
tracheoesophageal fistula
What is tracheoesophageal fistula associated with?
VACTREL Vertebral Anaal atresia Cardiac TE_F renal Limb abnormalities
Hernia presents at birth, repair if present after first few years of life.
Umbilical hernia
Hernia more common in males, rarely incarcerated. corrected by surgeon
Inguinal hernia
big concern with pyloric stenosis
FTT
what abx given in neonatal period has been associated w/ higher incidence of pyloric stenosis in infants (<30 days)
erythromycin
In childhood most are secondary to underlying illness, toxins, or drugs causing a breakdown in mucosal defenses.
PUD
Most accurate study for PUD
endoscopy
best test for H. Pylori
Usually the stool, because serum testing is for the antibody
End result is obstruction with dilated bowel proximally, small disused bowel distally
Intestinal atresia
double bubble sign refers to what type of obstruction
small intestine
tx for duodenal atresia
surgery – duodenoduodenoscopy (bipass stenosis)
Due to abnormal movement of intestine around the superior mesenteric artery as intestine reenters abdominal cavity at ~10 weeks
Malrotation
where does midgut malrotation appear
duodenojejunal junction-
presents with pain, bilious vomiting, distention.
Malrotation
Tx for malrotation
Surgical emergency
Herniation through cord
Associated with anomalies
omphacele
what is gastroschisis associated w/?
spina bifida
Tx for congenital diaphragmatic hernia
NPO, NG for gastric decompression, Surgery
Can present in toddlerhood with worsening respiratory distress and failure to thrive.
Congential diaphragmatic hernia
Outpouching of ileum in mid to distal ileum
Meckel diverticulum
tx for meckel diverticulum
surgery
Telescoping of bowel that causes progressive edema and ischemia
Intussusception
Present with ~20 minute cycles of intermittent pain,
vomiting
Heme positive stools (95% of the time.)
Intussusception
Is Meckel diverticulum painful?
No usually painless
what does meckel diverticulum usually present with?
bloody stools
what condition with have ribbon like stools?
Hirschsprung dz
Major compilation from hirschsprung dz
toxic megacolon
usually around 18 months-3 years old, intermittent episodes. Will bring knees to chest. Currant jelly stools.
Intussusception
tx for intussusception
contrast enema
most common cause of obstruction in first couple years of life
intussusception
most common cause of acute abdomen in older children
acute appendicitis
Abdominal pain Diarrhea, constipation Gassiness, distention, bloating Anorexia Poor weight gain, FTT (but can be obese) Irritability, lethargy
Celiac dz
will see distended belly and then wasting.
Celiac’s dz
tx for celiacs
avoid gluten
Gold standard for celiac dx
small bowel biopsy
bile ducts aren’t complete. Will have bile reflux back to liver. can cause jaundice after first few years of life.
biliary atresia
