GI Flashcards
sx w/out pathologic correlation
FUNCTIONAL
sx caused by a distinct pathological entity
ORGANIC
most common sources of acute abdomen in young children
Malrotation, intussusception, incarcerated hernia, congenital anomalies
most common sources of acute abdomen in older children
appendicitis
chronic abdominal pain in children
FUNCTIONAL 70-90% of the time- constipation, IBS
ORGANIC 10-30%- gastritis/ulcer, lactose intolerance, parasites, gall bladder disease
treat functional abdominal pain
reassurance and explanation of functional pain
Often have diarrhea as infants, then constipation as older children
Abdominal pain in early school years
Often stress-associated, risk of school avoidance
Rarely, if ever, awakens at night
IBS
most common cause of vomiting in childhood
viral gastroenteritis (obstructions, acute or chronic inflam of the gi tract, CNS inflam, metabolic derangements)
projectile vomiting means…
high obstruction, ie pyloric stenosis
bilious vomiting means…
OBSTRUCTION
Beyond ampulla of vater … duodenal, jejunal, ileal, colonic
** Malrotation
bloody vomiting means…
Mallory Weis tear (less common in peds)
Gastritis
Peptic ulcer?
neonatal vomiting common causes
OBSTRUCTION Duodenal atresia and stenosis Malrotation / volvulus Pyloric stenosis- forceful, nonbilious METABOLIC ACIDOSIS Sepsis Metabolic disorders / Inborn errors of metabolism
chronic vomiting in older children may mean
CNS (vomiting 1st thing in the morning associated w HA, no nausea, no abd pain)
Acute diarrhea in children- common cause
INFECTIOUS
viral- ROTAVIRUS, enterovirus, norovirus
management of acute diarrhea in children
supportivefluids, Na, K
Oral rehydration, starvation prolongs diarrhea
Avoiding lactose is helpful
should you give antidiarrheal meds?
NO. ineffective, possible can cause worsening illness
Bacterial diarrhea causes
Campylobacter, Salmonella, Shigella, E. coli, Yersinia, C diff
Bacterial diarrhea presentation
blood in stool, foreign travel, high fever
Functional causes of chronic diarrhea
IBS, toddler’s diarrhea
organic causes of chronic diarrhea
Food allergies Malnutrition / Malabsorption syndromes Impaction Inflammatory bowel disease Hirschsprung’s disease Immune deficiency syndromes
presentation functional chronic diarrhea
healthy appearing, 5-8 stools per day for an infant
presentation organic chronic diarrhea
weight loss, growth failure, ill-appearing
treatment of pseudomembranous colitis
oral metronidazole or vanco
most common causes of abx related c diff
clindamycin, cephalosporins, ampicillin
2nd most common cause of referrals to peds GI
constipation
chronic constipation
2 or more for at least 2 months: < 3 BM/Wk > 1 episode of encoporesis/wk impaction of rectum with stool stool that plugs toilet retentive posturing and fecal withholding pain with defecation
most common childhood constipation is…
FUNCTIONAL (withholding or IBS)
Organic causes of constipation
Hirschsprung’s disease
Absence of Meissner and Auerbach plexi
Sympathetic hyperactivity leading to tonic contraction (doesn’t relax)
Hirschsprung’s disease
Chronic constipation with dilatation of rectal ampulla and fecal soiling
encoporesis
treat encoporesis
Requires stool evacuation followed by chronic management to avoid reaccumulation of stool.
Stool softeners are important
treatment of diarrhea
Lifestyle: diet, behavioral modifications, biofeedback?
Signs that would suggest organic constipation
No passage of meconium within 2 days of birth
Hard, infrequent stooling since birth, especially if breast fed
Poor growth/ development
Distended abdomen
Abnormally placed anus, commonly anteriorly
Medical treatment for constipation
laxatives, usually osmotic (PEG 3350 common. Also can use lactuolose, magnesium hydroxide, mag citrate)
Most common source of significant GI bleed in kids
Peptic ulcer disease
Meckel’s diverticulum
Colitis
Intussusception
a true congenital diverticulum… a slight bulge in the small intestine present at birth
Meckel’s diverticulum
minor GI bleeding in kids causes
Anal fissures
Mallory-Weiss tear
Swallowed nasopharyngeal blood
rectal bleeding in infants common causes
colitis, anal fissure, milk protein allergy
rectal bleeding in older children common causes
Inflammatory Bowel Disease, Meckel’s diverticulum
causes of functional obstruction
disordered peristalsis, paralytic ileus, septic ileus, dysmotility
causes of mechanical obstruction
narrowing of the lumen, malrotation, intraluminal obstruction, meconium plug/CF
nonbilious vomiting
proximal to the ampulla of Vater
bilious vomiting
distal to the ampulla of Vater
infant has not passed stool in 24 hours. what do you think?
Hirschsprungs
Maternal hx polyhydramnios, what do you think about baby?
high obstruction
esophageal atresia, duodenal atresia
increased BS
obstruction
gastroienteritis
decreased BS
ileus, obstruction, ischemia
surgery pyloric stenosis
myotomy
surgery imperforate anus/Hirschsprungs
temporary colostomy
surgery intestinal atresias/webs
primary anastomosis
surgery malrotations/adhesions
lysis of adhesions and resection of nonviable intestine
surgery meconium ileus
theraputic enema
complications of pathologic reflux (GERD)
pain, which causes behaviors (crying, arching)
growth failure (FTT)
pulmonary complications (asp pneumo, asthma, apnea)
esophagitis
medical therapy GERD
H2, PPI
very severe GERD, meds don’t work, what can you do
surgical procedures: Nissen fundoplication
kid has copious oral secretions, choking aspiration, and you are unable to pass an NG tube. What do you think>
esophageal atresia
tracheoesophageal fistula
EA and TF associated with what
VACTERL
neonate took oral erythromycin and now comes in with projectile, nonbilious vomiting, constipation, dehydration, and weight loss
pyloric stenosis
gold standard diagnostic pyloric stenosis
US
most accurate test for PUD
endoscopy
kid comes in, abd pain several hours after meals that awakens him at night
PUD
treatment PUD
Acid suppression or neutralization
PPI , healing in 4-6 weeks
H pylori eradication if indicated
PPI + antibiotic regimen 1-2 weeks
most common site of intestinal atresia and stenosis
jejunum (duod second)
kid comes in polyhydramnios,bilious emesis, abdominal distension within hours of birth . he passes his meconium normally
duodenal atresia
duodenal atresia on x ray
double bubble sign
where does midgut volvulus usually occur
duodenojejunal junction
treatment of malrotation
Absolute Surgical Emergency .. Bowel ischemia and necrosis
kid born with guts out and no sac covering them
gastroschisis
herniation through the umbilical cord
omphalocele
Abdominal contents in chest due to failure in diaphragm formation at 8-10wk gestation
congenital diaphragmatic hernia
kid has persistent painless bloody stools
meckel diverticulum
common location for hirschprung
rectosigmoid colon
neonate fails to pass meconium by 24h what do you think
Hirschsprung
older child passing foul-smelling, ribbon like stools and has abd distention with prominent veins
Hirschs
major complication of hirschsprung
enterocolitis, colonic rupture
Translocation of Bacteria to bowel wall
NEC
Telescoping of bowel that causes progressive edema and ischemia
intussusception
usual location intussusception
Just proximal to ileocecal valve extending for varying distances into the colon
currant jelly stool
intussusception
most common cause of obs in first 2 years of life
intussusception
Most common indication for emergency abdominal surgery in childhood
acute appendicitis
greatest risk factor for IBD
family history
common trigger in Celiac disease
environmental agent-gliadin component of gluten
treatment Celiac
gluten free diet lifelong
gold standart celiac
SB biopsy
kid appears well but is jaundiced
biliary atresia
95% of the cause of pancreatic dysfunction in childhood
CF
