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Peds Exam 3 > GI > Flashcards

GI Flashcards

1
Q

Be familiar with Rome IV criteria for Dx of functional constipation in children (Infants up to 4 and >4yrs)

A
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2
Q

Babies should have 1st BM within ____ of birth

A

36hrs

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3
Q

By age 2, average is 2BM/day
By age 4, average is 1BM/day.

A
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4
Q

What 3 things must align for passing stool?

A

Increased intrarectal pressure
Relaxation of puborectalis muscle to strengthen the canal
Inhibition of external sphincter

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5
Q

How is Hirschprung different from constipation?

A

Failure of ganglion cells to migrate to distal bowel creating a functional obstruction:
Onset at birth, soiling is rare, FTT, Enterocolitis, significant abdominal distention, normal anal tone, no stool in rectal vault, no ganglion on biopsy

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6
Q

What are some red flags with constipation?

A

Fever, abdominal distention, weight loss, growth issues, anorexia, n/v, perianal fistulas, bloody diarrhea in infant with hx of constipation.

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7
Q

Disimpaction Regimen: Mirilax 1.5g/kg/24hrs in 3-4 divided doses x2-3 days (not to exceed 100g/24hr. Goal is Type_____ stool. Avoid enema when possible. Avoid stimulant if had stool is retained. Try ______ in children <1

A

6
2-4oz of 100% apple, prune or pear juice. Glycerin suppositories may be useful. Avoid mineral oil, stimulant laxatives or phosphate enemas.

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8
Q

Maintenance therapy:
Mirilax 0.4G/kg/24hr titrate for goal of 1-2 Type ____ stools daily.

A

3-4
Rarely add dulcolax for first 1-2 months
Repeat clean out 1-2x/month only for recurrent cases.
Aggressive treatment for 2-3mo minimum and most likely 6-18mo. Wean with a back up plan.

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9
Q

Treat constipation for ______ as long as they have been having symptoms. Why?

A

Twice.
Bowel stretches out. Needs time to return to normal size with nerves getting back in line.

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10
Q

Home remedy for constipation:

A

1/2oz apple juice, 1/2 oz carrot juice, 1/2oz prune juice and 1/2oz pure corn syrup. Warm and drink.

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11
Q

How long does abd pain have to be present to be termed “chronic”?

A

Usually 3 months but at a minimum 1-2 months.

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12
Q

Non-organic abd pain means ____

A

Pain that cannot be explained by inflammatory, anatomic, metabolic or neoplastic process.

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13
Q

Assess how much disability a pediatric patient has with abd pain:

A

“If you want to do something fun with your friends, are you able to or do you have to sit out?”

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14
Q

A few examples of NON-GI etiologies that could present with abd pain

A

Respiratory (PNA, inflammation near diaphragm)
GU (obstruction, hydronephrosis, kidney stones)
Metabolic/hematologic (DM, lead poisoning)
MSK (trauma, costrochondritis)

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15
Q

Typical presentation of celiac (50% present this way)

A

Abd pain, diarrhea, steatorrhea, IDA, abd distention and FTT.

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16
Q

TTG IgA levels are needed to dx ______, but ____ and _____ remain gold standard for Dx.

A

Celiac disease.
EGD and biopsy

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17
Q

What is hematochezia?

A

Frank blood per rectum.

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18
Q

Chron’s disease presentation is more ______ than UC.

A

Insidious.
Chronic abd pain, anorexia, wt loss, growth failure, diarrhea, joint pain.
UC presents with abd pain, hematochezia and diarrhea.

19
Q

Calprotectin and lactoferrin are ______

A

Fecal markers of inflammation.

20
Q

IBD have high ESR and low ______. Together, these labs had a more sensitive and specific PPV than serologic antibody testing.

A

Hgb (anemia)

21
Q

Dx of IBD - MR enterography, EGD, colonoscopy.

A
22
Q

Chronic constipation you can lose the feedback loop with the internal sphincter stretch.

A
23
Q

Functional abdominal pain disorders

A

Functional dyspepsia
IBS
Abdominal migraine
Functional abd pain - not otherwise specified.

24
Q

Why are kids/babies more prone to GER?

A

Gastroesophageal Reflux
Increased intra-abdominal pressure
Hypotensive LES
Transient lower esophageal sphincter relaxations. (TLESR)
Delayed gastric emptying.

25
Q

What is sandifer’s syndrome?

A

Paroxysmal systolic movement disorder where head and neck contract (Torticollis) and severe arching of the spine occurring in association with GER and hiatal hernia.

26
Q

LES should tighten around ______

A

6-12 mo - less spit up

27
Q

Pseudo- obstruction is a non mechanical /functional ileus where bowel is not necessarily obstructed, just NOT moving.

A
28
Q

Children with atresias sometimes have a hx of polynydramnios.

A
29
Q

Congenital obstructions vs acquired intestinal obstructions slides 56+57 GI Peds

A
30
Q

Atresia means

A

Absence or abnormal narrowing of a passage or opening that is supposed to be there:
Choanal atresia (absence of nare(s))
Anal atresia (absence of anus)
Biliary atresia
Esophageal atresia

31
Q

Pyloric Stenosis leads to:

A

Dehydration, hypochloremic metabolic alkalosis.
Projectile emesis and FTT.

32
Q

How can you dx pyloric stenosis?
Tx?

A

US of the pylorus muscle.
Pyloromyotomy surgery - ensure dehydration and metabolic alkalosis are corrected prior to surgery.

33
Q

80% of adhesions happen within _____ of laparotomy

A

2 years

34
Q

If a patient has abd pain within 2 years of an abdominal surgery or laparotomy , then what can be higher on your DDx?

A

Adhesions causing a BO.

35
Q

When does intussusception most likely to occur
M:F 3:2
Most commonly what area of GI tract?

A

6-18mo of age
Iliocolic (fixed with enema).

36
Q

Crampy abd pain, vomiting and “currant jelly” stools are classic triad for ______.
Parents often say patient has an episode of extreme irritability (crying, screaming, legs pulled up) followed by an episode of extreme exhaustion

A

Intussusception.

37
Q

4 types of diarrhea

A

Osmotic (malabsorption)
Secretory (persistent with fasting)
Motility disorder (moving too fast)
Inflammatory (blood, mucus)__

38
Q

Fecal elastase and stool pH <5.5 can signify issues with ______

A

Carbohydrate malabsorption.

39
Q

Imodium to kids?

A

Not really ever.
Short guy maybe
Adolescents with diagnosed IBS-D

40
Q

Review slide 96 - PE findings of malnutrition.

A
41
Q

Acral dermatitis could be a _____ deficiency.

A

Zinc.

42
Q

Enteral vs parenteral nutrition

A

Enteral - feed through GUT - oral, NG tube, OG tube, etc.
Parenteral - feed through veins - TPN

43
Q

What is the preferred form of nutritional support?

A

Enteral whether through oral or tubes - use the gut!

Peds Exam 3 (10 decks)

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