GI Flashcards
Be familiar with Rome IV criteria for Dx of functional constipation in children (Infants up to 4 and >4yrs)
Babies should have 1st BM within ____ of birth
36hrs
By age 2, average is 2BM/day
By age 4, average is 1BM/day.
What 3 things must align for passing stool?
Increased intrarectal pressure
Relaxation of puborectalis muscle to strengthen the canal
Inhibition of external sphincter
How is Hirschprung different from constipation?
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
What are some red flags with constipation?
Fever, abdominal distention, weight loss, growth issues, anorexia, n/v, perianal fistulas, bloody diarrhea in infant with hx of constipation.
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
6
2-4oz of 100% apple, prune or pear juice. Glycerin suppositories may be useful. Avoid mineral oil, stimulant laxatives or phosphate enemas.
Maintenance therapy:
Mirilax 0.4G/kg/24hr titrate for goal of 1-2 Type ____ stools daily.
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.
Treat constipation for ______ as long as they have been having symptoms. Why?
Twice.
Bowel stretches out. Needs time to return to normal size with nerves getting back in line.
Home remedy for constipation:
1/2oz apple juice, 1/2 oz carrot juice, 1/2oz prune juice and 1/2oz pure corn syrup. Warm and drink.
How long does abd pain have to be present to be termed “chronic”?
Usually 3 months but at a minimum 1-2 months.
Non-organic abd pain means ____
Pain that cannot be explained by inflammatory, anatomic, metabolic or neoplastic process.
Assess how much disability a pediatric patient has with abd pain:
“If you want to do something fun with your friends, are you able to or do you have to sit out?”
A few examples of NON-GI etiologies that could present with abd pain
Respiratory (PNA, inflammation near diaphragm)
GU (obstruction, hydronephrosis, kidney stones)
Metabolic/hematologic (DM, lead poisoning)
MSK (trauma, costrochondritis)
Typical presentation of celiac (50% present this way)
Abd pain, diarrhea, steatorrhea, IDA, abd distention and FTT.
TTG IgA levels are needed to dx ______, but ____ and _____ remain gold standard for Dx.
Celiac disease.
EGD and biopsy
What is hematochezia?
Frank blood per rectum.
Chron’s disease presentation is more ______ than UC.
Insidious.
Chronic abd pain, anorexia, wt loss, growth failure, diarrhea, joint pain.
UC presents with abd pain, hematochezia and diarrhea.
Calprotectin and lactoferrin are ______
Fecal markers of inflammation.
IBD have high ESR and low ______. Together, these labs had a more sensitive and specific PPV than serologic antibody testing.
Hgb (anemia)
Dx of IBD - MR enterography, EGD, colonoscopy.
Chronic constipation you can lose the feedback loop with the internal sphincter stretch.
Functional abdominal pain disorders
Functional dyspepsia
IBS
Abdominal migraine
Functional abd pain - not otherwise specified.
Why are kids/babies more prone to GER?
Gastroesophageal Reflux
Increased intra-abdominal pressure
Hypotensive LES
Transient lower esophageal sphincter relaxations. (TLESR)
Delayed gastric emptying.
What is sandifer’s syndrome?
Paroxysmal systolic movement disorder where head and neck contract (Torticollis) and severe arching of the spine occurring in association with GER and hiatal hernia.
LES should tighten around ______
6-12 mo - less spit up
Pseudo- obstruction is a non mechanical /functional ileus where bowel is not necessarily obstructed, just NOT moving.
Children with atresias sometimes have a hx of polynydramnios.
Congenital obstructions vs acquired intestinal obstructions slides 56+57 GI Peds
Atresia means
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
Pyloric Stenosis leads to:
Dehydration, hypochloremic metabolic alkalosis.
Projectile emesis and FTT.
How can you dx pyloric stenosis?
Tx?
US of the pylorus muscle.
Pyloromyotomy surgery - ensure dehydration and metabolic alkalosis are corrected prior to surgery.
80% of adhesions happen within _____ of laparotomy
2 years
If a patient has abd pain within 2 years of an abdominal surgery or laparotomy , then what can be higher on your DDx?
Adhesions causing a BO.
When does intussusception most likely to occur
M:F 3:2
Most commonly what area of GI tract?
6-18mo of age
Iliocolic (fixed with enema).
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
Intussusception.
4 types of diarrhea
Osmotic (malabsorption)
Secretory (persistent with fasting)
Motility disorder (moving too fast)
Inflammatory (blood, mucus)__
Fecal elastase and stool pH <5.5 can signify issues with ______
Carbohydrate malabsorption.
Imodium to kids?
Not really ever.
Short guy maybe
Adolescents with diagnosed IBS-D
Review slide 96 - PE findings of malnutrition.
Acral dermatitis could be a _____ deficiency.
Zinc.
Enteral vs parenteral nutrition
Enteral - feed through GUT - oral, NG tube, OG tube, etc.
Parenteral - feed through veins - TPN
What is the preferred form of nutritional support?
Enteral whether through oral or tubes - use the gut!
