GI Flashcards
Hirshsprung
Constipation without soiling, poor anal tone and dilated canal. Diagnose with barium enema, rectal manometry and biopsy showing high AChE and no ganglion cells.
Functional Constipation
Conditioned habit due to pain with defecation. Get withholding behaviors, overflow diarrhea, palpable mass, normal sphincter tone, normal anal wink. Normal first stool time (Hirsh around 36 hrs). Tx: laxatives, regular habits, eliminate pain.
Constipation DDx
Hypothyroid, metabolic (low K, high Ca), Anatomic (hirshsprung, imperforate anus with fistula, fistula, hemorrhoid, fissure), neuro (look for sacral dimple/pit, CNS issues, anal wink), drugs, neurofibromatosis.
Meckel Diverticulum
remnant of the vitelline duct. Contains gastric or pancreatic tissue that can cause ulceration. Often a painless bleed in early childhood.
TPN Complications
Common: Sepsis (1-5%); thrombosis, vein perforation, pneumothorax, bleed, brachial plexus injury. SI mucosa atrophy is reversable. Hyperglycemia and hyperTAG.
Hypertrophic Pyloric Stenosis
Persistent, Progressive, palpable olive (mid epigastric or RUQ), projectile. Non-bilious. Weight loss. Usually presents in week 2-6. Low Cl- and low K+ and metabolic alkalosis.
Pancreatitis acute
severe pain (10/10, radiating to back), N/V. Tender, guarding, rebound, distension, paralytic ileus.
Pancreatitis causes (GETSMASHED)
gallstones, ethanol, trauma, steroids, mumps, autpimmune (PAN), scorpion sting, hyperTAG, hyperCa2+, ERCP, drugs.
Gilbert Syndrome
Inherited deficiency of glucoronyltransferase (conjugates bili). 5% incidence. Unconjugated jaundice.
Criggler Najjir
Inherited, rare. Unconjugated. Dangerous hyperbilirubinemia.
peak age of brush border lactase activity
3 years.
Rome III criteria for IBS
Fucntional disorder: recurrent or continuous with no structural or biochemical abnormalities. IBS: Abdo pain that (2 or more): is relieved upon defecation, onset associated with change in stool frequency, and onset associated with change in stool quality.
Red flags against functinoal abdo pain
Failure to thrive, abnormal lab results, abnormal physical, blood in stool/vomit, bilious vomit, fever,
Primary teeth order/timing
6 mo: mandibular central incisors. Then max c.i’s. Then lateral incisors. First molar, cuspids and then 2nd molars around 2 years of age. Last teeth: maxillary second molars.
Things that activated charcoal wont help bind
strong bases or acids, ferrous sulfate, alcohols, cyanide, lithium, K+
Broken tooth procedure
Replant ASAP, at scene if possible then go to dentist (5% success by 2 hr). Can rinse in cold water, dont brush, can transport in milk. Depends on integrity of periodontal ligament.
caustic ingestion
Generally supportive care. Figure out agent, concentration and volume. Consult poison control/MDS. Do not induce vomit. Do not neutralize (exothermic reaction). Do not give NG by traditional methods. Can give small volumes of water/milk. Diluents though are often discouraged.
Fe Ingestion
Caustic to GI tract (diarrhea, vomiting) and causes metabolic acidosis. Aggressive fluid care by IV, whole bowel irrigation, desfuroxime. Ipecac not recommended. NG lavage may help.
Hemorrhagic disease of newborn
Rare now with Vit K injection. Presents a few days after birth: hematemesis, bloody stool, purpura, blood from umbilical stump.
Vitamin C deficiency
Diffuse tenderness (worse in legs), poor wound healing, evidence of hemorrhage, low fever, poor appetite, tachy, swelling.
Vit A deficiency
Vision affected first, then moisture: poor vision, night blindness, conjunctival/sclera dryness. Dry skin. Growth failure
Secondary teeth
Replacement goes from age 6 to 12 usually. More teeth.
Necrotizing Enterocolitis
Mostly premature babies. Hematemesis, bloody stool, distension, hypoxia, acidosis. Dx by plain film and apt test. Usually presents a few days after birth.
