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Special Pops - Peds > GI > Flashcards

GI Flashcards

1
Q

Infants with gastroesophageal reflux

A

Usually benign, self limited (85% resolve by 12 mo)

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2
Q

When to treat infants with GER?

A
  • FTT
  • Rumination
  • Apnea
  • Aspiration
  • Irritability
  • Neck contortions (Sandifer syndrome)
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3
Q

What is Sandifer syndrome?

A

Infants with gastroesophageal reflux and associated neuro symptoms (neck contortions)

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4
Q

What is a red flag a/w gastroesophageal reflux in infants?

A

Bilious vomitus (indicates malrotation with vovlulus, intussusception)

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5
Q

How do older children with gastroesophageal reflux present?

A

Adult-type symptoms: heartburn, dysphagia, cough, reactive airways

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6
Q

Purpose of antacid trial in GER?

A

Both diagnostic and therapeutic

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7
Q

Treatment of GER in children

A
  • Smaller, more frequent meals
  • Thickened feedings/formulas
  • H2 blockers/PPIs reduce discomfort NOT frequency of reflux
  • Surgery if severe
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8
Q

Describe eosinophilic esophagitis

A
  • Vague symptoms c/w GERD including dysphagia

- MC in boys than girls

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9
Q

Diagnosis of eosinophilic esophagitis?

A
  • Symptoms unresponsive to antacid
  • Endoscopy shows white exudate with eosinophils, hypertrophied mucosal rings
  • Skin testing may show specific allergens
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10
Q

Treatment of eosinophilic esophagitis

A
  • Exclusion/elimination diet
  • Swallowed “inhaled” steroids or systemic steroids
  • Esophageal dilation for strictures
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11
Q

Who is MC affected by achalasia of the esophagus?

A

Children over 5 yo

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12
Q

Treatment of achalasia of the esophagus

A
  • Botulism toxin injection in LES (relapse is over 50% though)
  • Pneumatic dilation of LES
  • Surgical myotomy
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13
Q

Describe caustic burns of the esophagus based on pH

A
  • pH under 2 causes less injury due to sore taste

- pH over 12 larger volume of ingestion, deeper injury w/liquefactive necrosis

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14
Q

Role of endoscopy in caustic burns of the esophagus

A
  • Performed under 48 hrs may underestimate injury

- Performed over 72 hrs may risk perforation

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15
Q

What type of caustic burn to the esophagus MC leads to strictures?

A

Full thickness necrosis with circumferential lesions

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16
Q

MC FB in the GI tract?

A

Coins

pins/screws/nails with blunt end heavier than sharp end usually pass w/o problem

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17
Q

Foreign bodies in the GI tract

A
  • 80-90% pass
  • Pins/screws/nails with blunt end heavier than sharp end usually pass w/o problem
  • Removal recommended
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18
Q

Who is MC affected by pyloric stenosis?

A

4:1 males

13% with family history

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19
Q

Clinical presentation of pyloric stenosis

A
  • Symptoms 2-4 wks, up to 12 wks
  • Postprandial nonbilious vomiting (occasionally projectile)
  • Ravenous after vomiting
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20
Q

Treatment of pyloric stenosis

A
  • Fluid resuscitation prior to surgery

- Pyloromyotomy

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21
Q

Who is MC affected by gastric and duodenal ulcers?

A

Males

Any age!

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22
Q

Symptoms of gastric/duodenal ulcers

A
  • Pain and bleeding MC
  • Obstruction
  • Anemia
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23
Q

MC causes of gastric/duodenal ulcers

A
  • Underlying severe illness (US)
  • H pylori infection (world)
  • Toxins (US)
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24
Q

Treatment of gastric/duodenal ulcers

A
  • Acid suppression/neutralization
  • Limit caffeine, aspirin, ETOH, NSAIDs
  • H pylori treatment
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25
Q

Which type of hernia occurs through the foramen of Bochdalek?

A

Congenital diaphragmatic hernia (posterolateral)

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26
Q

What improves survival in infants with congenital diaphragmatic hernia?

A

Extracorporeal membrane oxygenation with NO, high frequency oscillatory ventilation

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27
Q

Types of intestinal atresia

A

50% are jejunoileal

45% are duodenal

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28
Q

Double bubble on x-ray indicates:

A

Intestinal atresia

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29
Q

Describe short bowel syndrome

A

Malabsorption disorder caused by the removal of over 50% of small intestine

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30
Q

Etiology of short bowel syndrome

A
  • Necrotized enterocolitis (45%)
  • Intestinal atresia (23%)
  • Gastroschisis (15%)
  • Volvulus (15%)
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31
Q

Treatment of short bowel syndrome

A
  • Parenteral or enteral nutrition

- Bowel lengthening procedures

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32
Q

MC cause of intestinal obstruction in the 1st 2 years of life?

A

Intussusception

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33
Q

Define intussusception and where it typically occurs

A
  • Inversion of one portion of the intestine within another

- Typically occurs just proximal to ileocecal valve telescoping into the colon

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34
Q

Causes of intussusception

A
  • Unknown in 85%

- In children over 6 yo, lymphoma is leading cause

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35
Q

Treatment of intussusception

A
  • Barium and air enemas are diagnostic/therapeutic

- Surgery if toxic, unsuccessful, signs of bowel perforation

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36
Q

What is the MC cause of intussusception in children over 6 yo?

A

Lymphoma

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37
Q

What is the MC form of inguinal hernia in children?

A

Indirect (follows the processus vaginalis)

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38
Q

Clinical presentation of inguinal hernias in children

A
  • Males 9:1, premature
  • Painless mass
  • History is often enough for surgical referral
39
Q

Clinical presentation of umbilical hernias in children

A
  • MC blacks, preterm

- Most regress spontaneously if fascial defect less than 1 cm

40
Q

Which type of hernia in children is more likely to spontaneously regress?

A

Umbilical

41
Q

Describe Meckel diverticulum

A
  • Slight bulge in the small intestine present at birth and a vestigial remnant of the omphalomesenteric duct
  • Most complications occur under 2 yo
  • 40-60% have rectal bleeding d/t heterotopic gastric mucosa
42
Q

40-60% of children with Meckel diverticulum have:

A

Rectal bleeding due to heterotopic gastric mucosa

43
Q

Diagnosis of Meckel diverticulum

A

99mTc nuclear scan

44
Q

Treatment of Meckel diverticulum

A

Surgical resection

45
Q

Define chronic constipation in children

A

2 or more of:

  • Less than 3 BM/wk
  • 1 or more episode of soiling per wk
  • Impaction of rectum w/stool
  • Passage of toilet obstructing stool
  • Retentive posturing and fecal withholding
  • Tenesmus, hematochezia common due to anal fissures
46
Q

Diagnosis of chronic constipation

A
  • HISTORY

- KUB can be helpful

47
Q

Clinical presentation of appendicitis in children

A
  • Peak age 15-30 yo but not uncommon in toddlers
  • Positive CRP and leukocytosis have PPV of 92%
  • US
  • Negative abd CT has NPV of 99%
48
Q

What has a 99% negative predictive value of appendicitis?

A

Negative abd CT (with non-visualized appendix)

49
Q

What has a 92% positive predictive value of appendicitis?

A

Positive CRP and leukocytosis

50
Q

How does anterior displacement of the anus present?

A
  • Constipation w/straining

- Severe displacement may be a form of imperforate anus

51
Q

Severe anterior displacement of the anus may be a form of:

A

Imperforate anus

52
Q

How does anal stenosis present?

A
  • Ribbon like stools
  • Blood, mucus at rectum
  • Fecal impaction
  • Abd distention
53
Q

MC anorectal abnormality in children?

A

Imperforate anus

54
Q

Clinical presentation of imperforate anus

A
  • Infants fail to pass meconium

- Anal musculature development may be nonexistent

55
Q

Complication of imperforate anus

A

Anal musculature may not be developed

56
Q

What is pseudomembranous enterocolitis?

A
  • AKA C. diff colitis
  • Colitis develops after abx use
  • Treated by stopping abx with observation
57
Q

____ may be normal flora in up to 50% of newborns

A

C. diff

58
Q

Conditions associated with celiac disease in children

A
  • DM type 1
  • Down syndrome
  • Turner syndrome
  • IgA deficiency
  • Autoimmune thyroiditis
  • FH of celiac disease
59
Q

Classic presentation of celiac disease in children?

A

GI manifestations

  • Symptoms start when gluten is introduced (6-24 mo)
  • Chronic diarrhea, distention, anorexia, vomiting, irritability
60
Q

Non-GI manifestations of celiac disease in children?

A
  • Delayed puberty/short stature
  • Iron deficiency anemia
  • Osteopenia/porosis
  • Elevated LFTs
61
Q

Diagnosis of celiac disease

A
  • Biopsy with and w/o gluten exposure (initially the gold standard)
  • IgA anti-tissue transglutaminase Ab (most sensitive and specific)
62
Q

What is the most sensitive and specific test for celiac disease?

A

IgA anti-tissue transglutaminase Ab

63
Q

What is the initial gold standard for testing celiac disease?

A

Biopsy with and w/o gluten exposure

64
Q

Treatment of celiac disease

A

Gluten free diet for life

65
Q

Describe congenital lactase deficiency

A
  • RARE

- Genetic forms appear after 5 yo (Asian/Native American 100%, AAs 70%, caucasians 30-60%)

66
Q

Treatment of congenital lactase deficiency

A

Lactose restriction and/or lactase supplementation

67
Q

Clinical presentation of cow’s milk protein intolerance

A
  • Flecks of blood in stool
  • Occurs w/introduction of milk protein
  • Skin testing is UNRELIABLE (esp under 6 mo)
68
Q

Skin testing for cow’s milk protein intolerance

A

Unreliable especially under 6 mo

69
Q

Prognosis of cow’s milk protein intolerance

A
  • Allergic colitis in infants self-limited (resolve by 8-12 mo)
  • In older children, may induce eosinophilic gastroenteritis
70
Q

Etiology of IBD

A

Multifactorial - leads to maladaptive immune response to bowel flora

71
Q

Clinical presentation of IBD

A
  • Younger presentation is more severe
  • Abd pain, diarrhea, bloody stools
  • Anorexia, wt loss
  • Extra-intestinal signs
72
Q

Extra-intestinal signs of IBD

A
  • Uveitis
  • Arthritis
  • Growth delay
  • Rash
  • Anemia
73
Q

Where does Crohn’s affect the GI tract?

A

ANY part of GI with skip areas (most often the ileum)

74
Q

Where does UC affect the GI tract?

A

Proctitis extending to proximal colon

75
Q

Complications of Crohn’s

A
  • Malnutrition
  • Side effects of corticosteroids
  • Increased potential for carcinomas of the colon
76
Q

Complications of UC

A
  • 3-5% end up diagnosed as Crohn’s
  • Arthritis
  • Growth failure
  • Increased potential for carcinomas of the colon
77
Q

What is a potential complication of either UC and Crohn’s?

A

Increased potential for carcinomas of the colon

78
Q

Treatment of IBD

A
  • Diet
  • Aminosalicylates (ASA)
  • Corticosteroids
  • Immunomodulators
  • Abx
  • Infliximab
  • Surgery (NOT curative for Crohns)
79
Q

Is surgery curative for Crohn’s or UC?

A

UC

80
Q

Clinical presentation of rotovirus

A
  • MC in 3-15 mo, winter/spring
  • Incubation 1-3 days then vomiting (80-90%)
  • Then profuse watery diarrhea lasting 4-8 days
81
Q

Treatment of rotovirus

A

Supportive

  • IV fluids
  • Refeeding with regular diet when tolerated
  • Antidiarrheals are ineffective and potentially dangerous
82
Q

Antidiarrheal use in rotovirus?

A

Ineffective and potentially dangerous

83
Q

Causes of chronic diarrhea

A
  • Abx (eradicates normal flora)
  • Extra intestinal infections (UTI, URI)
  • Malnutrition
  • Diet (overfeeding, fruit juices)
  • Meds (laxative abuse)
84
Q

Describe allergic diarrhea

A
  • Cow’s milk often implicated but uncommon!
  • Older children may present similarly to celiac disease
  • IgE mediated reactions to foods may lead to vomiting, diarrhea, pallor, shock
85
Q

How may older children with allergic diarrhea present?

A

Similar to celiac disease

86
Q

What is toddler’s diarrhea?

A
  • Chronic nonspecific diarrhea
  • Healthy thriving 6-20 mo (resolves by 3.5 yo)
  • Diarrhea is worse on low residue, low fat, high carb diet
87
Q

Treatment of toddler’s diarrhea

A
  • Change of dietary fiber (either up or down in amount based on current diet)
  • Slight increase in dietary fat
  • Restriction of osmotically active carbs (fruit juices)
88
Q

Parasites/bacteria that cause chronic diarrhea?

A

Giardia, salmonella, yersinia

89
Q

Describe post-infectious diarrhea

A
  • Prolonged diarrhea following enteritis

- Often improves with resuming more normal, varied diet

90
Q

Causes of vomiting in children

A
  • Viral gastroenteritis (MC)
  • Obstruction and acute/chronic inflammation of GI tract
  • CNS inflammation, tumor
  • Metabolic derangements (including inborn errors)
  • Vestibular responses (motion sickness)
91
Q

Describe cyclic vomiting syndrome

A
  • Vomiting lasting up to 72 hrs or more
  • Typically occurs over 1 yo
  • 50-70% have fam hx of migraines
92
Q

Majority of patients with cyclic vomiting syndrome have:

A

Family history of migraines

93
Q

Treatment of cyclic vomiting syndrome

A
  • Avoidance of triggers
  • Antihistamines/benzodiazapines
  • Migraine meds (sumatriptan)

Special Pops - Peds (10 decks)

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