GI Flashcards
Chief GI complaints
- vomiting
- abdominal pain
- constipation
- diarrhea
Chief GI complaints
- vomiting
- abdominal pain
- constipation
- diarrhea
In what age group is gastroesophageal reflux common
What is the diff btn GER and GERD
GER: happy spitter, growing well, healthy
GERD: unhappy spitter, FTT, Fussy, feeding refusal, occult blood in stool, respiratory complications, dystonic neck posture
GERD diagnosis
- clinically
- hemoccult
- endoscopy
GERD Tx infants
- positional therapy
- elimination diet/change formula
- thickened feeds
- smaller freq feeds
- Meds; H2 blocker (ranitidine) and PPI (iansoprazole)>1yr
Etiology of pyloric stenosis
Pylorus muscle thickening obstructing gastric outlet-hypertrophy and hyperplasia of 2 muscular layers of pylorus
Pyloric stenosis epidemiology
M>F, More common in first born chn
Pyloric stenosis epidemiology
M>F, More common in first born chn
In what age group is gastroesophageal reflux common
What is the diff btn GER and GERD
GER: happy spitter, growing well, healthy
GERD: unhappy spitter, FTT, Fussy, feeding refusal, occult blood in stool, respiratory complications, dystonic neck posture
GERD diagnosis
- clinically
- hemoccult
- endoscopy
GERD Tx infants
- positional therapy
- elimination diet/change formula
- thickened feeds
- smaller freq feeds
- Meds; H2 blocker (ranitidine) and PPI (iansoprazole)>1yr
how long does it take GERD sys to resolve post TX
9-12mos
Etiology of pyloric stenosis
Pylorus muscle thickening obstructing gastric outlet
Dx congenital atresia
- CMP: electrolytes and bilirubin
- Abdominal plain film: *Duodenal=double bubble sign *Jejunoileal/colonic=dilated loops
- UGI/contrast enema; confirm dx/identify area of obstruction
Clinical presentation of pyloric stenosis
- projectile non-bilous vomiting after feeding (3-12wks old) after which they are hungry
- FTT and dehydration
Physical exam pyloric stenosis
- Upper abdomen distended after feeding
- prominent peristaltic waves moving from L to R
- Olive size mass in RUQ
Labs pyloric stenosis
CBC
CMP
Ultrasound (test of choice) = thickening of pylorus; if undiagnostic, UGI done (string sign)
Tx pyloric stenosis
- IV fluids, electrolytes
- Pyloromyotomy
Disease in which one or more of the segments of the bowel are absent/obstructed
Congenital atresia
3 types of congenital atresia
- Duodenal (trisomy 21) 8-10wks of gestation
- Jejunoileal (cystic fibrosis) uterovascular accident w/ death of bowel and reabsorption during gestation (11-12wks
- Colonic (least common); unknown mech
Presentation of congenital atresia
- Bile stained vomit within first 24-48hrs of life
- Mild abdominal distention
- Failure to pass meconium
Dx congenital atresia
- CMP: electrolytes and bilirubin
- Abdominal plain film: *Duodenal=double bubble sign *Jejunoileal/colonic=dilated loops
- UGI/contrast enema; confirm dx/identify area of obstruction
Can congenital atresia be diagnosed pre-nataly
Yes, double bubble sign on ultra sound, polyhydramions
Most frequent cause of intestinal obstruction
Intussusception
Etiology for midgut rotation +/- volvulus
incomplete rotation of mid gut during embryonic debt.
Results of midgut malrotation
-shortening of mesenteric root leading to volvulus (small intestine twists around SMA) = vascular compromise (EMERGENT)
Clinical presentation mid gut malrotation +/- volvulus
- 50% before 1mo of age
- Bilious vomiting w/ abdominal pain, hematochezia
Physical exam mid gut malrotation
Abdominal distention
Tenderness
Visible peristalisis
Tx intussuscption
IV fluid resuscitation
Urgent surgical consult
Air enema for reduction
Tx midgut malrotation +/- volvulus
Surgical intervention to prevent ischemia
invagination of one portion of intestine over another
Intussusception
Most frequent cause of intestinal obstruction
In
Etiologies for intussusception
Idiopathic (75%) crohns celiac cystic fibrosis bacterial enteritis rotavirus
Clinical presentation intussusception
- Currant jelly stools
- Cries and draws legs up to chest
- Vomiting
- Triad (pain, palpable sausage shape, currant jelly stools)
Physical exam findings for intussuception
Abdomen distended & tender
sausage shaped mass in mid abdomen
Labs for intussusception
CBC
CMP
Abdominal ultrasound
Tx intussuscption
IV fluid resuscitation
Urgent surgical consult
Air enema for reduction
Gestational failure to obliterate vitiline duct making acid the causes ulceration and bleeding
Meckels diverticulum
Clinical presentation of appendicitis
Migrating periumbilical pain Anorexia Vomiting Fever Signs of peritoneal irritation (guarding, rebound tenderness, positive rovsing sign, obturator/ileopsoas sign)
Meckel’s diverticulum rule of 2s
2% of pop
2:1 ratio M:F
2% symptomatic
Clinical presentation of Meckel’s diverticulum
- Painless rectal bleeding
- Obstruction
- Diverticulitis
Diagnostic labs for Meckel’s diverticulum
Technetium 99 scan : Tc-99 taken up by ectopic mucosa
Most common cause of lower bowel obstruction (colon) in neonates
Hirschsprung disease
Clinical presentation of hirschsprung disease
Failure to pass meconium within 48-72hr Bilious vomiting Explosive diarrhea Abdominal distention Newborns that pass meconium develop sxs. later; chronic constipation
What is the most common pediatric surgical emergency
Appendicitis
Etiology of appendicitis
Obstruction of appendices lumen due to inflammation
Clinical presentation of appendicitis
Migrating periumbilical pain
Anorexia
Vomiting
Fever
Dx appendicitis
- Hx and Physical
- US (no radn)
- Low does CT
- Surgical consult
Clinical presentation of IBS
- Diarrhea, abdominal pain, hematochezia
- weight loss
- growth failure
Hirschsprung’s disease etiology
congenital aganglionic megacolon; failure of peristaltic wave to be transmitted past distal bowel due to denervation
Most common cause of lower bowel obstruction (colon) in neonates
Hirschsprung disease
Tx IBS
Disease maintenance 5-ASA immunomodulating agents Biologics Steroids
Physical exam findings Hirschsprung
- abdominal distension
- narrow anal canal
- anal canal devoid of fecal material with squirt out when finger is removed
Labs Hirschsprung
- Contrast enema
- Rectal biopsy (Gold std)
Tx Hirschsprung
Colostomy (resection of aganglionic segment)
Racial incidence of IBS
White>African american>hispanic
Etiology of constipation
- Functional - with holding (5-6yo)
* Organic - anatomic
Presentation of Crohns disease
transmural inflammation, cn occur from mouth to anus,
Colonoscopy; skip lesions, cobblestone appearance
Presentation of ulcerative colitis
Involves mucosal layer, rectum and extends proximally. Present with sxs. of colitis
Dx: colonoscopy- erythematous friable mucosa w/ erosions
(High risk of colon CA)
Tx IBS
Disease maintenance
5-AS
Diarrhea defn.
> 3 watery stools/day
Diarrhea red flags
Fever Severe abdominal pain' stool in blood Vomiting Dehydration Leukocytosis FTT
Tx diarrhea
-Hydaration, +/- Abx, anti motility agents rarely
-ORS (pedialyte)
if red flags present do further work up
Constipation defn
regular passage of firm hard stools or infreq. passage of stools
Etiology of constipation
- Functional - with holding (5-6yo)
* Organic - anatomic
Clinical presentation constipation
Encopresis
abdominal discomfort
Emotional disturbance
