GI Flashcards
1
Q
Chief GI complaints
A
- vomiting
- abdominal pain
- constipation
- diarrhea
2
Q
Chief GI complaints
A
- vomiting
- abdominal pain
- constipation
- diarrhea
3
Q
In what age group is gastroesophageal reflux common
A
4
Q
What is the diff btn GER and GERD
A
GER: happy spitter, growing well, healthy
GERD: unhappy spitter, FTT, Fussy, feeding refusal, occult blood in stool, respiratory complications, dystonic neck posture
5
Q
GERD diagnosis
A
- clinically
- hemoccult
- endoscopy
6
Q
GERD Tx infants
A
- positional therapy
- elimination diet/change formula
- thickened feeds
- smaller freq feeds
- Meds; H2 blocker (ranitidine) and PPI (iansoprazole)>1yr
7
Q
Etiology of pyloric stenosis
A
Pylorus muscle thickening obstructing gastric outlet-hypertrophy and hyperplasia of 2 muscular layers of pylorus
8
Q
Pyloric stenosis epidemiology
A
M>F, More common in first born chn
9
Q
Pyloric stenosis epidemiology
A
M>F, More common in first born chn
10
Q
In what age group is gastroesophageal reflux common
A
11
Q
What is the diff btn GER and GERD
A
GER: happy spitter, growing well, healthy
GERD: unhappy spitter, FTT, Fussy, feeding refusal, occult blood in stool, respiratory complications, dystonic neck posture
12
Q
GERD diagnosis
A
- clinically
- hemoccult
- endoscopy
13
Q
GERD Tx infants
A
- positional therapy
- elimination diet/change formula
- thickened feeds
- smaller freq feeds
- Meds; H2 blocker (ranitidine) and PPI (iansoprazole)>1yr
14
Q
how long does it take GERD sys to resolve post TX
A
9-12mos
15
Q
Etiology of pyloric stenosis
A
Pylorus muscle thickening obstructing gastric outlet
16
Q
Dx congenital atresia
A
- CMP: electrolytes and bilirubin
- Abdominal plain film: *Duodenal=double bubble sign *Jejunoileal/colonic=dilated loops
- UGI/contrast enema; confirm dx/identify area of obstruction
17
Q
Clinical presentation of pyloric stenosis
A
- projectile non-bilous vomiting after feeding (3-12wks old) after which they are hungry
- FTT and dehydration
18
Q
Physical exam pyloric stenosis
A
- Upper abdomen distended after feeding
- prominent peristaltic waves moving from L to R
- Olive size mass in RUQ
19
Q
Labs pyloric stenosis
A
CBC
CMP
Ultrasound (test of choice) = thickening of pylorus; if undiagnostic, UGI done (string sign)
20
Q
Tx pyloric stenosis
A
- IV fluids, electrolytes
- Pyloromyotomy
21
Q
Disease in which one or more of the segments of the bowel are absent/obstructed
A
Congenital atresia
22
Q
3 types of congenital atresia
A
- 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
23
Q
Presentation of congenital atresia
A
- Bile stained vomit within first 24-48hrs of life
- Mild abdominal distention
- Failure to pass meconium
24
Q
Dx congenital atresia
A
- CMP: electrolytes and bilirubin
- Abdominal plain film: *Duodenal=double bubble sign *Jejunoileal/colonic=dilated loops
- UGI/contrast enema; confirm dx/identify area of obstruction
25
Can congenital atresia be diagnosed pre-nataly
Yes, double bubble sign on ultra sound, polyhydramions
26
Most frequent cause of intestinal obstruction
Intussusception
27
Etiology for midgut rotation +/- volvulus
incomplete rotation of mid gut during embryonic debt.
28
Results of midgut malrotation
-shortening of mesenteric root leading to volvulus (small intestine twists around SMA) = vascular compromise (EMERGENT)
29
Clinical presentation mid gut malrotation +/- volvulus
- 50% before 1mo of age
| - Bilious vomiting w/ abdominal pain, hematochezia
30
Physical exam mid gut malrotation
Abdominal distention
Tenderness
Visible peristalisis
31
Tx intussuscption
IV fluid resuscitation
Urgent surgical consult
Air enema for reduction
32
Tx midgut malrotation +/- volvulus
Surgical intervention to prevent ischemia
33
invagination of one portion of intestine over another
Intussusception
34
Most frequent cause of intestinal obstruction
In
35
Etiologies for intussusception
```
Idiopathic (75%)
crohns
celiac
cystic fibrosis
bacterial enteritis
rotavirus
```
36
Clinical presentation intussusception
- Currant jelly stools
- Cries and draws legs up to chest
- Vomiting
* Triad (pain, palpable sausage shape, currant jelly stools)
37
Physical exam findings for intussuception
Abdomen distended & tender
| sausage shaped mass in mid abdomen
38
Labs for intussusception
CBC
CMP
Abdominal ultrasound
39
Tx intussuscption
IV fluid resuscitation
Urgent surgical consult
Air enema for reduction
40
Gestational failure to obliterate vitiline duct making acid the causes ulceration and bleeding
Meckels diverticulum
41
Clinical presentation of appendicitis
```
Migrating periumbilical pain
Anorexia
Vomiting
Fever
Signs of peritoneal irritation (guarding, rebound tenderness, positive rovsing sign, obturator/ileopsoas sign)
```
42
Meckel's diverticulum rule of 2s
2% of pop
2:1 ratio M:F
2% symptomatic
43
Clinical presentation of Meckel's diverticulum
- Painless rectal bleeding
- Obstruction
- Diverticulitis
44
Diagnostic labs for Meckel's diverticulum
Technetium 99 scan : Tc-99 taken up by ectopic mucosa
45
Most common cause of lower bowel obstruction (colon) in neonates
Hirschsprung disease
46
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
```
47
What is the most common pediatric surgical emergency
Appendicitis
48
Etiology of appendicitis
Obstruction of appendices lumen due to inflammation
49
Clinical presentation of appendicitis
Migrating periumbilical pain
Anorexia
Vomiting
Fever
50
Dx appendicitis
- Hx and Physical
- US (no radn)
- Low does CT
- Surgical consult
51
Clinical presentation of IBS
- Diarrhea, abdominal pain, hematochezia
- weight loss
- growth failure
52
Hirschsprung's disease etiology
congenital aganglionic megacolon; failure of peristaltic wave to be transmitted past distal bowel due to denervation
53
Most common cause of lower bowel obstruction (colon) in neonates
Hirschsprung disease
54
Tx IBS
```
Disease maintenance
5-ASA
immunomodulating agents
Biologics
Steroids
```
55
Physical exam findings Hirschsprung
- abdominal distension
- narrow anal canal
- anal canal devoid of fecal material with squirt out when finger is removed
56
Labs Hirschsprung
- Contrast enema
| - Rectal biopsy (Gold std)
57
Tx Hirschsprung
Colostomy (resection of aganglionic segment)
58
Racial incidence of IBS
White>African american>hispanic
59
Etiology of constipation
* Functional - with holding (5-6yo)
| * Organic - anatomic
60
Presentation of Crohns disease
transmural inflammation, cn occur from mouth to anus,
| Colonoscopy; skip lesions, cobblestone appearance
61
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)
62
Tx IBS
Disease maintenance
| 5-AS
63
Diarrhea defn.
>3 watery stools/day
64
Diarrhea red flags
```
Fever
Severe abdominal pain'
stool in blood
Vomiting
Dehydration
Leukocytosis
FTT
```
65
Tx diarrhea
-Hydaration, +/- Abx, anti motility agents rarely
-ORS (pedialyte)
if red flags present do further work up
66
Constipation defn
regular passage of firm hard stools or infreq. passage of stools
67
Etiology of constipation
* Functional - with holding (5-6yo)
| * Organic - anatomic
68
Clinical presentation constipation
Encopresis
abdominal discomfort
Emotional disturbance
