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Peds > GI > Flashcards

GI Flashcards

1
Q

Chief GI complaints

A
  • vomiting
  • abdominal pain
  • constipation
  • diarrhea
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2
Q

Chief GI complaints

A
  • vomiting
  • abdominal pain
  • constipation
  • diarrhea
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3
Q

In what age group is gastroesophageal reflux common

A
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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

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5
Q

GERD diagnosis

A
  • clinically
  • hemoccult
  • endoscopy
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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
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7
Q

Etiology of pyloric stenosis

A

Pylorus muscle thickening obstructing gastric outlet-hypertrophy and hyperplasia of 2 muscular layers of pylorus

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8
Q

Pyloric stenosis epidemiology

A

M>F, More common in first born chn

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9
Q

Pyloric stenosis epidemiology

A

M>F, More common in first born chn

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10
Q

In what age group is gastroesophageal reflux common

A
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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

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12
Q

GERD diagnosis

A
  • clinically
  • hemoccult
  • endoscopy
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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
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14
Q

how long does it take GERD sys to resolve post TX

A

9-12mos

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15
Q

Etiology of pyloric stenosis

A

Pylorus muscle thickening obstructing gastric outlet

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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
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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
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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
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19
Q

Labs pyloric stenosis

A

CBC
CMP
Ultrasound (test of choice) = thickening of pylorus; if undiagnostic, UGI done (string sign)

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20
Q

Tx pyloric stenosis

A
  • IV fluids, electrolytes

- Pyloromyotomy

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21
Q

Disease in which one or more of the segments of the bowel are absent/obstructed

A

Congenital atresia

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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
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23
Q

Presentation of congenital atresia

A
  • Bile stained vomit within first 24-48hrs of life
  • Mild abdominal distention
  • Failure to pass meconium
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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
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25
Q

Can congenital atresia be diagnosed pre-nataly

A

Yes, double bubble sign on ultra sound, polyhydramions

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26
Q

Most frequent cause of intestinal obstruction

A

Intussusception

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27
Q

Etiology for midgut rotation +/- volvulus

A

incomplete rotation of mid gut during embryonic debt.

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28
Q

Results of midgut malrotation

A

-shortening of mesenteric root leading to volvulus (small intestine twists around SMA) = vascular compromise (EMERGENT)

29
Q

Clinical presentation mid gut malrotation +/- volvulus

A
  • 50% before 1mo of age

- Bilious vomiting w/ abdominal pain, hematochezia

30
Q

Physical exam mid gut malrotation

A

Abdominal distention
Tenderness
Visible peristalisis

31
Q

Tx intussuscption

A

IV fluid resuscitation
Urgent surgical consult
Air enema for reduction

32
Q

Tx midgut malrotation +/- volvulus

A

Surgical intervention to prevent ischemia

33
Q

invagination of one portion of intestine over another

A

Intussusception

34
Q

Most frequent cause of intestinal obstruction

A

In

35
Q

Etiologies for intussusception

A 
Idiopathic (75%)
crohns
celiac
cystic fibrosis
bacterial enteritis
rotavirus
36
Q

Clinical presentation intussusception

A
  • Currant jelly stools
  • Cries and draws legs up to chest
  • Vomiting
  • Triad (pain, palpable sausage shape, currant jelly stools)
37
Q

Physical exam findings for intussuception

A

Abdomen distended & tender

sausage shaped mass in mid abdomen

38
Q

Labs for intussusception

A

CBC
CMP
Abdominal ultrasound

39
Q

Tx intussuscption

A

IV fluid resuscitation
Urgent surgical consult
Air enema for reduction

40
Q

Gestational failure to obliterate vitiline duct making acid the causes ulceration and bleeding

A

Meckels diverticulum

41
Q

Clinical presentation of appendicitis

A 
Migrating periumbilical pain
Anorexia
Vomiting
Fever
Signs of peritoneal irritation (guarding, rebound tenderness, positive rovsing sign, obturator/ileopsoas sign)
42
Q

Meckel’s diverticulum rule of 2s

A

2% of pop
2:1 ratio M:F
2% symptomatic

43
Q

Clinical presentation of Meckel’s diverticulum

A
  • Painless rectal bleeding
  • Obstruction
  • Diverticulitis
44
Q

Diagnostic labs for Meckel’s diverticulum

A

Technetium 99 scan : Tc-99 taken up by ectopic mucosa

45
Q

Most common cause of lower bowel obstruction (colon) in neonates

A

Hirschsprung disease

46
Q

Clinical presentation of hirschsprung disease

A 
Failure to pass meconium within 48-72hr
Bilious vomiting
Explosive diarrhea
Abdominal distention
Newborns that pass meconium develop sxs. later; chronic constipation
47
Q

What is the most common pediatric surgical emergency

A

Appendicitis

48
Q

Etiology of appendicitis

A

Obstruction of appendices lumen due to inflammation

49
Q

Clinical presentation of appendicitis

A

Migrating periumbilical pain
Anorexia
Vomiting
Fever

50
Q

Dx appendicitis

A
  • Hx and Physical
  • US (no radn)
  • Low does CT
  • Surgical consult
51
Q

Clinical presentation of IBS

A
  • Diarrhea, abdominal pain, hematochezia
  • weight loss
  • growth failure
52
Q

Hirschsprung’s disease etiology

A

congenital aganglionic megacolon; failure of peristaltic wave to be transmitted past distal bowel due to denervation

53
Q

Most common cause of lower bowel obstruction (colon) in neonates

A

Hirschsprung disease

54
Q

Tx IBS

A 
Disease maintenance
5-ASA
immunomodulating agents
Biologics
Steroids
55
Q

Physical exam findings Hirschsprung

A
  • abdominal distension
  • narrow anal canal
  • anal canal devoid of fecal material with squirt out when finger is removed
56
Q

Labs Hirschsprung

A
  • Contrast enema

- Rectal biopsy (Gold std)

57
Q

Tx Hirschsprung

A

Colostomy (resection of aganglionic segment)

58
Q

Racial incidence of IBS

A

White>African american>hispanic

59
Q

Etiology of constipation

A
  • Functional - with holding (5-6yo)

* Organic - anatomic

60
Q

Presentation of Crohns disease

A

transmural inflammation, cn occur from mouth to anus,

Colonoscopy; skip lesions, cobblestone appearance

61
Q

Presentation of ulcerative colitis

A

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
Q

Tx IBS

A

Disease maintenance

5-AS

63
Q

Diarrhea defn.

A

> 3 watery stools/day

64
Q

Diarrhea red flags

A 
Fever
Severe abdominal pain'
stool in blood 
Vomiting
Dehydration
Leukocytosis
FTT
65
Q

Tx diarrhea

A

-Hydaration, +/- Abx, anti motility agents rarely
-ORS (pedialyte)
if red flags present do further work up

66
Q

Constipation defn

A

regular passage of firm hard stools or infreq. passage of stools

67
Q

Etiology of constipation

A
  • Functional - with holding (5-6yo)

* Organic - anatomic

68
Q

Clinical presentation constipation

A

Encopresis
abdominal discomfort
Emotional disturbance

Peds (11 decks)

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