GI Flashcards
What is the approach you should take for abdominal pain in pediatrics?
Look at vital signs; FULL exam including genitalia & rectal; labs (CBC, ESR/CRP, LFT’s, H&H), plain abdominal xray; and ultrasound
What does functional constipation lead to and what does it cause?
Leads to Voluntary Stool Withholding – usually occurs at the introduction of solid foods
Cause: frightening, painful/bad experience
What would you notice on exam with constipation in a child?
Abdominal distention, palpable stool mass, soiled underwear, impacted stool on rectal exam
How do you diagnose constipation in peds?
Abdominal x-ray
How do you treat constipation in peds?
Infants = glycerin suppository; sorbitol-containing juices (apple, prune)
Children = polyethelen glycol (miralax), disimpaction, and diet change
What is the definition of diarrhea in peds?
Loose or watery stools 3 or more times/day
What do you need to look for on exam when you suspect diarrhea?
Eval for dehydration (urine output, HR, dry mucus membranes, delayed cap refill, and reduced skin turgor); is stool bloody; have you traveled; recent Abx
How do you diagnose & treat diarrhea in a child?
Diagnose = abdominal x-ray, stool culture (for bloody), UA (to r/o UTI), or air contract enema
Treat = hydration
What disorder is the most common congenital craniofacial anomaly that can lead to feeding difficulties and nasal regurgitation?
Cleft lip/palate
If an infant has a chronic cough, wheezing, asthma, acid brash (wet burps) and vomiting shortly after feeding – what diagnosis do you think of?
GERD
How do you confirm the diagnosis of GERD in peds?
2-4 weeks of a PPI (or just start with H2 blocker) → Barium swallow → endoscopy if sxs continue for 2 years
How do you treat GERD in a child?
Lifestyle modifications, PPI’s, and H2 blockers
What is commonly connected with GERD?
Asthma
IF a brand new baby comes out and they have drooling, choking, respiratory distress, and gastric distention – what diagnosis?
Tracheoesophageal Fistula & Esophageal Atresia
How would you confirm diagnosis of a tracheoesophageal fistula?
Inability to pass a NG tube into the stomach
If an infant has projectile vomiting after feeding – what diagnosis? What would see on exam?
Pyloric stenosis & see an olive-shaped
What is occurring in pyloric stenosis?
Hypertrophy of the musculature around the pyloric sphincter resulting in gastric outlet obstruction
How would you confirm diagnosis of pyloric stenosis? How do you treat?
Ultrasound
Barium swallow – “string sign”
Tx = Surgery
If an infant has sudden onset of bilious vomit (green) and is inconsolable, what diagnosis?
Volvulus (malrotation of the intestine – caused by lads bands)
How do you confirm diagnosis of volvulus? How do you treat?
Barium study = bird-beak cut off and corkscrew of duodenum & Abdominal x-ray shows “double bubble” sign.
Treat = emergent surgery!
What must you consider if a neonate is unable to pass Meconium within 72 hours of life?
Hirschsprungs disease
What would you do on exam for Hirschsprungs disease? How would you confirm diagnosis?
Explosive expulsion of gas & stool after digital rectal exam (squirt sign)
Must do a rectal biopsy**
If a child presents with painless GI bleeding and sxs similar to appendicitis (even after an appendectomy) what diagnosis do you think of? How do you confirm diagnosis?
Meckel’s diverticulum
Do a Meckel’s Scan! “The Rules of Twos!”
If a child presents with sudden onset of intermittent severe abdominal pain with episodes of drawing the knees towards the chest in, what diagnosis should you have on your differential?
Intussusception
What would you find on PE and how would you confirm diagnosis of intussusception?
PE = sausage-shaped abdominal mass on the right side of the colon & currant-jelly stools
Diagnose = Ultrasound showing “target sign” or “bulls eye”
How do you treat intussusception?
Barium or Air-enema (help diagnose & treat)
Right after a baby is born, what do you always need to check on their bum?
Their Anus! Making sure it’s not imperforated → if it is imperforated something else is wrong
If you suspect appendicitis in a pediatric patient what would you do on exam and how would you confirm?
+McBurney’s point (peritoneal inflammation = Rovsing sign, obturator sign, psoas sign); pain with coughing or jumping; CT imaging; and if a girl has started her period be sure to R/O ectopic pregnancy!
What are the 3 types of hernias seen in children?
Umbilical, diaphragmatic (diagnose with chest x-ray), and inguinal hernia
What are the 3 ways a hernia can present?
Either reducible, incarcerated (cannot reduce but blood supply is not compromised) or strangulated
What type of hernia is the worst and often seen within the first hours of life?
Diaphragmatic hernia allows the abdominal viscera to herniate into the chest. Do chest xray
How do you diagnose lactose intolerance in children?
Lactose breath hydrogen test
