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Pediatrics > GI > Flashcards

GI Flashcards

1
Q

Constipation definition

A

Less than 3 BM per week
Hard stools
Excessive straining
Incomplete evacuation

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2
Q

Basis for diagnosis of constipation

A

BM frequency and completeness

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3
Q

Pediatric constipation definition

A

2 or more of the following w/in 8 weeks:
Fewer than 3 BMs in 1 week
Greater than 1 episode of fecal incontinence a week
Large stool in rectum or palpable on ab exam
Painful defecation
Passing stool large enough to obstruct the toilet
Retentive posturing and withholding behavior

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4
Q

“Functional” constipation definition

A

2 or more of the following w/in 2 months if older than 4 years or 2 or more of the following within 1 month if younger than 4 years:
2 or less defectations per week
At least 1 episode of fecal incontinence a week
H/o large diameter stools obstructing the toilet
H/o painful or hard BMs
H/o retentive posturing or excessive volitional stool retention
Presence of large fecal mass in rectum

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5
Q

What does withholding cause

A

Decreased ability to pass stool
Decreased sensitivity to pass stool
Increased stool time in rectum (stool becomes harder/larger)

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6
Q

Constipation differential diagnosis

A

Anatomic
Dietary
Medication related

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7
Q

Constipation differential diagnosis: anatomic

A

CF
Metabolic and endocrine (DM, hypercalcemia, hypothyroidism)
Neurologic (Cerebral palsy, Hirschsprung disease, Spina Bifida)
SLE

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8
Q

Constipation differential diagnosis: Dietary

A

Dehydration
High in fat
Low in fiber

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9
Q

Constipation differential diagnosis: medication related

A 
Antacids - Ca containing
Antidepressants
Antihistamines
Cathartics (abuse/overuse)
Iron supplements
Opioids
Pseudoephedrine
Vincristine
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10
Q

Constipation s/sx

A

Ab distention
Ab pain
Bloating
Nausea

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11
Q

Functional constipation s/sx

A 
Becoming fidgety 
Decreased appetite
Decreased food intake
Rocking back and forth
Standing on tiptoes
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12
Q

Constipation non-pharmacologic treatment

A

Behavior modification
Diet
Digital disimpaction

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13
Q

Constipation pharmacologic treatment

A

Lubricants (soften stool, prevent reabsorption of water)
Osmotic laxatives
Osmotic enemas
Stimulant laxatives

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14
Q

Constipation pharmacologic plan to avoid recurrences

A

Lubricants
Osmotic laxatives
Stool softener

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15
Q

Stool softener

A

Docusate
Reduces surface tension on the water/oil interface in stool
Increases water absorption in stool

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16
Q

Diarrhea definition

A

> /= 3 water, loose stools per day

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17
Q

Acute diarrhea

A

Increased number and stool consistency change for less than 7 days

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18
Q

Chronic diarrhea

A

Diarrhea lasting more than 14 consecutive days

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19
Q

Diarrhea pathophysiology

A

Normal GI tract fx is impaired (Impaired fluid and electrolyte balance)
Fluid volume in GI lumen

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20
Q

How is fluid volume in the GI lumen affected in diarrhea?

A

Dietary fluid intake
Intestinal secretions
Colonic reabsorption

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21
Q

Electrolyte contents in fecal stool

A

Na - 40
K - 90
Cl - 15
Na bicarb - 30

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22
Q

Types of diarrhea

A

Secretory
Osmotic
Exudative
Changed motility

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23
Q

Secretory diarrhea

A

Stimulant
Increases secretion of water into lumen
Decreases absorption of water and electrolytes from lumen (inhibits Na/K ATP ase)

24
Q

Secretory diarrhea causes

A 
Bacterial toxins
Hormones (secretin)
Increased bile acids
Laxatives
Unabsorbed dietary fat
25
Q

Osmotic diarrhea

A

Created of osmotic gradient in lumen d/t poorly absorbed substances in GI tract

26
Q

Osmotic diarrhea causes

A

Lactose intolerance
Malabsorption
Medications (lactulose, Mg containing products)

27
Q

Exudative diarrhea

A

Injury to mucosal lining in lumen

Inflamed intestine prevents proper water and electrolyte transfer

28
Q

Exudative diarrhea causes

A

IBD (CD/UC)

29
Q

Changed motility diarrhea

A

Decreased time for normal absorption

30
Q

Changed motility diarrhea causes

A

Bacterial over growth
Early colonic emptying
Reduction in small intestine transit time

31
Q

Viral diarrhea differential diagnosis

A

Adenovirus
CMV
Norovirus
Rotavirus

32
Q

Bacterial diarrhea differential diagnosis

A 
C diff
E coli
Salmonella
Shigella
Yersinia
33
Q

Parasitic diarrhea differential diagnosis

A

Cryptosporidium
Entameba histolytica
Giardia

34
Q

Toxin diarrhea causes

A

C diff toxin

Enterotoxins

35
Q

Exposure diarrhea causes

A 
Chemo
Laxative abuse/overuse
Medications
Radiation
Tumor secretions
36
Q

Malabsorption diarrhea causes

A 
Allergic enteropathy
Celiac disease
Chronic liver disease
Glucose/galactose transport defect
Pancreatic insufficiancy
37
Q

IBD diarrhea causes

A

Allergic colitis
CD
Eosinophilic gastroenteritis
UC

38
Q

Intake diarrhea causes

A

High carb load

39
Q

Non-pharmacologic treatment of diarrhea

A 
Restore fluid and electrolyte balance
Adjust diet (continue feedings during acute diarrhea phases)
40
Q

Oral replacement therapy

A

Pedialyte
Enfalyte
Rehydralyte
Cerelyte

41
Q

Pharmacologic treatment of diarrhea

A 
Bismuth subsalicylate
Cholestyramine
Probiotics
Psyllium
Opioids
Vitamin A
Zinc
42
Q

Bismuth subsalicylate

A

Facilitated extra water absorption from the lumen
Inhibits PGs decreasing GI tract inflammation
Caution with viral infections

43
Q

Cholestyramine

A

Used in increased bile acid related diarrhea
Duration of therapy in patients under 2 years of age = 2 days
Interactions with medication absorption

44
Q

Opioid examples

A

Diphenoxylate
Loperamide (do not use under 3 yo)
Morphine

45
Q

GERD definition

A

Passage of stomach contents into the esophagus

46
Q

GERD mechanism

A 
LES relaxation (w/out swallowing)
Stomach contents reflux into stomach
47
Q

GERD in pediatric non-pharmacologic treatment

A

Feeding changes
Change volumes
Modify frequency
Thicken feeds

48
Q

GERD sx

A

Ab pain
Food refusal
Heartburn
Regurgitation

49
Q

GERD complications

A

Barrett’s esophagus
Hemorrhage
Reflux esophagus
Stricture

50
Q

GERD RF

A

Chronic lung disease
Esophageal atresia
Neurologic impaired (cerebral palsy)
Prematurity

51
Q

H2RA disadvantages

A

ADR: HA, irritability, somnolence

Tolerance development

52
Q

GERD pharmacologic treatments

A 
Antacids
H2RAs
Prokinetic agents
PPI
Surface-protectant agents
53
Q

Prokinetic agent advantages

A

Facilitates gastric emptying

Improves sx

54
Q

Prokinetic agent disadvantages

A

ADR: EPS, GI upset, hepatotoxicity
Limited evidence
Not efficacious

55
Q

Prokinetic agent examples

A

Bethanecol
Erythromycin
Metoclopramide

56
Q

PPI ADRs

A

Constipation
Diarrhea
HA
Nausea

57
Q

Surface-protectant agent advantages

A

Aids mucosal healing

Low risk of ADR

Pediatrics (9 decks)

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