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PEDS 2- clinical disciplines > GI > Flashcards

GI Flashcards

1
Q

What is esophageal atresia?

A

blind esophageal pouch w/ or w/o a fistulous connection between the proximal or distal esophagus & trachea

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2
Q

Clinical presentation of esophageal atresia?

A

Polyhydramnios (excess amniotic fluid)

only sxs within hrs of birth : infants in the 1st few hrs of life w/ copious secretions, choking, cyanosis & respiratory distress

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3
Q

Can esophageal FBs pass spontaneously?

A

yes, 80-90%

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4
Q

What is the MC FB ingested?

A

coin

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5
Q

management for coin ingestion?

A

Plain neck, chest, &/or abdominal radiographs

Esophageal coin on AP CXR

Tracheal coin - tends to be on its edge

Protect the airway

Give continuous oropharyngeal suction

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6
Q

Tx for coin ingestion?

A

Retrieval if:
Not passed into stomach
button battery
multiple magnets

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7
Q

What FB ingestion is a medical emergency?

A

button battery

may have perforation in 2 hrs

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8
Q

Tx for button battery?

A

Requires endoscopic retrieval if lodged in the esophagus:

If in stomach, watch for 24-48 hours to see if it passes, if not, must be removed endoscopically

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9
Q

Gastroesophageal reflux (GER) v GERD?

A

GER: uncomplicated recurrent spitting & vomiting
resolves spontaneously

GERD:
present when reflux causes secondary sx or complications

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10
Q

What is GER?

A

Reflux of gastric contents into the esophagus

occurs during relaxation of LE sphincter

common in young infants

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11
Q

sxs of GER?

A

infants: postprandial regurgitation from effortless to forceful

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12
Q

Tx of GER?

A

Usually benign

expected to resolve by 12-18mo of life

When infants develop sx like FTT, food refusal, pain, GI bleeding, upper or lower airway sx, etc. GER becomes GERD

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13
Q

sxs of GERD?

A

Older children = heartburn, dysphagia

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14
Q

Who is at risk for GERD?

A

asthmatics, Cystic Fibrosis, Developmental handicaps, Hiatal hernia, repaired TE fistula

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15
Q

complications of GERD?

A

esophagitits

recurrent pneumonia

recurrent cough
dental erosions

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16
Q

warning signs for GERD?

A

bile stained emesis (intestinal obstruction)

GI bleeding

Onset of vomiting after 6mo

Failure to thrive (FTT)

diarrhea, fever, hepatosplenomegaly

abdominal tenderness or distension or neuro changes

Need further work up!

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17
Q

Tx for GERD?

A

thickened feeds with oat cereal

milk free diet for 2 wks

H2 blocker v. PPI

Surg: Nissen Fundoplication

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18
Q

Epidemiology of eosinophillic esophagitis? EOE

A

all ages, M >F

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19
Q

What are the 2 MC comps of EOE?

A

1) esophageal food impactions

2) esophageal stricture

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20
Q

s/s of EOE?

A

feeding dysfunction, vague non specific sx of GERD

long meal times (washing down food w/ liquids)

avoidance of highly textured foods

No response to medical/ surg GERD tx

FH or PMH of atopy, asthma, dysphagia or food impaction

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21
Q

Dx of EOE?

A

Endoscopy:
esophageal mucosa w/ thickening, mucosal fissures, strictures & rings

esophagus sprinkled w/ pinpoint white exudates (resembles candida)

white spots composed of eosinophils

Need to r/o other causes

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22
Q

Tx of EOE?

A

elimination of food allergens

swallowed topical steroids (MDI)
-2 puffs of Fluticasone BID

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23
Q

What is Pica?

A

Persistent eating of nonnutritive substances

ex. Animal feces, Clay, Dirt, Hairballs, Ice, Paint, Sand

At least 1 month

Inappropriate to developmental level

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24
Q

Pica may be assoc. with…

A

iron and zinc deficiency

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25
Q

What is rumination?

A

Repeated regurgitation and re-chewing of food

At least 1 mo

More common 3 to 12 months

Less common in older children

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26
Q

Presentation of rumination?

A

Malnutrition

Failure to thrive

Weight loss

Bad breath

Tooth caries

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27
Q

Presentation of malabsorption?

A 
Weight loss
Malnutrition
Diarrhea/steatorrhea (fat malabsorption)
N/V
Abd pain
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28
Q

Assessment of malabsorption?

A

Stool sample
Substance removal and challenge
Work up for celiac disease or cystic fibrosis

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29
Q

What is PhenylketonuriaPKU?

A

Most common inborn error of amino acid metabolism

Decreased activity of phenylalanine hydroxylase (enzyme that converts phenylalanine to tyrosine)

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30
Q

Presentation of PKU?

A

Intellectual disability *MC

Fair skin and hair (impairment of melanin synthesis)

Atopic dermatitis

hyperactivity

seizures

Musty or mousy odor to body & urine

Epilepsy (50%)

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31
Q

When do we check for PKU?

A

newborn screen

autosomal recessive trait

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32
Q

What are some common allergies?

A

cow’s milk, fruits, egg, fish, nuts, cereal

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33
Q

Skin presentation for food allergies?

A

Urticaria and angioedema

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34
Q

dx of food allergies?

A

In vivo IgE against a specific food (skin testing)

In vitro for specific IgE
RAST (radioallergosorbent testing )

fluorescent-enzyme immunoassay

Removal + re-challenge

Clinical reactivity vs IgE antibodies

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35
Q

Tx of food allergies?

A

Avoidance and re-introduction annually

Epinephrine

H1 blockers

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36
Q

What is celiac disease?

A

Immune mediated enteropathy triggered by gluten

1 in 100

Gluten = protein in wheat, rye & barley

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37
Q

s/s of celiac disease?

A

abd pain, V/D

abdominal bloating or distention

constipation

othersL oral ulcers, pruritic rash, growth/puberty delay, iron def. anemia, decreased BMD

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38
Q

risk factors for celiac disease

A 
T1DM 
Down syndrome 
Turner syndrome 
Autoimmune thyroidititis
Family hx of CD
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39
Q

Dx of celiac disease?

A

serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes)

40
Q

Tx of celiac disease?

A

gluten restriction for life (wheat, rye & barley)

intestinal mucosa improves by 6 to 12mo

supplemental calories, vitamins, & minerals (only in acute phase)

41
Q

What are some abdominal wall defects?

A

Gastroschisis & Omphalocele

42
Q

Complications of abdominal wall defects?

A

GERD
Volvulus
Malabsorption

43
Q

dx of abdominal wall defects?

A

maternal elevated AFP

Discovered on prenatal u/s (usually 1st trimester)

Delivered via c-section w/ surgical correction

44
Q

What is a omphalocele?

A

Membrane covered herniation of the abdominal contents into the base of the umbilical cord

sac may contain liver, spleen, intestine

45
Q

What is gastroscisis?

A

Uncovered (no sac) intestine through small abdominal wall defect to the right of the umbilical cord

no sac

Intestinal atresia in approximately 10-20% of infants

46
Q

Prevalence for gastroschisis, why?

A

illicit drugs like meth & cocaine

possible link w/ aspirin & ibuprofen use during pregnancy

young maternal age

47
Q

When are diaphragmatic hernias usually diagnosed?

A

8-10 wks gestation

dx of prenatal US

Polyhydramnios (50%) (excess amniotic fluid)

48
Q

Tx of diaphragmatic hernia?

A

intubation, mechanical ventilation & decompression of the GI tract w/ OG tube

Surg to reduce abdominal contents & close diaphragmatic defect

49
Q

complications of diaphragmatic hernias?

A

pulmonary hypertension
severe GER/GERD

at risk for behavior problems

hearing loss, poor growth

50
Q

umbilical hernias are MC in?

A

full term, African American infants

most regress spontaneously, esp if fascial defect has a diameter of <1cm

51
Q

When should you consider repairing umbilical hernias?

A

if persist beyond 4 years of age

52
Q

What is pyloric stenosis?

A

Postnatal muscular hypertrophy of the pylorus

Progressive gastric outlet obstruction

53
Q

Epidemiology of pyloric stenosis?

A

30-40% are first born

M> F 4:1

more common in whites

54
Q

s/s pf pyloric stenosis?

A

projectile postprandial vomiting

sx usually begin between 3-6wks of age, may start as late as 12wks (rare)

infants are usually hungry and nurse avidly (“hungry vomiter”)

55
Q

PE findings in pyloric stenosis?

A

Some upper abd distention after feeding

prominent gastric peristaltic waves (possibly seen)

Hallmark sign: olive mass (5-15mm mass in RUQ esp. after vomiting)

56
Q

Dx of pyloric stenosis?

A

pyloric US

barium upper GI: string sign

57
Q

Tx of pyloric stenosis?

A

surg repair:

  • pyloromyotomy
  • good px but 3-4x risk for chronic abd pain in childhood
58
Q

Apple core or String sign on US indicates…

A

pyloric stenosis

indicating the elongated narrowed pyloric canal (short arrow).

59
Q

duodenal atresia is assoc. with..

A

down syndrome

60
Q

X-ray findings seen in duodenal atresia?

A

double bubble sign

61
Q

presentation of duodenal atresia?

A

bilious vomiting hours after birth

62
Q

Tx of duodenal atresia?

A

surg correction

63
Q

What is short bowel syndrome?

A

A condition resulting from reduced intestinal absorptive surface >

leads to alternation in intestinal function

compromises growth, fluid/electrolyte balance &/or hydration status

64
Q

When does short bowel syndrome usually occur?

A

after surg resection of intestine

65
Q

s/s of short bowel syndrome?

A

generally related to their malabsorptive state:
diarrhea

dehydration

electrolyte or micronutrient deficiency states

excessive gas, foul ambling stool

66
Q

Tx of short bowel syndrome?

A

goal: promote growth
Diet
Total parenteral nutrition (TPN) - worry about liver issues w/ prolonged use

Enteral nutrition (g-tube)

Meds to slow motility

Antacids, H2 blockers, or PPI

Abx to prevent or treat bacterial overgrowth

Surgery (STEP)

Intestinal transplantation (last resort)

67
Q

What is intussusception?

A

Telescoping of one segment of the intestine into another segment

MCC of bowel obstruction in the first 2yrs of life

MCly starts just proximal to the ileocecal valve

68
Q

Epidemiology of intussusception?

A

3x more in Males

69
Q

s/s of intussusception?

A

recurrent paroxysms of abdominal pain (screams, draws up knees)

int. severe, crampy abd pain

V/D Passage of rectal blood/mucous: “red currant jelly” pathonomonic

70
Q

PE findings for intussusception?

A

Palpable right-sided sausage-shaped mass

71
Q

hirschsprung disease is assoc. with..

A

downs

72
Q

Tx of hirschsprung disease?

A

surg removal of aganglionic bowel: temporary colostomy

surg reconstruction

73
Q

What is the rule of two’s?

A

Meckel’s diverticulum:

  • 2% of the population
  • Male-to-female 2:1
  • 50% of complications occur in first 2yrs of life
  • Within 2 feet from the ileocecal valve
  • 2 inches in length
74
Q

presentation of meckel’s diverticulum?

A

painless lower GI bleed

recurrent or atypical intussusception

75
Q

Dx of meckel’s diverticulum?

A

arteriography or CT angiography

76
Q

Tx of meckel’s diverticulum?

A

surg resection if sxs

77
Q

What is Gilbert’s syndrome?

A

familial unconjugated hyperbilirubinemia

78
Q

Epidemiology of Gilbert’s syndrome?

A

autosomal dominant

79
Q

Dx of gilbert’s syndrome?

A

serum unconjugated bili usually <3-6

an increased of 1.4 of unconjugated bilirubin after a 2 day fast is dx

80
Q

tx of Gilbert’s syndrome

A

no tx necessary

81
Q

Cystic fibrosis primary affects which 4 areas?

A

Lung, pancreas, intestine and liver

82
Q

When should you suspect CF? dx?

A

Suspect in any child with meconium ileus, cholestasis, recurrent URI/lung disease or malabsorption

Sweat chloride test
Newborn screening available

83
Q

Tx of cystic fibrosis?

A

Oral supplementation of pancreatic enzymes improves digestion

Ursodiol can help to relieve the manifestations of cholestasis

84
Q

What are pilonidal cysts?

A

Infx of the skin or subcutaneous tissue at or near the upper part of the natal cleft of the buttock

85
Q

patho of pilonidal cysts?

A

Develop when ingrown hair forms in the skin>

Forms a cyst that becomes a sinus

Most sinuses become infected

86
Q

risk factors for pilondal cysts?

A

overweight/obesity

local trauma or irritation

sedentary lifestyle or prolonged sitting

deep natal cleft

family hx

87
Q

Tx of pilonidal cysts?

A

Soaking in warm water ease pain of pilonidal cysts

Surgical opening and draining of the infected sinus

88
Q

What is Enterobiasis (Pinworms)?

A

Worms in the stool or eggs on perianal skin

intense anal pruritus

89
Q

Dx of pinworms?

A

scotch tape test

90
Q

Tx of pinworms

A

treat all household members at the same time to prevent reinfections

repeat tx in 2 weeks

Pyrantel pamoate 11mg/kg (max 1g)- OTC

keep nails short/clean

wash sheets freq.

91
Q

What is encopresis?

A

Repeated passage of feces into inappropriate places (e.g., clothing or floor)
Involuntary or intentional

at least 3 mos

at least 4 yrs of age or equivalent developmental level

92
Q

tx of encopresis?

A

behavioral-education tx

pharm: initally suppositories & enemas

Miralax

laxatives (mineral oil, high fiber diet, etc)

biofeedback therapy

93
Q

What is considered constipation?

A

2 or more for 2 months:

1) < 3 BMs per wk
2) > 1 episode of encopresis per wk
3) impaction of the rectum w/ stool
4) passage of stool so large it obstructs the toilet
5) retentive posturing & fecal witholding
6) pain w/ defecation

94
Q

What causes constipation?

A

dehydration, excessive milk, lack of fiber

meds

thyroid disease, CP

anal fissues

95
Q

Tx of constipation?

A

diet changes to “p”

Miralax
Lactulose
Milk of Magnesia

PEDS 2- clinical disciplines (5 decks)

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