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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
What is rumination?
Repeated regurgitation and re-chewing of food At least 1 mo More common 3 to 12 months Less common in older children
26
Presentation of rumination?
Malnutrition Failure to thrive Weight loss Bad breath Tooth caries
27
Presentation of malabsorption?
``` Weight loss Malnutrition Diarrhea/steatorrhea (fat malabsorption) N/V Abd pain ```
28
Assessment of malabsorption?
Stool sample Substance removal and challenge Work up for celiac disease or cystic fibrosis
29
What is PhenylketonuriaPKU?
Most common inborn error of amino acid metabolism Decreased activity of phenylalanine hydroxylase (enzyme that converts phenylalanine to tyrosine)
30
Presentation of PKU?
Intellectual disability *MC Fair skin and hair (impairment of melanin synthesis) Atopic dermatitis hyperactivity seizures Musty or mousy odor to body & urine Epilepsy (50%)
31
When do we check for PKU?
newborn screen autosomal recessive trait
32
What are some common allergies?
cow's milk, fruits, egg, fish, nuts, cereal
33
Skin presentation for food allergies?
Urticaria and angioedema 
34
dx of food allergies?
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
35
Tx of food allergies?
Avoidance and re-introduction annually Epinephrine H1 blockers
36
What is celiac disease?
Immune mediated enteropathy triggered by gluten 1 in 100 Gluten = protein in wheat, rye & barley
37
s/s of celiac disease?
abd pain, V/D abdominal bloating or distention constipation othersL oral ulcers, pruritic rash, growth/puberty delay, iron def. anemia, decreased BMD
38
risk factors for celiac disease
``` T1DM Down syndrome Turner syndrome Autoimmune thyroidititis Family hx of CD ```
39
Dx of celiac disease?
serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes)
40
Tx of celiac disease?
gluten restriction for life (wheat, rye & barley) intestinal mucosa improves by 6 to 12mo supplemental calories, vitamins, & minerals (only in acute phase)
41
What are some abdominal wall defects?
Gastroschisis & Omphalocele
42
Complications of abdominal wall defects?
GERD Volvulus Malabsorption
43
dx of abdominal wall defects?
maternal elevated AFP Discovered on prenatal u/s (usually 1st trimester) Delivered via c-section w/ surgical correction
44
What is a omphalocele?
Membrane covered herniation of the abdominal contents into the base of the umbilical cord sac may contain liver, spleen, intestine
45
What is gastroscisis?
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
Prevalence for gastroschisis, why?
illicit drugs like meth & cocaine possible link w/ aspirin & ibuprofen use during pregnancy young maternal age
47
When are diaphragmatic hernias usually diagnosed?
8-10 wks gestation dx of prenatal US Polyhydramnios (50%) (excess amniotic fluid)
48
Tx of diaphragmatic hernia?
intubation, mechanical ventilation & decompression of the GI tract w/ OG tube Surg to reduce abdominal contents & close diaphragmatic defect
49
complications of diaphragmatic hernias?
pulmonary hypertension severe GER/GERD at risk for behavior problems hearing loss, poor growth
50
umbilical hernias are MC in?
full term, African American infants most regress spontaneously, esp if fascial defect has a diameter of <1cm
51
When should you consider repairing umbilical hernias?
if persist beyond 4 years of age
52
What is pyloric stenosis?
Postnatal muscular hypertrophy of the pylorus Progressive gastric outlet obstruction
53
Epidemiology of pyloric stenosis?
30-40% are first born M> F 4:1 more common in whites
54
s/s pf pyloric stenosis?
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
PE findings in pyloric stenosis?
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
Dx of pyloric stenosis?
pyloric US barium upper GI: string sign
57
Tx of pyloric stenosis?
surg repair: - pyloromyotomy - good px but 3-4x risk for chronic abd pain in childhood
58
Apple core or String sign on US indicates...
pyloric stenosis indicating the elongated narrowed pyloric canal (short arrow).
59
duodenal atresia is assoc. with..
down syndrome
60
X-ray findings seen in duodenal atresia?
double bubble sign
61
presentation of duodenal atresia?
bilious vomiting hours after birth
62
Tx of duodenal atresia?
surg correction
63
What is short bowel syndrome?
A condition resulting from reduced intestinal absorptive surface > leads to alternation in intestinal function compromises growth, fluid/electrolyte balance &/or hydration status
64
When does short bowel syndrome usually occur?
after surg resection of intestine
65
s/s of short bowel syndrome?
generally related to their malabsorptive state: diarrhea dehydration electrolyte or micronutrient deficiency states excessive gas, foul ambling stool
66
Tx of short bowel syndrome?
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
What is intussusception?
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
Epidemiology of intussusception?
3x more in Males
69
s/s of intussusception?
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
PE findings for intussusception?
Palpable right-sided sausage-shaped mass
71
hirschsprung disease is assoc. with..
downs
72
Tx of hirschsprung disease?
surg removal of aganglionic bowel: temporary colostomy surg reconstruction
73
What is the rule of two's?
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
presentation of meckel's diverticulum?
painless lower GI bleed recurrent or atypical intussusception
75
Dx of meckel's diverticulum?
arteriography or CT angiography
76
Tx of meckel's diverticulum?
surg resection if sxs
77
What is Gilbert's syndrome?
familial unconjugated hyperbilirubinemia
78
Epidemiology of Gilbert's syndrome?
autosomal dominant
79
Dx of gilbert's syndrome?
serum unconjugated bili usually <3-6 an increased of 1.4 of unconjugated bilirubin after a 2 day fast is dx
80
tx of Gilbert's syndrome
no tx necessary
81
Cystic fibrosis primary affects which 4 areas?
Lung, pancreas, intestine and liver
82
When should you suspect CF? dx?
Suspect in any child with meconium ileus, cholestasis, recurrent URI/lung disease or malabsorption Sweat chloride test Newborn screening available
83
Tx of cystic fibrosis?
Oral supplementation of pancreatic enzymes improves digestion Ursodiol can help to relieve the manifestations of cholestasis
84
What are pilonidal cysts?
Infx of the skin or subcutaneous tissue at or near the upper part of the natal cleft of the buttock
85
patho of pilonidal cysts?
Develop when ingrown hair forms in the skin> Forms a cyst that becomes a sinus Most sinuses become infected
86
risk factors for pilondal cysts?
overweight/obesity local trauma or irritation sedentary lifestyle or prolonged sitting deep natal cleft family hx
87
Tx of pilonidal cysts?
Soaking in warm water ease pain of pilonidal cysts Surgical opening and draining of the infected sinus
88
What is Enterobiasis (Pinworms)?
Worms in the stool or eggs on perianal skin intense anal pruritus
89
Dx of pinworms?
scotch tape test
90
Tx of pinworms
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
What is encopresis?
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
tx of encopresis?
behavioral-education tx pharm: initally suppositories & enemas Miralax laxatives (mineral oil, high fiber diet, etc) biofeedback therapy
93
What is considered constipation?
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
What causes constipation?
dehydration, excessive milk, lack of fiber meds thyroid disease, CP anal fissues
95
Tx of constipation?
diet changes to "p" Miralax Lactulose Milk of Magnesia

PEDS 2- clinical disciplines (5 decks)

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