GI Flashcards
Jaundice
- when check newborn
- at birth
- 2-5 days
Jaundice
- 2 main physiologic causes
- increased production fo bilirubin
- decreased ability to metabolize/excrete bilirubin
Jaundice
- 5 types
- physiologic
- Rh/ABO incompatibility
- Breastmilk jaundice
- Breastfeeding jaundice
- Extravasated blood
Jaundice
- physiologic jaundice
- MC
- inability of immature liver to metal and excrete bilirubin
- usually benign
- usually resolves in 1-2 weeks
Jaundice
- Rh/ABO incompatibility
- increased bd of fetal RBCs overwhelm liver
- Rh incompatibility: sensitized Rh- mother vs. Rh+ child
- ABO: maternal blood type O has predominantly IgG antibodies that cross the placenta and cause harm to the baby (non type O)
Jaundice
- Breastmilk jaundice
- towards end of first week of life
- chemicals in breast milk thought to be responsible
- usually harmless and resolves spontaneously
- moms can keep breastfeeding
Jaundice
- Breastfeeding jaundice
- inadequate milk production
- dehydration
- fewer bowel movements of baby
- decreased bilirubin excretion from body
Jaundice
- extravasated blood
- cephalohematoma
- peripheral ecchymosis
Jaundice
- W/u
- bili measurements in hospital and at newborn office visit
- newborn screening
- ABO typing
Jaundice
- tx
- sunlight if <15
- phototherapy if >15
- feeding/supplementation: ensure adequate food supply
Jaundice
- complications
Kernicterus (bilirubin encephalopathy) from high levels of indirect bilirubin (>20 in term infant)
- can occur at lower levels of bilirubin in presence of acidosis, hypoalbuminemia, certain drugs
Gastroenteritis
- how common? why a big deal?
- one of the MC problems in peds
- still major cause of morbidity and mortality
Gastroenteritis
- w/u
- history!!! onset, duration, frequency of BM/vomiting, etc. etc
- PE: VITALS, saliva/tears for dehydration, feel the belly for rigidity
- always look for other causes of vomiting like strep throat!
Gastroenteritis
- stool studies: when to use, what is covered
- if ill >7 days or severe illness
- rotavirus
- c. diff
- fecal leukocyte stain to ID bacterial etiology
- culture: salmonella, shigella, yersinia
- e. coli
- campylobacter
- ova and parasite: giardiasis and cryptosporidium
C. diff
- sx
- frequent, water diarrhea
- mucus
- sig odor
- weight loss
- abd pain and cramping
c. diff
- predisposing factors
- previous c diff infection
- multiple abx
- hospitalizations
- PPIs
c. diff
- tx
- if asx, no tx
- Metronidazole
- 2nd occurrence: PO vanc
E. coli
- two types
- enterohemorrhagic (shiga toxin): more severe. Severe stomach cramps, diarrhea (bloody often), vomiting
- Enterotoxogenic: profuse watery diarrhea, abd cramping, fever, nausea, +/- vomiting, chills, muscle aches, bloating
Campylobacter
diarrhea, cramping, abd pain, fever, +/- n/v
1 week
Giardia
- cyclical diarrhea
- cramping, bloating, abd pain, dehydration
Gastroenteritis
- tx
- zofran
- phenergen gel for tiny babies
- BRATT diet
- pedialyte
- NO anti-diarrheal (salicylate)
- FOLLOW UP
Dehydration
- impact
- causes
- dehydration 2nd to diarrheal illness is leading cause of infant and child mortality worldwide
- Fluid loss
- Deficient intake
- Fluid shift (ascites, effusion, cap leak from burn or sepsis)
stages of dehydration
chart in the lecture. she specifically mentioned checking fontanel and cap refill
Three types of dehydration (list)
- Isonatremic (isotonic)
- Hyponatremic (hypotonic)
- Hypernatremic (hypertonic)
Isonatremic dehydration
- lost fluid is similar in sodium concentration to blood
- least dangerous, MC
Hyponatremic dehydration
- lost fluid contains more sodium than blood
- low serum sodium = fluid shift into extravascular space, exaggerating intravascular volume depletion
Hypernatremic dehydration
- lost fluid contains less sodium than the blood
- serum sodium is high, fluid shifts to intravascular space
- intravascular volume depletion is minimized for given amount of body water lost
Neuro complications of hyponatremia
- intractable seizures
- if correct too fast = central pontine myelinolysis
Neuro complications of hypernatremia
- if correct too fast = cerebral edema
(when fluid leaves cells for intravascular space, creates osmotically active pressure in cells which can pull too much water in during rehydration)
**slowly rehydrate over 48 hours
Dehydration
- non pharm tx
- No anti-diarrheal meds
- Oral rehydration: vomiting is not a CI, give frequent small amounts of fluid with correct Na and glucose proportions (pedialyte, infalyte, etc.)
- do not give apple juice, ginger ale, milk, cx broth
- IV rehydration
Dehydration
- pharm tx
- avoid empiric abx (c.diff!)
- Ondansetron or phenergen gel for nausea
Dehydration
- diet to return to food
- start feeding as soon as tolerated
- BRATT diet
- no dairy until 24 hours after diarrhea/vomiting free
- foods with complex carbs
- avoid fatty foods an simple carbs
- probiotics
Constipation
- criteria for dx
- Rome III
- 2 of the follow sx over preceding 3 months:
- fewer than 3 BM/week
- straining
- lumpy/hard stool
- sensation of anorectal obstruction
- manual maneuvering required to defecate
Constipation
- may be asx except for the following sx
- abd bloating
- pain on defecation
- rectal bleeding
- spurious diarrhea
- low back pain
Constipation
- Overview of types
Primary: - functional Secondary - dietary - structural - systemic dz - medication - psychologic
Constipation
- Primary/functional
- withholding dt fear of pain, “too busy”, scared of public bathroom, etc.
- often a consequence of a single episode fo painful defecation…
Constipation
- secondary causes: dietary
- inadequate fiber/water
- overuse of coffee/tea/alcohol (???)
- diet change: nursing/formula to cow milk
Constipation
- secondary causes: structural
- colon obstruction
- stricture
- volvulus
- outlet obstruction
