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Pediatrics Exam 1 > GI > Flashcards

GI Flashcards

1
Q

Big red flags for pediatric GI issues

A

weight loss, blood, pain away from umbilicus, unrelenting, growth fialure, arthritis, perianal disease

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2
Q

valve between stomach and small intestine hypertrophies and spasms → food is blocked from intestines

A

pyloric stenosis

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3
Q

Who is pyloric stenosis MC in?

A

first-born males

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4
Q

what medication increases the risk for pyloric stenosis when given to infants?

A

macrolides (erythromycin and azithromycin)

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5
Q

why would you give a macrolide to an infant

A

pneumonia, congenital chlamydia, whooping cough/pertussis

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6
Q

when does pyloric stenosis present?

A

1-5 weeks old

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7
Q

Patient presents with forecful vomiting after feeding “projectile vomiting”

A

pyloric stenosis

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8
Q

persistent hungry + stomach contractions + dehydration + hypochloremic/hypokalemic metabolic acidosis

A

pyloric stenosis

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9
Q

Worrisome symptoms with pyloric stenosis

A

weight loss or failure to gain adequate weight

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10
Q

what will you be able to palpate on patient with pyloric stenosis?

A

olive mass in RUQ

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11
Q

Diagnostic test of choice for pyloric stenosis

A

abdominal ultrasound

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12
Q

if the abdominal US didn’t work for a patient with suspected pyloric stenosis, what would you order next? What would you see on this study?

A

barium swallow

“string sign”

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13
Q

Treatment for pyloric stenosis

A

surgery → pyloromyotomy

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14
Q

laparoscopic procedure where surgeon cuts through outside layer of thickened muscle that allows the inner muscle to bulge out and opening a channel for food to pass

A

pyloromyotomy

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15
Q

when does GERD become an issue?

A 
failure to thrive 
poor intake (dysphagia, irritable, apnea, cyanotic)
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16
Q

How do you diagnose GERD?

A

clinical diagnosis

Can do pH probe

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17
Q

Nonpharmacological treatment for GERD

A

supportive

thicken feeding, sit upright, check bottle, smaller feeds

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18
Q

Pharmacological treatment for GERD

A

ranitidine
PPI
formula change

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19
Q

when will GERD improve in a baby?

A

by 12 - 15 months

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20
Q

symptoms that may also present with GERD

A 
cough
hoarseness 
wheezing 
abdominal pain 
FTT 
recurrent OM or sinusitis
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21
Q

what food should you avoid with GERD?

A

spicy, acidic, coffee, chocolate, alcohol, fatty/greasy

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22
Q

characterized by severe or paroxysmal crying that occurs mainly in late afternoon

A

colic

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23
Q

cause of colic

A

unknown

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24
Q

when will colic begin? When does it peak?

A

begins first few weeks of life

peak at 2 - 3 months

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25
Q

infant who draws knees up, clenches fists, passes gas appears to be in pain, and is unresponsive to soothing

A

colic

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26
Q

Wessel’s Rule of 3’s for Colic

A

cries > 3 hr/day
> 3 days/weeks
> 3 weeks

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27
Q

when does a baby outgrow colic?

A

around 3 months

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28
Q

how do you approach a baby with colic?

A

the child is healthy → rule out causes of crying (hunger, GERD, allergy, etc

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29
Q

Treatment for colic

A

education → reassure the family and talk about techaniques for calming, child safety
consider diet changes
no meds

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30
Q

what is congenital duodenal obstruction commonly associated with?

A

Down Syndrome

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31
Q

when are most instances of congenital duodenal obstruction diagnosed?

A

prenatally → if there is genetic abnormality they will screen for this as well

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32
Q

prenatal screen with polyhydramnios in 3rd trimester + dilated bowels +/- ascites

A

congenital duodenal obstruction

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33
Q

If congenital duodenal obstruction is not caught prenatally, how would an infant present?

A

feeding dificulties

bilious emesis

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34
Q

what will you see on x-ray for congenital duodenal obstruction?

A

“double bubble” → one bubble in stomach and one in proximal duodenum

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35
Q

what diagnostic procedure can be done for conegenital duodenal obstruction?

A

upper GI series

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36
Q

treatment for congenital duodenal obstruction

A

surgery

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37
Q

abnormal twisting of a part of larger or small intestins

A

volvulus

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38
Q

what can a volvulus cause

A

bowel obstruction and necrosis

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39
Q

where is volvulus usually in children?

A

small intestine

40
Q

what often causes volvulus in infants?

A

congenital malrotation

41
Q

60% of children will have _____ in the first month of life with a volvulus

A

bilious vomiting

42
Q

this clinical sign indicated perforation due to volvulus

A

peritonitis

43
Q

this clinical sign indicated ischemia due to volvulus

A

hematochezia

44
Q

how do you diagnose a patient with a volvulus

A

Uper GI contrast series → duodenum will have “corkscrew” appearance and duodenal obstruction will have “beak” appearance

45
Q

treatment of volvulus

A

surgery

46
Q

motor disorder in the gut, fialure of neural crest cells (precursors of enteric ganglion cells) to migrate completely during intestinal development during fetal life → aganglionic segment of colon fails to relax → functional obstruction

A

Hirschsprung Disease

47
Q

signs of Hirschsprungs Disease

A

chronic constipation
Failure to pass meconium in first 48 hr of birth
abdominal distention
vomiting

48
Q

life-threatening illness where patients have sepsis like picutres → fever, vomiting, diarrhea, abdominal distension → can progress to toxic megacolon

A

enterocolitis

49
Q

gold standard for diagnosing hirschsprung disease

A

rectal biopsy

50
Q

Treatment for Hirschsprungs Disease

A

refer to GI or surgery

51
Q

how can you manage mild Hirschsprung Disease?

A

Miralax for life

52
Q

MC food allergy in young children

A

cows milk protein allergy

53
Q

two types of cows milk protein allergy

A

IgE mediated

non-IgE mediated

54
Q

with this type of allergy symptoms occur within minutes - hours of exposure → respiratory symptoms, cardiac symptoms, hives, angioedema, GI symptoms

A

IgE mediated

55
Q

with this allergy exposure produces chronic irritated type gut symptoms (Food Protein-Inducted enterocolitis syndrome, proctitis, enteropathy, GERD, Colic, Constipation )

A

Non-IgE mediated

56
Q

IgE and Non-IgE mediated allergy both have

A

atopic dermatitis

eosinophilic esophagitis

57
Q

Treatment for cows milk protein allergy

A 
eliminated cows milk from mom's diet 
hypoallergenic formula (soy after a couple weeks)
58
Q

when can you reintroduce cows milk into the diet?

A

after 1 -2 years of age

59
Q

when does the first BM occur in full term infant?

A

within 36 hours

60
Q

during the first week of life how many stools will an infant pass per day

A

four stool

61
Q

How often may breast fed babies poop? What does it look like?

A

with every feeding or 1 time/week

Dijon Mustard

62
Q

difficult, infrequent, incomplete defecation

A

constipation

63
Q

what percentage of constipation is an actual medical issue?

A

5%

64
Q

MC causes of constipation

A

diet
lack of water
stool withholding
genetics

65
Q

when do you start to see stool withholding?

A

18 mo - 2 years

66
Q

treatment for constipation in infants

A

consider cow milk protein allergy or soy formula → change formula
add dark karo syrup, a little water, prune juice

67
Q

treatment for constipation in toddlers and children

A

increase fiber in diet
increase fluids
polyethylene glycol (Miralax)
toilet time after meal

68
Q

how much fiber should child havE?

A

age + 5-10 grams

69
Q

how much fluid should child have?

A

32 - 64 oz/day

70
Q

constipation so severe in potty trained child (> 4 yo) → stool leaks and child soils their underwear

A

encopresis

71
Q

Treatment for Encopresis

A 
disimpaction (Miralax)
prolonged laxative treatment and behavior therapy (regulate them and avoid the problem) 
dietary changes (increase fiber)
72
Q

Part of the intestine slide into another part of the intestines “telescoping”

A

intussusception

73
Q

MC cause of intestinal obstruction in children under 3

A

intussusception

74
Q

How will the stool look with intussuception?

A

currant jelly

75
Q

Pain comes and goes + every 15-20 minutes → episodes last longer and happen more often as time passes

A

intussusception

76
Q

classic finding of intussusception

A

pulling up the knees

77
Q

What do you see on ultrasound of intussusception?

A

target sign, bulls eye or coiled spring

78
Q

Nonoperative treatment of intussusception

A

Enema (Air > barium)

79
Q

affects colon + inflammation of mucosal layer

A

UC

80
Q

involves any part of GI tract + transmural inflammation

A

Crohns

81
Q

What are the 2 complications of CD and US in children?

A

growth failure

delayed puberty

82
Q

when is peak incidence for IBD?

A

15 - 30 yo

83
Q

fistula, anal skin tag, or fissure

A

perianal disease

84
Q 
Lab values for IBD 
CBC
ESR/CRP 
Albumin 
Heme
A

CBC → anemia
ESR/CRP → elevated
decreased albumin
heme positive stool

85
Q

pain nearly dialy not associated with meals or relieved by defecation and often associated with perfectionism or tendency towards anxiety

A

functional abdominal pain

86
Q

how long must you have pain to be considered Functional Abdominal Pain?

A

> 2 months

87
Q

how will patient with functional abdominal pain present clinically?

A

no alarming findings (fever, weight loss, pain at night)
normal physical exam
stool negative for blood

88
Q

MC condition seen in pediatric and school age children

A

functional abdominal pain

89
Q

goal of treating functiona abdominal pain

A

control trigger and coping skills in the kids

90
Q

persistent loose, water, painless stools (> 4 daily) for at least 2-4 weeks → normal growth and no blood

A

toddlers diarrhea

91
Q

dietary modifications for toddlers diarrhea

A

reduce/eliminate fruit juice (<4 oz/day)
fat content 35-50% of total calories
probiotics

92
Q

MC helminthic infection in the US

A

pinworms (enterobiasis)

93
Q

MC symptom of pinworms

A

perianal itching

94
Q

How do you diagnose pinworms?

A

scotch tape test

95
Q

Treatment for pinworms

A

pyrantel pamoate

Pediatrics Exam 1 (7 decks)

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