GI Flashcards
Big red flags for pediatric GI issues
weight loss, blood, pain away from umbilicus, unrelenting, growth fialure, arthritis, perianal disease
valve between stomach and small intestine hypertrophies and spasms → food is blocked from intestines
pyloric stenosis
Who is pyloric stenosis MC in?
first-born males
what medication increases the risk for pyloric stenosis when given to infants?
macrolides (erythromycin and azithromycin)
why would you give a macrolide to an infant
pneumonia, congenital chlamydia, whooping cough/pertussis
when does pyloric stenosis present?
1-5 weeks old
Patient presents with forecful vomiting after feeding “projectile vomiting”
pyloric stenosis
persistent hungry + stomach contractions + dehydration + hypochloremic/hypokalemic metabolic acidosis
pyloric stenosis
Worrisome symptoms with pyloric stenosis
weight loss or failure to gain adequate weight
what will you be able to palpate on patient with pyloric stenosis?
olive mass in RUQ
Diagnostic test of choice for pyloric stenosis
abdominal ultrasound
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?
barium swallow
“string sign”
Treatment for pyloric stenosis
surgery → pyloromyotomy
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
pyloromyotomy
when does GERD become an issue?
failure to thrive poor intake (dysphagia, irritable, apnea, cyanotic)
How do you diagnose GERD?
clinical diagnosis
Can do pH probe
Nonpharmacological treatment for GERD
supportive
thicken feeding, sit upright, check bottle, smaller feeds
Pharmacological treatment for GERD
ranitidine
PPI
formula change
when will GERD improve in a baby?
by 12 - 15 months
symptoms that may also present with GERD
cough hoarseness wheezing abdominal pain FTT recurrent OM or sinusitis
what food should you avoid with GERD?
spicy, acidic, coffee, chocolate, alcohol, fatty/greasy
characterized by severe or paroxysmal crying that occurs mainly in late afternoon
colic
cause of colic
unknown
when will colic begin? When does it peak?
begins first few weeks of life
peak at 2 - 3 months
infant who draws knees up, clenches fists, passes gas appears to be in pain, and is unresponsive to soothing
colic
Wessel’s Rule of 3’s for Colic
cries > 3 hr/day
> 3 days/weeks
> 3 weeks
when does a baby outgrow colic?
around 3 months
how do you approach a baby with colic?
the child is healthy → rule out causes of crying (hunger, GERD, allergy, etc
Treatment for colic
education → reassure the family and talk about techaniques for calming, child safety
consider diet changes
no meds
what is congenital duodenal obstruction commonly associated with?
Down Syndrome
when are most instances of congenital duodenal obstruction diagnosed?
prenatally → if there is genetic abnormality they will screen for this as well
prenatal screen with polyhydramnios in 3rd trimester + dilated bowels +/- ascites
congenital duodenal obstruction
If congenital duodenal obstruction is not caught prenatally, how would an infant present?
feeding dificulties
bilious emesis
what will you see on x-ray for congenital duodenal obstruction?
“double bubble” → one bubble in stomach and one in proximal duodenum
what diagnostic procedure can be done for conegenital duodenal obstruction?
upper GI series
treatment for congenital duodenal obstruction
surgery
abnormal twisting of a part of larger or small intestins
volvulus
what can a volvulus cause
bowel obstruction and necrosis
where is volvulus usually in children?
small intestine
what often causes volvulus in infants?
congenital malrotation
60% of children will have _____ in the first month of life with a volvulus
bilious vomiting
this clinical sign indicated perforation due to volvulus
peritonitis
this clinical sign indicated ischemia due to volvulus
hematochezia
how do you diagnose a patient with a volvulus
Uper GI contrast series → duodenum will have “corkscrew” appearance and duodenal obstruction will have “beak” appearance
treatment of volvulus
surgery
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
Hirschsprung Disease
signs of Hirschsprungs Disease
chronic constipation
Failure to pass meconium in first 48 hr of birth
abdominal distention
vomiting
life-threatening illness where patients have sepsis like picutres → fever, vomiting, diarrhea, abdominal distension → can progress to toxic megacolon
enterocolitis
gold standard for diagnosing hirschsprung disease
rectal biopsy
Treatment for Hirschsprungs Disease
refer to GI or surgery
how can you manage mild Hirschsprung Disease?
Miralax for life
MC food allergy in young children
cows milk protein allergy
two types of cows milk protein allergy
IgE mediated
non-IgE mediated
with this type of allergy symptoms occur within minutes - hours of exposure → respiratory symptoms, cardiac symptoms, hives, angioedema, GI symptoms
IgE mediated
with this allergy exposure produces chronic irritated type gut symptoms (Food Protein-Inducted enterocolitis syndrome, proctitis, enteropathy, GERD, Colic, Constipation )
Non-IgE mediated
IgE and Non-IgE mediated allergy both have
atopic dermatitis
eosinophilic esophagitis
Treatment for cows milk protein allergy
eliminated cows milk from mom's diet hypoallergenic formula (soy after a couple weeks)
when can you reintroduce cows milk into the diet?
after 1 -2 years of age
when does the first BM occur in full term infant?
within 36 hours
during the first week of life how many stools will an infant pass per day
four stool
How often may breast fed babies poop? What does it look like?
with every feeding or 1 time/week
Dijon Mustard
difficult, infrequent, incomplete defecation
constipation
what percentage of constipation is an actual medical issue?
5%
MC causes of constipation
diet
lack of water
stool withholding
genetics
when do you start to see stool withholding?
18 mo - 2 years
treatment for constipation in infants
consider cow milk protein allergy or soy formula → change formula
add dark karo syrup, a little water, prune juice
treatment for constipation in toddlers and children
increase fiber in diet
increase fluids
polyethylene glycol (Miralax)
toilet time after meal
how much fiber should child havE?
age + 5-10 grams
how much fluid should child have?
32 - 64 oz/day
constipation so severe in potty trained child (> 4 yo) → stool leaks and child soils their underwear
encopresis
Treatment for Encopresis
disimpaction (Miralax) prolonged laxative treatment and behavior therapy (regulate them and avoid the problem) dietary changes (increase fiber)
Part of the intestine slide into another part of the intestines “telescoping”
intussusception
MC cause of intestinal obstruction in children under 3
intussusception
How will the stool look with intussuception?
currant jelly
Pain comes and goes + every 15-20 minutes → episodes last longer and happen more often as time passes
intussusception
classic finding of intussusception
pulling up the knees
What do you see on ultrasound of intussusception?
target sign, bulls eye or coiled spring
Nonoperative treatment of intussusception
Enema (Air > barium)
affects colon + inflammation of mucosal layer
UC
involves any part of GI tract + transmural inflammation
Crohns
What are the 2 complications of CD and US in children?
growth failure
delayed puberty
when is peak incidence for IBD?
15 - 30 yo
fistula, anal skin tag, or fissure
perianal disease
Lab values for IBD CBC ESR/CRP Albumin Heme
CBC → anemia
ESR/CRP → elevated
decreased albumin
heme positive stool
pain nearly dialy not associated with meals or relieved by defecation and often associated with perfectionism or tendency towards anxiety
functional abdominal pain
how long must you have pain to be considered Functional Abdominal Pain?
> 2 months
how will patient with functional abdominal pain present clinically?
no alarming findings (fever, weight loss, pain at night)
normal physical exam
stool negative for blood
MC condition seen in pediatric and school age children
functional abdominal pain
goal of treating functiona abdominal pain
control trigger and coping skills in the kids
persistent loose, water, painless stools (> 4 daily) for at least 2-4 weeks → normal growth and no blood
toddlers diarrhea
dietary modifications for toddlers diarrhea
reduce/eliminate fruit juice (<4 oz/day)
fat content 35-50% of total calories
probiotics
MC helminthic infection in the US
pinworms (enterobiasis)
MC symptom of pinworms
perianal itching
How do you diagnose pinworms?
scotch tape test
Treatment for pinworms
pyrantel pamoate
