GI Flashcards
Babies that are fed what do not spit up as much?
Breast fed babies do not spit up as much
When does infantile GERD end and adult begin?
18 months - infancy should result
What is normal regurgitation for a baby <3 months, 4 months, and 12 months?
<3: 1 time day in 1/2
2/3 by 4 months
5% by 12 months
A child over 8 YO will start complaining of ___ with GERD
Heartburn
Most common factor in GERD:
Transient release LES sphincter
Infants take in ___ the amount of older children in terms of stomach size
x2
Labs are ___ indicated for GERD but could be used if the patient is vomiting a lot
RARELY
How can you manage GERD (3):
- Decrease amount of feeding and increase frequency
- Add 1 tbs of oat cereal to the bottle
- Avoid tobacco
GERD should resolve in:
1 year
What is the easiest formula on the stomach?
Hydrolyzed milk - consider a 2-4 week trial
What are two drugs you can use for GERD?
- PPI (approved down to 1 month)
- H2 blockers
Refer to GI if an infant has (3) associated with its GERD:
- Poor weight gain
- Hematemesis
- Respiratory disease
You loose more fluid from __ than ___
Diarrhea > Vomiting
What are three other causes of vomiting in infants?
- Shaken baby
- Cow’s milk allergy
- Metabolic disease
What medication can cause vomiting?
Erythromyocin
What is cyclic vomiting?
Related to migrants - attacks of 1 hour - 10 days of vomiting - Average dx. 9.6 YO
When is diarrhea acute, persistent or chronic?
Acute: Under 14 d
Persistent: Over 14 d
Chronic: Over 14 d with another cause
What is Osmotic diarrhea?
Small volume, stops when you stop eating food
What is Osmotic diarrhea caused from?
Decreased absorption due to infection, lack of enzymes, or excessive intake
What is secretory diarrhea?
Watery; continues despite stopping to eat, bacteria, viral or parasite
What is the most common complication of viral gastroenteritis?
Dehydration
Progression of viral gastroenteritis (most common in winter):
URI –> Fever –> 3-8 d of vomiting and diarrhea
When is enterovirus must common?
Summer
You should not use a pool with diarrhea for how long?
Up to two weeks
Infectious agents that cause bloody diarrhea (3):
- Campy
- Shigella
- E. coli with shiga
You will experience tenesmus with what infectious diarrheal agent?
Shigella
You can treat Shigella with:
Azithromycin or 3rd generation cephalosporin
Antimicrobial therapy is not needed for:
Salmonella
What diarrheal disease can progress to HUS?
Shiga toxin-producing E.coli
What are the three symptoms of Hemolytic Uremic Syndrome?
- Hemolytic anemia
- Thrombocytopenia
- AKI
When does HUS present after the onset of the diarrheal illness?
5-10 d after
How do you treat Giardia?
Metronidazole, (5-7d) <1
Nitazoxanide (3d) 1-3
Tinidazole >3
What two races experience the highest amount of food intolerance to lactose?
Asians, Native americans
What is Toddler’s diarrhea?
Drinking too much juice - osmotic
Urinary symptoms and ___ symptoms always go together
POOPING ISSUES
What is Hirshsprung’s disease?
No ganglion cells in the distal rectum - cannot relax = functional obstruction
If a baby has Hirshsprungs, 50-90% will:
NOT HAVE passed a stool in the first 48 hours of life
When is Hishsprung’s diagnosed?
Later in life 5-6
You can see what type of emesis in Hirschsprung’s?
Bilious
What are two risk factors of Hirschsprung’s?
- Down’s
- FH
What is a complication of Hirschsprung’s?
Toxic megacolon - explosive bloody diarrhea, fever, vomiting
What are two other things on the DDX for constipation?
Hypothyroidism and Imperforate anus
What does not cause constipation?
Iron
How do you treat constipation in a child (3)?
- 1-2 ox of fruit juice
- Glycerin suppositories
- Polyethylene glycol (for 6 mon - 1 yr)
Functional abdominal pain is related to what?
Functional visceral hypersensitivity and anxiety
What is the dx criteria for Functional abdominal pain?
Chronic recurrent abdominal pain on 3 or more occasions in a 3 month period of time
Irritable Bowel syndrome is diagnosed with:
Abdominal pain + (2):
Improvement after BM, 4+ BM/day, 2/fewer a week, hard or loose, urgency, feeling of incomplete evacuation, mucus, bloating
What is functional dyspepsia?
Epigastric pain not relieved with a BM - can follow a viral illness
What is an abdominal migraine?
Paroxysmal episodes of peri-umbilical pain that lasts several hours with migraines, vomiting and pallor
What is treatment for an abdominal migraine?
Reassurance
When you are vomiting blood, where is it coming from?
Proximal to the ligament of Treitz
When you are pooping blood, where it is coming form?
Left colon - distal
When is Necrotizing Entercolitis seen and what is the risk highest in?
Seen in the first month of life - highest in premies and those with low birth weight
How do you diagnose Necrotizing Enterocolitis?
Abdominal x-ray - pneumatosis intestinalis (gas wall seen)
What is the treatment for those with Necrotizing Entercolitis?
Supporting, ABX and surgery
*Mortality is inversely related to weight and age
Most common cause of anorectal bleeding in kids:
Anal fissures
What is Meckel’s diverticulum?
Remnant of an embryonic vitellointestinal duct that should be gone by 5-6 weeks of gestation - ulcerates and bleeds
What are symptoms of Meckel’s diverticulum?
Painless rectal bleeding, recurrent intussusception, abdominal pain
*Incidental finding
Meckel’s is the disease of 2’s:
- 2%
- 2x common in males
- 2 ft from ileocecal valve
- 2 inches in length
- 2-4 % complications
- 2 yrs old at dx (or before)
What scan do you do for Meckel’s?
A Meckel’s scan with radiopaque dye
What are the three treatments for anal fissures?
- Fiber
- Sitz baths
- Lidocaine topical gel
What drug can turn your puke red?
Amoxicillin
What drug can turn your poop red?
Cefdinir - Omnicef
When are pinworms diagnosed?
5-10 years of age
Anal strep compared to pin worms visually:
Anal strep is very well defined margins
How do you treat pin worms (2)?
- Albendazole 400 mg
- Pyrantal pamoate
- Both are single dose treatments
What is the biological name for pinworms?
E. vermicularis
