GI and Nutrition Flashcards
GERD
Is only significant when children have failure to thrive, positioning, sandifer syndrome (torticollis and arching related), etc.
50% resolved by 6 months of age, 95% by 12 months of age and 98% resolved by 15 months of age.
Do not treat with cisapride as it causes long QT
Diagnosis: used to be pH probe, now that is no longer necessary
Treatment: Do not smoke around the child, thickened feeds, upright after feeds for 30 minutes,
decreased abdominal pressure during feeds (do not feed in a bumbo chair).
5th day of life Billirubin Thresholds
High Risk: 260; Medium Risk: 300; Low Risk 350
Meckel’s Rule of 2’s
This is a remnant of the omphalomesenteric dcut (mid gut to the yolk sac). Blood is from Vitilline artery. It is made up of gastric mucosa.
Rule of 2's 2% of the population Occurs most commonly before the age of 2 2:1 male to female ratio 2 ft from the ileocecal valve
Presents as painless GI bleeding, recurrent intussusseption, appy presentation with out an inflamed appendix.
Hirschprung Disease
5 Associations
Characteristic Exam
Smith Lemli Opitz Down Syndrome Golderberg Cartilage Hair Hypoplasia Congenital Hypoventilation
Exam: Tight rectum on exam, with empty rectum. An abrupt narrowing at the transition zone is noticed on barium enema.
Diagnosis is made with a rectal biopsy.
Normal Newborn Growth
0-3 months: 30 g/day except for sunday
3-6 months: 15-20 g/day
6-12 months: 10-15 g/day
Double your birth weight by 6 months; triple by a year
Head circumferences
3 months 40; 9 months 45
3 years: 50; 9 years 55 cm
Height: 1/2 final adult height at 2 years of age
Should grow about 5 cm/year until puberty (<4 cm/year is pathological)
Contraindications to Breastfeeding
HIV
TB (not treated yet for 2 weeks)
HTLV
Bilateral Mastitis with pus
Substance Abuse
Chloroquine if baby is G6Pd
High dose metronidazole
Radiation Treatment
Chemotherapy treatment
Galactosemia (give soy) , Urea Cycle Defect and PKU
Chron’s
Diagnosis: Endoscopy, ruling out other infections, Fecal calprotectin, MRI imaging.
The amount of arthritis that is present, positively correlates with the extent of the disease.
Characteristics:
Erythema Nodosum
Growth failure and abdominal pain
Gum to bum; migratory non deforming arthritis; bloody diarrhea
ASCA antibody
Transmural, terminal ileum (B12 and bile acid problems); skip lesions
It is more common to have systemic symptoms
Treatment:
Active Disease: 5-ASA
Moderate to severe: Addition of steroids
Immunomodulators: 6MP, Azathioprine and Infliximab (remicade)
Colitis
Diagnosis: Colonoscopy
Clinical characteristic:
Pyoderma gangrenosusm
Toxic Megacolon and sclerosing cholangitis
Crypt Abscesses
P ANCA +
Nocturnal bowel movements and pain; Mucous and pus present
IPEX
Immune dysfunction
Polyendocrinopathy
Enteropathy
X Linked
Intestinal Absorption of Nutrients Dudoenum and Jejunum Proximal Small Bowel Mid Small Bowel Distal Ileum
Calcium, Mag and Phos; Iron, Folic Acid
Proximal: Protein, CHO , Water soluble vitamins
Middle: Medium Chain Triglycerides and Micelles
Ileum: B12 and Bile salts
Pearson Syndrome
Very similar to Schwacman diamond but instead of neutropenia there is macrocytic anemia
Thrombocytopenia
Pancreatic Insufficiency
Vitamin Deficiencies
Fat Soluble Vitamins: A, D, E and K
Vitamin A: Night time blindness, Bitot spots on the eyes, hyperkeratosis and plaques
Vitamin D: Rickets (callous formation at the wrists, widening of joints, Cupping/splaying/fraying; Ricketic rosary, craniotabes
Vitamin E: Hemolytic Anemia, Ataxia, thrombocytopenia and edema. No upward gaze in older children. premature infants are most significantly at risk for this.
Vitamin K: Bleeding.
Vitamin Deficiencies
Water Soluble Vitamins
B1 Thiamine: Wernicke’s encephalopathy and Beri Beri; peripheral neuropathy, hoarse voice
B2 Riboflavin: cheliosis, gloissitis, normocytic anemia
B3 Niacin: Pellegra: Dermaitis, Diarrhea and Dementia
B6 Pyrodoxine: Seizures, vomiting, FTT, many medications can affect B6
B12: Will be a late manifestation but there is peripheral neuropathy and ataxia.
Vitamin C: Scurvy: Collagen synthesis affected - Gum changes, leg swelling, pseudoparalysis
Menkes vs. Wilson Diseae
Menkes: AR. Copper Absoprtion problem. Kinky hair
Wilson’s Disease: Kaiser Flysher rings in the eyes, cirrohsis, Copper deposits because it is not metabolized properly.
Zinc
Acrodermatitis Enteropathica
Skin manifestations on the perianal area and the face
Treatment of GERD in adolescents
Do not eat 3-4 hours before bed; no late meals No caffeine No smoking Weight Loss No carbonated beverages smaller volume meals
Indications for Fundoplication
Apnea’s associated with GERD
All medications have been tried and failed
Recurrent aspirations
TPN Risk factors for Cholestasis
Not a long enough cycle time
Prematurity
Intercurrent infection (NEC)
Low birth weight
5 Features of Portal Hypertension
Splenomegally
Liver Failure - caput medusa, jaundice
Esophageal varices - Upper GI bleed
Ascites
5 Causes of Villous Atrophy
Carbohydrate Intolerance Allergy Crohn's Celiac Post infectious Congenital Abscence
Celiac Diease Typical Presentation and Atypical
Recurrent Diarrhea, abdominal distension, failure to thrive, vomiting and irritability
Atypical: Dermatitis herpetiforms, arthritis, dental erosion and short stature.
Differential Diagnosis for Protein Losing Enteropathy
GI: Crohns, Celiac, Allergic enteropathy, post infectious enteropathy
Lymphatic: Lymphangectasia, post fontan (due to increased pressures)
Causes of Rectal Prolapse
CF, Constipation, Marfans and Ehlers Danlos, Celiac and Myelomeningocele.
