GI Cases in pediatrics (Dow) Flashcards
Na <130
hyponatremic
Na 130-150
isonatremic
what are the 5 approaches to fluid replacement in dehydration
- Restore intravascular volume for hemodynamic stability: the boluses!
- Calculate 24 hr water requirements
Maintenance – given at constant rate over 24 hrs
Deficit – divided so that ½ is given over first 8 hrs, then ½ over the next 16 hrs. - Calculate 24 hr electrolyte requirements
Maintenance Na+ and K+
Deficit Na+ and K+ (especially important in hypo/hypernatremic dehydration)*** - Select appropriate fluids
- Replace ongoing losses
what are the steps in restoring intravascular volume
Preservation of cardiovascular function
Perfusion of brain and kidneys
This is usually for hemodynamically unstable patients - severe dehydration**
Bolus therapy
Rapid infusion of relatively isotonic fluid
20 ml/kg (consider 10 ml/kg for cardiac pts)
Normal saline or Lactated ringers
Reassess after initial bolus if still compromised CV function then repeat till function restored.
Example: 12 kg child needs:
Holliday segar method
24 hr calculation: (10 X 100) + (2 X 50) = 1000 + 100 = 1100 ml/day (which is about 49 ml/hr)
know that chart***
what is the fluid deficit calculation
Fluid deficit (ml) = %dehydration of pre-illness wt.(kg) X 1000 ml/kg
Example: infant with weak pulses, tenting of skin, irritability, etc, would be estimated at 10% dehydration, so:
10% of 12 kg child = 1.2 kg
then 1.2 kg X 1000 ml/kg = 1200 ml fluid deficit
when you have a newborn throwing up bilious emesis what should you think of
obstruction
DDx: Intestinal atresia Duodenal Ileal Jejunal Hirschsprung disease Intestinal duplication Intestinal malrotation with midgut volvulus Meconium plug Ileus Necrotizing other Organomegaly causing obstruction Annular pancreas Peritonitis Viscous perforation
what orders do you place if you are concerned about obstructive cause
Place NG tube with suction*** NPO*** (nothing orally) Begin IVF*** (IV fluids) Labs CBC with diff BMP with liver panel Abd x-ray If negative consider contrast studies or U/S Surgical consult Neonatology consult
what is the double bubble sign
obstruction b/c of duodenal atresia
With intervention, this child will survive
Without intervention, this is 100% fatal
what is duodenal atresia
what conditions is it associated with
Congenital obstruction of 2nd portion duodenum
Failure of recanalization of bowel segment
Recanalization occurs during the 4th - 5th week of gestation
Usually occurs below the ampulla of Vater
It accounts for about 1/3 of all atresias
Occurrence
M>F
1:5,000-10,000
Associations
Polyhydramnios
Down syndrome 25% of patients
CHD in 20%
what is more common bacterial or viral gastroenteritis
viral- most common
- rotavirus
- caliciviruses
- astroviruses
noroviruses
what are the signs of viral gastroenteritis
Low-grade fevers
Vomiting followed by copious watery diarrhea **(up to 10-20 per day)
Persists for 3-8 days
what are the signs of bacterial gastroenteritis
High fevers Shaking chills Bloody bowel movements Abdominal cramping Fecal leukocytes
what is the most common esophageal disorder in children of all ages
GERD
Reflux episodes occur most often during transient relaxations of the lower esophageal sphincter (LES) unaccompanied by swallowing, which permit gastric contents to flow into the esophagus
what are symptoms that may be associated with GERD
Recurrent regurgitation with/without vomiting*** Weight loss or poor weight gain Irritability in infants Ruminative behavior Heartburn or chest pain Hematemesis Dysphagia, odynophagia Wheezing Stridor Cough*** Hoarseness
