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Phase 2 PEDs > GI disorders > Flashcards

GI disorders Flashcards

1
Q

TXT for thrush?

A

1L Nystatin - not systemic

2L Azole antifungals (Fluconazoles)

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2
Q

If infant is being treated for Thrush what other consideration is there for TXT?

A

Txt of Moms nipples/areolae
or
Boil bottle nipples 20m

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3
Q

GER is normal in what age ranges?

A

<8-12mo (Must stop 9-12mo)

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4
Q

Considerations if child has GER?

A

Adequate nutrition

No S/S of resp complication or esophagitis

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5
Q

When does GER become GERD?

A

FTT or poor growth
Esophagitis - Pain/IDA
Breathing difficulties (Apnea, Wheeze, cough, stridor)

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6
Q

Complications of GERD

A

Dyspepsia
Esophageal stricture
Asthma
Barretts esophagus

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7
Q

Gold standard for Dx GERD?

A

24hr esophageal pH probe

- admit (intranasal probe)

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8
Q

Other Dx tests for GERD?

A

GI - barium flouroscopy

Upper endoscopy

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9
Q

GI Barium flouroscopy rules out?

A

Anatomic causes:

  1. Outlet obstruct (strictures)
  2. Malrotation
  3. Hiatal Hernia
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10
Q

Best for evaluating GERD progression?

A

Upper endoscopy:

development of PUD, strictures

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11
Q

GER/GERD conservative TXT?

A

Lifestyle mod
Casein hydrolysate formula
Common sense -Older PEDs

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12
Q

GERD Rx TXT

A

H2 blockers - Ranitidine
Prokinetic - Metoclopromide
PPI

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13
Q

GERD surgical TXT

A

Fundoplication - Nissan operation

Jejunostomy - req feeding tubes

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14
Q

Esophagitis 3 common causes?

A

GERD
Candida
Rx/Caustic ingestion

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15
Q

Primary S/S of esophagitis?

A

Retrosternal/epigastic pain

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16
Q

Best method to Dx esophagitis?

A

Endoscopy

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17
Q

TXT of Esophagitis? (5)

A 
Fluids
Viscous lidocaine
PPI
Sucralfate
Metoclopramide
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18
Q

Different age Presentations of EOS esophagitis?

A

Young - Vomit, food/drink aversion, FTT
School aged - Vomit, vague abd pain
Adolescents - Dysphagia, food impactions

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19
Q

EOS esophagitis is Dx via?

A

Endoscopy + Bx
Barium Swallow
Allergy Patch testing or RAST (blood)

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20
Q

Txt EOS esophagitis?

A

High dose PPI

ID and eliminate antigen

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21
Q

Fx GI d/o of childhood?

A

Fx ABD pain (+ IBS)
Fx Diarrhea
Fx constipation

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22
Q

Peak incidence of Recurrent abd pain ?

A

7-12yo

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23
Q

Characteristics of Fx abd pain?

A

Almost daily pain (worse in AM)
Not ass/w meals or defecation
Ass/w Anxiety/perfectionism (school stress)
— Pvt school attendance at times

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24
Q

Fx ABD pain criteria?`

A

Once/wk for >2mo AND all -
Abd pain that is episodic or continous
Doesnt fit other GI criteria
No evidence of other processes.

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25
Q

A Subset of Fx Abd pain?

A

Irritable Bowel syndrome

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26
Q

Criteria for IBS?

A

Once/wk >2mo AND all -

  • Abd discomfort or Pain + at least 2
    1. Defecation helps, 2. change stool freq, 3. stool form
  • No evidence of other processes.
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27
Q

General characteristics of IBS?

A

Stool freq/consistency changes w/ pain onset
Stools change from diarrhea to constipation often
Defecation relieves pain

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28
Q

Common IBS lifestyle associations?

A

Anxiety, Peer relationships, Avoids school, 2ndy gains

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29
Q

Another name for Fx diarrhea?

A

Toddler’s diarrhea

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30
Q

Def of Fx diarrhea?

A

Freq watery stools in presence of normal growth and weight gain.

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31
Q

What are causes of Fx diarrhea?

A

Excess intake of sweetened liquids

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32
Q

Criteria of Fx diarrhea?

A

ALL

  • Daily painless >2 large unformed stools while awake
  • S/S lasts >4w
  • S/S onset 6-36mo age
  • No FTT
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33
Q

Fx d/o mgmt?

A

Normal activies right away (break cycle)
Fiber, probiotics, CBT, amitriptyline, SSRI
Good rapport w/ pt/family
Lifestyle mod (S/S diary, reassure, relax, diet)

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34
Q

Constipation is defined as?

A

<3 stools/wk OR or passage of hard pellet stools >2wks

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35
Q

Common ages constipation can occur?

A

6mo - Solid foods started
2-3yo - Fx constipation (toilet training)
4-5yo - School starts

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36
Q

Fx constipation is defined as?

A

Voluntary withholding stool (retentive posture)
<3 stools/wk
Large diameter painful stools
Encorpresis

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37
Q

Txt of Fx constipation?

A

Polyethylene glycol or milk of magnesia (stool soft)
Mineral oil
Sits on toilet 1st thing in AM and after meals

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38
Q

Gastro-colic reflex is?

A

Urge to defecate following a meal.

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39
Q

Encopresis is?

A

> 4yo regular passing of stool other than in a toilet.

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40
Q

What gender is encopresis more common in?

A

Males

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41
Q

Etiology of encopresis?

A 
Chronic constipation (MC cause)
Non-retentive soiling (Emotional/situational)
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42
Q

Encopresis work up is tailored how?

A

Similar to a constipation W/U

+- KUB (fecal mass size, placement, rectal dilation)

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43
Q

If Hirsachsprungs dz is suspected what are specific studies?

A

Anal manometry
Colonoscopy
Barium Enema

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44
Q

Mgmt of encopresis due to MC cause?

A 
--- Fx constipation
Education
Lfestyle mod (diary)
Diet changes (fluid/fiber, exercise, less cow milk)
Rx - Stool softeners
\+- disimpaction if needed 1st
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45
Q

Mgmt of encopresis due to other causes?

A

— Emotional/situational

CBT, diet, lifestyle

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46
Q

Celiac disease is defined as?

A

Allergy to Gluten ingestion leading to malnutrition

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47
Q

Celiac disease is AKA?

A

Sprue gluten-sensitive enteropathy

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48
Q

Celiac disease is ass/w what conditions?

A

DM1
Thyroiditis
Turner syndrome
Trisomy 21

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49
Q

S/S of celiac disease?

A 
Diarrhea +- constipation 
Abdominal bloating
FTT, Irritable
Decreased appetite, Ascites
Extra-intestinal manifestations (list if possible)
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50
Q

Ascites is a sign of what lab diagnostic?

A

Hypoproteinemia (ass/w celiac disease, etc)

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51
Q

Extra-intestinal manifestations of celiac disease?

A 
Osteoporosis
Pulm hemorrhage
Seizures or encephalopathy
Dermatitis
Herpetiformis
Erythema nodosum
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52
Q

Dx of celiac disease is made by?

A

(While eating gluten products)
Serum IgA anti-GLIADIN ABs
IgA tiss Transglutaminase AND anti-ENDOMYSIAL ABs
Endoscopic SML intestine Bx

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53
Q

Endoscopic SML intestine Bx can be used to determine what? How?

A

Celiac disease

    • Villous atrophy
    • Crypt hyperplasia
    • Mucosal inflammation
    • Increased intraepithelial lymph
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54
Q

TXT of celiac disease?

A

Lifelong gluten avoidance

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55
Q

What is ok to eat w/ celiac disease?

A

Oats, Rice, Tapioca, Corn, Buckwheat

ALL in small quantities

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56
Q

Allergic Colitis is AKA? defined as?

A

Milk protein allergy — Milk/soy protein induced colitis

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57
Q

When does allergic colitis typically resolve w/ PEDs?

A

6-18mo

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58
Q

Allergic collitis is MC w/ formula fed or breast fed?

A

Formula fed

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59
Q

S/S of allergic collitis?

A

+- Abd distention
Gas and Fussiness after feeds
Loose stools that are blood streaked

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60
Q

What is typically absent in allergic colitis?

A

N/V or ABD pain

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61
Q

Allergic colitis W/U?

A

CBC

EOS in feces and rectal mucosa via Bx

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62
Q

TXT of Allergic Colitis?

A

Diet modification

Casein hydrolysate

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63
Q

Acute gastroenteritis is def as?

A

Inflammation due to viral/bacterial/parasitic infection of the GI tract.

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64
Q

MC cause of diarrhea during winter months?

A

Rotavirus

65
Q

Predominate S/S timeframe of Rotavirus

A

3-4d - Vomiting

7-10d - Diarrhea

66
Q

Viral AGE ass/w ocean cruises?

A

Norovirus

67
Q

Norovirus viral species?

A

Calcivirus

68
Q

Norovirus vs Rotavirus - are they clinically different?

A

NO

69
Q

Organisms causing typhoid fever?

A

Salmonella typhi or paratyphi

70
Q

Clinical picture of typhoid fever?

A

Fever - HA
ABD pain worse over 48-72hr
Nausea - decreased appetitie
Constipation w/ inconsistent diarrhea

71
Q

UNtxt - typhoid fever can progress to?

A

Sig weight loss
Occ. Hematochezia or Melena
Bowel perf (rare in PEDs)

72
Q

UNtxt typhoid fever may last how long?

A

2-3wks

73
Q

A pt may be a chronic carrier of what AGE related organism?

A

Salmonella typhi or paratyphi

74
Q

Non-typhoidal salmonella is transmitted via?

A 
Infected animals (Chicken, reptiles, turtles)
Contaminated food - Diary, eggs, poultry
75
Q

Colony count req and Incubation period of Non-typhoidal salmonella?

A

1K-10 Billion - incubates 6-72hr (typically <24h)

76
Q

Dysentery is defined as?

A

Bloody/Mucous diarrhea w/ high fever (+- febrile seizures). Foul smelling. Bleed may be significant.

77
Q

Causes of dysentery?

A

Shigella Dysenteriae (shiga toxin)
Ambeic dysentery (E. Histolytica)
E. Coli 0157:H7
Severe C. Jejuni

78
Q

Colony count req and Incubation period of Shigella?

A

10-100 - incubates 1-7D

79
Q

Enterotoxin producing organisms?

A

V. Cholerae

ETEC (E.Coli)

80
Q

V. Cholerae and ETEC (E.Coli) will produce what s/s?

A

No/Low fever

4-5 loose watery stools (involving ileum) for 3-4d

81
Q

Inflammation GI tract location of
Dysentery vs
Enterotoxigenic Dz vs
C. Jejuni?

A

Dysentery - Colon or rectum
Enterotoxigenic - Ileum
C. Jejuni - Jejunum, ileum, colon

82
Q

C. Jejuni is transmitted via?

A 
Person to person (A2M)
Contaminated food (Raw milk/cheese - poultry)
83
Q

C. Jejuni Mgmt?

A

SL unless complicated > ABX

84
Q

C. Jejuni concerning complications?

A

High fever, septicemia
Grossly bloody diarrhea
>1wk S/S

85
Q

Y. Enterocolitica transmitted via?

A

Pets

Contaminated foods

86
Q

Y. Enterocolitica infantile/toddler presentation?

A

Diarrhea illness

87
Q

Y. Enterocolitica older children presentation?

A

Terminal ileum lesions or LAD of mesenteric

mimic appendicitis or Crohns

88
Q

What are post infectious manifestations of Y. Enterocolitica?

A

Arthritis
Rash
Spondylopathy

89
Q

TXT of Y. Enterocolitica?

A

Supportive only (Ciprofloxacin if invades out of GI)

90
Q

Clostridium Difficile is AKA?

A

Pseudomembranous colitis

91
Q

C. Diff is typically transmitted via?

A

P2P contact (admit - pt to pt)

92
Q

How does C. diff develop?

A

ABX use disrupts NL flora of bowel

93
Q

C. Diff MGMT?

A

DC ABX

Metronidazole or Vancomycin

94
Q

E. Histolytica AGE infection occurs in what geograph?

A

Warmer climates

95
Q

G. Lamblia AGE is ass/w what demograph?

A

Day care centers

96
Q

AGE G. Lamblia is transmitted via?

A

P2P
Contaminated food
Freshwater/well water (infected feces (cysts)

97
Q

S/S of AGE G. Lamblia?

A

Insidious onset

  • Nausea, Gassy, abd distention
  • Anorexia / wgt loss
  • watery diarrhea
  • 2ndy lactose intolerance
98
Q

AGE G. Lamblia is a gradual or sudden onset?

A

Gradual (insidious onset)

99
Q

AGE Cryptosporidium parvum presentation in Immuno-compentent individual?

A

Mild, watery diarrhea

100
Q

AGE Cryptosporidium parvum presentation in Immuno-suprressed individual?

A

MC AIDS pt - Severe - prolonged diarrhea

101
Q

Principles of AGE TXT?

A 
Correct dehydration/lytes - Most important
Supportive 
\+- ABX
\+- Anti-diarrheal agents 
\+- Anti-emetic agents (Zofran)
102
Q

Complications of anti-diarrheal agents for TXT of AGE?

A

Worsens infectious/inflammatory process causing toxic megacolon.

103
Q

ABX are always recommended for what organisms of AGE?

A 
S. Typhi
Sepsis
Infants <3mo w/ nontyphoidal salmonella
C. Difficile
Shigella outbreaks
104
Q

Shigella ABX TXT?

A

Cephalosporin or Ciprofloxacin

105
Q

Salmonella ABX TXT? And immuno-compromised?

A

Ciprofloxacin

— X-imm = Ampicillin

106
Q

E.Coli ABX TXT?

A

Ciprofloxacin, Azithromycin, TMP/SMZ

NOT FOR O157:H7

107
Q

Why do we not TXT E.Coli O157:H7?

A

Toxin producing bacteria will lyse from ABX

108
Q

C. Diff ABX TXT?

A

Metronidazole

109
Q

Giardia ABX TXT?

A

Metronidazole,

— Albendazole, Furazolidone, or Quinacrine

110
Q

INITIAL IV Rehydration - for AGE TXT dosing?

A

Bolus - 20mL/kg isotonic (NS/LR) over 20m
(10mL/kg if neonate)
MAX 3 boluses before admission

111
Q

MAINTENANCE IV Rehydration - for AGE TXT dosing?

A 
4mL/kg/hr - 1st 10kg wgt
-
2mL/kg/hr - 2ND 10kg wgt
-
1mL/kg/hr - each 1 kg wgt (after 20kg)
HOURLY > DAILY then 
HALF over 1st 8hrs > HALF over next 16hrs
112
Q

MC DM in child hood?

A

DM1

113
Q

DM1 pathophys?

A

Autoimmune of pancreatic beta-cells = permanent insulin deficiency

114
Q

DM2 pathophys?

A

Insulin resistance +- insulin deficiency (exogenous obesity)

115
Q

DM Dx criteria requirment?

A 
2 seperate tests of 
>126 FG
>200 Random glu
>200 OGTT w/ 2hr post feed or 75g Glucose load.
>6.5 Hgb A1c
116
Q

Pre-DM lab values?

A

100-125 FG
140-199 OGTT
Hgb A1c 5.7-6.4%

117
Q

3 P’s of DM

A

Polydipsia
Polyphagia
Polyuria

118
Q

S/S of DM?

A

3 P’s

  • Enuresis
  • Fatigue/weak/wgt loss
  • Blurry vision
  • Yeast infections
119
Q

Glucosuria will appear on UA if?

A

Glucose is above renal threshold >160-190

120
Q

Define Honeymoon period in terms of DM?

A

3-6mo no more than 2yrs where Beta-cells not completely destroyed yet.

121
Q

Insulin requirements of DM pt?

A

0.4-0.6 U/kg/d - honeymoon
0.5-1 U/kg/d - prepubertal w/ DM >1-2yrs
1-2 U/kg/d - Middle adolescence (growth hormone)

122
Q

When to check insulin regimen intervals?

A

Before meals, bedtime, 2-3am

123
Q

A1C goals of PEDs?

A

<6yo - 7.5-8.5%
6-13yo - <8%
13-18yo - <7.5%

124
Q

Blood glucose goals of PEDs?

A

<5yo - 80-180
School aged - 80 - 150
Adolescents - 70 - 130

125
Q

Complications of DM1?

A

Hypoglycemia
Hyperglycemia
DKA

126
Q

S/S of DM hypoglycemia?

A

HA, vision changes, confusion, seizures (Neuro)

Tremors, Tachy-C, Sweating, Anxiety (Catecholamines)

127
Q

TXT of hypoglycemia?

A

If mild - Sugar intake
Severe (seizures/LOC) - Glucagon
If admitted - IV GLU

128
Q

Concepts/complications ass/w or causing hyperglycemia?

A 
Dawn phenomenon (Common)
Somogyi phenomenon (rare)
129
Q

Dawn phenomenon is?

A
  1. Physiologic Growth hormone release all night

2. Early AM HYPERglycemia persisting to morning

130
Q

Somogyi phenomenon is?

A
  1. Too large of a nightime insulin dose
  2. Early AM HYPOglycemia
  3. Rebound hyperglycemia by morning
131
Q

TXT of Dawn phenomenon?

A

Increase evening insulin dose

132
Q

TXT of Somogyi phenomenon?

A

Decrease evening insulin dose

133
Q

When would DKA occur?

A

DM1 is not dectected/Dx
Poor compliance
Extra stress

134
Q

DKA pathophys?

A
  • (1. Not enough insulin)
    2. Hepatic oxidaiton of fatty acids to Ketones
    3. Metabolic acidosis
135
Q

What does DKA do to anion gap?

A

Elevates it

136
Q

Most common complication of DM1

A

Hypoglycemia

137
Q

DM polyuria is due to?

A

Hyperglycemia causing osmotic diuresis

138
Q

DM polydipsia is due to?

A

Osmotic diuresis of polyuria causes dehydration

139
Q

DM N/V is due to?

A

Metabolic acidosis

140
Q

Breathing pattern related to DKA?

A

Kussmaul respirations (metabolic acidosis)

141
Q

DM causing electrolytes to?

A

*Intra-RBC k+ is depleted

PO4 and NA+ is depleted as well

142
Q

What causes fruity breath odor of DKA?

A

Acetone

143
Q

Expected labs of DKA?

GLU - ABG pH - Bicarb

A

GLU - (200 to >1000)
ABG pH - <7.3
Bicarb - <15

144
Q

DKA TXT?

A

Fluid/lyte replacement
Insulin - correct acidosis/hyperglycemia
(Never rapidly shift osmo/fluids)

145
Q

Most serious complication of DKA is?

A

Cerebral edema

146
Q

Pathophys of cerebral edema in context of DKA?

A

Rapid reduction of hyperglycemia due to insulin admin

147
Q

What electrolyte should be measured often and fixed in DKA?

A

K+ (DECREASED)

148
Q

TXT of cerebral edema?

A

IV mannitol, intubation/vent

149
Q

Other Chronic complications of DM1?

A 
Retinopathy - annual exam 
Nephropathy - annual UA for MICRO-Alb
Coronary Dz - Annual Lipids/BP
Addisons Dz/Thyroiditis - annual TFTs
PUD
Neuropathy
Celiac Dz
150
Q

What Rx can slow/stop microalbuminuria?

A

ACEI

151
Q

MC form of DM2?

A

Peripheral insulin resistance >
Hyperinsulinemia >
Pancreatic failure of insulin secretion

152
Q

Biggest difference of DM1 vs DM2 when considering labs?

A

No auto-antibodies

153
Q

Skin condition ass/w DM2?

A

Acanthosis nigricans

154
Q

DM2 TXT?

A

Lifestyle mod
1L Rx - Metofrmin
Insulin therapy

155
Q

What does MODY stand for?

A

Maturity onset DM of youth.

156
Q

What is MODY?

A

Inherited forms of mild DM w/out insulin resistance

157
Q

Primary ABNL finding of MODY?

A

Insufficent insulin for glycemic stimulation

158
Q

TXT of MODY?

A

+- Sulfonylureas

Phase 2 PEDs (23 decks)

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