GI Emergencies Ch. 18 Flashcards
Factors that contribute to reflux in peds
- shorter esophagus
- stomach is more horizontal
- sphincter is underdeveloped
Describe gastric motility in the ped
it is irregular due to immature nervous system development
What risk do flexible ribs pose?
Increase injury to underlying organs like liver an spleen
The abdominal wall in a toddler
- has less musculature that provides less protection to underlying organs
- Incomplete intestinal attachment increases injuries from deceleration, shearing, and compression
Most common type of pathogen causes NVD
viral
Tongue finding for DHN Scale
0- moist
1- sticky
2- dry
Clinical DHN scale
scored 0-8 with 0 being no DHN and progressing to
1-4 moderate and 5-8 moderate to severe
General appearance for DHN
0- normal
1-thirsty, restless, irritable, sleepy
2- drowsy, limp, cold, coma
Eyes for DHN scaale
0- normal
1-slighty sunken
2- deeply sunken
Tears for DHN scale
0- present
1- decreased
2- absent
Factors measured for clinical DHN scale
general appearance, eyes, tongue and tears
Rate for oral DHN
2-5ml every 2-5 min.
What is the leading emergent surgical issue in children
appendicitis
At what age does appendicitis most commonly occur?
the second decade of life, between 10-20
Rosvings sign
LLQ palpation causes RLQ pain 2* to stretching perotoneal fibers
Psoas sign
lifting right leg and flexing thigh against resistance elicits pain
Causes of cholecystitis on kids (6)
- obesity
- sickle cell
- infection
- hemolytic anemia
- cysytic fibrosis
- diabetes
CHoley S/SX
- pain onset after ingestion of a fatty meal
- RUQ pain
- Murphys sign pain to R subcostal region on inspiration
Pancreatitis causes
- injury
- infection
- drugs toxins
- systemic disease
Pancreatitis S/Sx
- pain mid epigastric
- distention
- pain radiating to the back
- vomiting
Another name for Hirshprungs diesease
A ganglionic megacolon
Hirshsprungs S/Sx (7)
- no meconium passed in 1st 2 days
- distention
- feeding intolerance
- bilious emesis
- chronic constipation
- empty rectum
- tight internal sphincter
Pyloric stenosis S/Sx and age of occurrence
- occurs more in males and 1st born
- presents around 2-6 weeks
- non-blious vomiting that becomes PROJECTILE
- Olive shaped mass in RUQ
Intucessception S/SX
- venoous and lymphatic obstruction
- bowel obstruction
- bowel ischemia and necrosis
- occurs b/t 5-12 mo
Intucessception S/SX
- venoous and lymphatic obstruction
- bowel obstruction
- bowel ischemia and necrosis
- occurs b/t 5-12 mo
- SUDDEN colicky pain
- Sausage shaped masss
- CURRANT JELLY stool
Other concurrent medical problems seen with Intucesseption (4)
- cystic fibrosis
- lymphoma
- meckels divertiuculum
- Henoch-Scheindlin Purpura
Intucessception treatment
- air or contrast enema
2. surgery
Volvus/Malrotation ages affected
- usually occurs before 5 years old
- 50% by age 1
- causes ischemia and necrosis
Bilious emesis sign
” is critical in any child and warrants rapid evaluation to rule out obstruction”
What is Meckels diverticulum
“when the vitalline duct in the distal ileum fails to close” during embryo development. Causes an outpouching of the small intestine,
Meckels diverticulum S/SX (3)
- bleeding, painless, rectal
- bowel obstruction
- perforation
Congenital Diaphragmatic hernia
- abdominal contents end up in the chest cavity
- causes pulmonary hypoplasia and hypertension
- S/SX- scaphiod (concave) abdomen
- requires surgery
How soon should a FB battery be removed from esophagus
2 hours
Esopgageal atresia
when esophagus does not connect with stomach
Tracheoesophageal fistula
traches connects to stomach via an abnormal route or fistula
How soon should feeding tubes be replaced if dislodged
4-6 hours
Leading cause of death in children over 1 yr
abdominal trauma (p. 205, pp. 2)
Injuries that lap belts can cause
- small bowel rupture
2. Chance FX, (flexion injury of spine)
Facts about Liver injuries
- most commonly injured organ
2. Right shoulder pain (Kehrs sign)
Spleen injuries sign
- left shoulder pain
Pancreatic injury signs (3)
LUQ pain
Grey- Turners sign- bruising to flank
Cullens sign - umbilical bruising
Hollow viscus injuries
- may be hard to diagnose on imaging, may require serial images and evalution.
- Include; “hematomas, perforations, contusions, transections, tears, and avulsions from the mesentary”
Abdominal compartment syndrome (ACS), cause of
sustained abdominal hypertension
Outcomes of ACS
organ failure
Two types of Abdominal Compartment Syndrome
primary or secondary issues that result in increased fluid in the abdominal cavity
Causes of Primary ACS (6)
- bowel obstruction or lileus
2. infection- abcess, perforation, pancreatitis
Causes of Secondary ACS (4)
- sepsis
2, burns - trauma
- fluid rescecitation
indirect causes
Signs of ACS (4)
- difficulty bagging
- abdominal distenstion
- decreased UO
- pressure measurement via manometry of urinary catheter
Treatment for ACS
ex lap to decompress abdomen
What percent of children are overweight or obese?
1/3 (p,207, pp.5)
What is the mortality rate for pedi ACS?
25-85%
Most common causes of Hollow organ injury? (4)
seatbelts, bicycle handlebars, falls, recreational sports
What percentage of children are overweight or obese?
1/3 or 33%
At what ages does intussusception tend to occur?
5-12 mos.
