GI/GU Flashcards
Anything that effects physical mobility will also affect GI motility. True or False?
True.
Generally speaking, which area of the abdominal assessment is LEAST likely to be serious
Peri-umbilical pain
Which growth parameter is least affected by acute GI disturbance?
Height. (weight will fluctuate more acutely)
Bilious emesis in the infant is a _______ issue until proven otherwise
Malrotation (Volvulus)
Rovsing’s sign is:
A sign of peritoneal irritation (including appy). Palpation of the LEFT illiac fossa produces pain in the RIGHT illiac fossa
Obturator sign is:
A sign of peritoneal irritation. A supine patient flexes the right leg 45 degrees and internally rotates the hip. If abdominal pain occurs, it is a positive obturator sign.
Psoas sign is:
A sign of peritoneal irritation. A patient lays on their left side and extends and flexes the right leg at the hip. If abdominal pain occurs, a positive Psoas sign is present.
Emergent situations that requires immediate abdominal surgery include:
Vascular compromise (volvulus, incarcerated hernia, non-reducable intussusception, ischemic bowel, torsion) Perforation Uncontrolled intra-abdominal bleeding
Emergent situations which require abdominal surgery ASAP include:
Intestinal obstruction, Non-perforated appy, Refractory Irritable Bowel Disease, Tumors
Typhlitis is a diagnosis best made by:
CT exam
Typhlitis is:
Neutropenic enterocolitis is a life-threatening, necrotizing enterocolitis occurring primarily in neutropenic patients. It usually involves the cecum.
In the menstruating female with abdominal pain, a DDx should include: (9)
Pregnancy, Mittleschmerz, PID, Ovarian cyst, Ovarian torsion, Endometriosis, Ectopic pregnancy, UTI, pylonephritis.
Define Mittleschmerz disorder:
Mittelschmerz is unilateral, lower abdominal pain that occurs at or around the time an egg is released from the ovaries.
Regurgitation is a
Passive reflux of gastric contents into the oropharynx.
Projectile vomiting often arises from a _____ origin
CNS
DDx for vomiting in infant:
Gastroenteritis, GERD, Overfeeding, Anatomic obstruction (pyloric stenosis, volvulus, etc.), Pertussis syndrome, OM, Viral, bacterial infection
DDx for vomiting in child/adolescent:
Gastroenteritis, GERD, Gastritis, infection, Toxic ingestion, Appy, OM, Sinusitis, SBO, viral, bacterial infection, pregnancy.
Cyclic Vomiting Syndrome is often associated with____.
Abdominal migraines
Eosinophilic Esophagitis is:
An isolated inflammation of the esophagus by eosinophil related to food ingestion.
Peptic Ulcer Disease (PUD) is the result of an imbalance between what two factors?
Protective factors and Aggressive factors.
(mucous lining/acid-pepsin environment, H. Pylori
What is the “rule of 3’s” with reference to infantile colic?
crying for 3 hours a day, 3 times a week, for 3 weeks.
Clinical findings consistent with infantile colic are
Positive rule of 3’s
Excessive gas
Inconsolable
Demand for frequent feeding & fussy feeding
Button battery ingestion requires____.
emergent endoscopic retrieval.
The Classic triad of Intussusception is:
Intermittent colicky pain, Vomiting, Bloody mucoidal stool
Intussusception usually occurs at the _____ junction/valve.
ileocecal junction/valve
Celiac Disease is a _____ mediated syndrome triggered by three items.
Celiac disease is IMMUNE-mediated response triggered by gluten, barley and/or rye.
Cow’s Milk Protein Intolerance (CMPI) and Cow’s milk allergy is an _____ mediated syndrome
Antigen-mediated (Check serum IgE)
Functional Abdominal Pain is:
A term used in gastroenterology if no specific structural infectious, inflammatory or biochemical cause.
Pathogenesis of functional bowel disease involves three traditional concepts:
Mobility, Sensory, psychological.
Constipation is best treated by:
Dietary changes including increased fluids and fiber-rich foods. Increased exercise.
Encopresis types are (3):
Primary: never had bowel control
Secondary: Had bowel control, now does not
Subtypes: With constipation or use of laxatives, strange bathroom, lack of routine, etc.
3 basic causes of Failure To Thrive (FTT)
Inadequate caloric intake
Inadequate caloric absorption
Excessive caloric expenditure
Crohn’s disease is a:
Crohn’s disease is a chronic disease with dysregulated inflammation and cytokine production in the intestinal tract.
Crohn’s disease vs ulcerative colitis
Crohn’s disease is segmental and can involve any portion or portions of the GI tract, but is most prominent in the terminal ileum and colon.
Ulcerative colitis is diffuse inflammation of the mucoid layer of the colon and rectum
According to the standard or care, at what age to we begin screening for HTN?
3 years of age. (to help prevent kidney damage)
T or F? Preventative screening for asymptomatic bacteremia/CKD is recommended at any age
FALSE. There is no age specific age identified.
Deformities of the ear can be a predictive marker for kidney issues. T or F.
True. The inner and outer ear structures are formed inutero during the same gestational period.
The diagnostic study considered “Gold Standard” for UTI is
Urine Culture
What are the 3 types of UTI in pediatrics?
- Asymptomatic bacteriurea
- Cystitis
- Pylonephritis.
Any child between 3-6 months with urinary tract infections should be considered
A complicated UTI until proven otherwise
The most common organism responsible for UTI and Pylo is
E. Coli
What findings in a UA will raise or lower your suspicion of a UTI ? (9)
Foul odor, Cloudiness, Nitrates, Leukocytes, Alkaline pH, Proteinuria, Hematuria, Pyuria, Bacteriuria
What diagnostic serum studies should you consider for an ill appearing child with suspected UTI? (fever)
CBC, ESR, CRP, BUN, Creatinine, Serum Calcitonin marker, Blood cultures
DDx for pediatric UTI: (9)
Urethritis, vaginitis, viral cystitis, foreign body, sexual abuse, dysfunctional voiding, Appy, pelvic abscess, PID
T or F. Asymptomatic bacteriuria should be treated with antibiotics.
False. Asymptomatic bacteriurea should not be treated with Abx unless there are many leukocytes in the UA.
Vesicourethral refux (VUR) is
A congenital disorder that causes regurg from the bladder to the kidneys. (Grade I-V)
VUR grade II will require surgical repair (T or F)
FALSE. Most Grade I and II VUR will resolve as the child grows.
VUR grade IV and V occurs when
There is distention of the ureters/renal pelvis, hydronephrosis and reflux into the intra-renal collecting system. This requires specialty eval and surgical repair.
Nephrotic syndrome can be defined as
Excessive excretion of protein in urine from increased Glomerular filtration permeability. (Usually 3-4+) It can be either selective (Albumin only) or non-selective (most surum proteins)
Most Neprotic syndrome is caused by
90% is idiopathic.
The cardinal feature of nephrotic syndrome is
Edema and periorbital swelling
Name the four groups of Proteinurea:
- Isolated - (orthostatic, persistant-asymptomatic)
- Transient or Functional - (Exercised or fever-induced)
- Glomerular -
- Tubulointerstitial -
Pseudoproteinurea can be caused by: (2)
- semi-synthetic penicillans
2. anti-inflammatory agents
95% of children with minimal change nephrotic syndrome (MCNS) will have remission with what treatment?
Steroids
Describe: Post-Streptococcal Glomerulonephritis (PSGN)
The most common form of nephritis in children between 5-12 years old. Occurs 2-3 weeks after strep infection. Abrupt onset gross hematuria. Decreased UO. 95% of cases are self limiting within 6-12 months.
Describe: The management of Post-Streptococcal Glomerulonephritis (PSGN)
Mostly supportive. Monitor for transient HTN, salt and fluid intake, fever.
Give antibiotics if culture +.
Define: Renal Tubular Acidosis (RTA)
Dysfunction of the renal tubule transport capability and usually results in low serum CO2 (<16) there are several types.
Define: Type I Renal Tubular Acidosis (RTA)
A defect in the DISTAL tubule
Result in: Hypokalemia, Hypercholemia, CO2 <16 and Urine pH of >5.5
Define: Type II Renal Tubule Acidosis (RTA)
Also known as “pRTA” (for proximal) or “bicarb wasting RTS”
Results in: Hypokalemia, Hypercholemia, CO2 <16, and Urine pH <5.5
Define: Type III Renal Tubule Acidosis (RTA)
Same as type I RTS, but is seen in in premature infants
Define: Type IV Renal Tubule Acidosis (RTA)
Also known as “Hyperkalemic RTA”
Results in Hyperkalemia, Hypercholemia, CO2 <16 usually as a result of aldosterone functioning most commonly following relief of obstructive uropathy
Define: Fanconi Syndrome (hint: RTA)
Fanconi syndrome is a form of renal tubular acidosis that is uncommon and a more complex form of Type II RTS
Complications of Nephritis and/or Glomerulonephritis include: (5)
Prolonged Oliguria Renal failure hypertensive encephalopathy CHF Irreversible renal parenchyma damage
the prognosis for IgA nephropathy is (good or poor)
There is a POOR prognosis for IgA nephropathy
Management of RTA (Renal Tubule Acidosis) include:
Correction of Acidosis, Maintain Bicarb, Oral alkalizing agents, maximizing caloric intake and meticulous F/U.
A child with nephrolithiasis and/or Urolithiasis should be referred to urology for follow up. (T/F)
True. Kiddos shouldn’t have kidney stones. If they do there could be structural anomalies.
The most common Pediatric GU-tract malignancy is a ____
Wilms Tumor
Wilms tumor has five grades. Grade 5 is bilateral involvement. At what age do most Wilms tumors occur in kids?
most Wilms Tumors occur between the ages of 2-5 years.
Clinical findings of a Wilms tumor include:
Firm, smooth abdominal or flank mass that does not cross midline. Left varicocele if spermatic vein is obstructed. Some congenital abnormalities such as: Ambiguous genitalia.
In a male patient, if the urethral meatus appears on the ventral surface of the penis it is called:
Hydrospadia
Do not allow circumcision…refer to pedi urology
If the penis bows ventrally (points to the toes) it is called:
Chordee
Rotation of the penis in either direction is referred to as:
Torsion
Epispadias
When the urinary meatus presents on the superior aspect of the penis.
Undescended testicles of any kind are called
Cryptorchidism
Majority will descend by 3 months
Hydrocele
Painless, scrotal swelling with serous fluid
Two types of Hydrocele
Communicating and Non-communicating
Define: Spermatocele
Benign, painless mass on epididymis or testicular adenexa which presents in older adolescent males.
Define: Varicocele
Benign enlargement of testicular veins. (Feels like a bag of worms). Pain gets worse with prolonged standing.
Complications of a hernia
Incarceration or Strangulation
Testicular masses:
Most often a malignancy can occur at any age.
Immediate referral is recommended.
Define: Balanitis and Balanoposthitis
Balanitis: Inflammation of the glans
Balanoposthitis: Inflammation of the foreskin and glans
DDx for Epididymitis
Testicular torsion, hernia, hydrocele, varicocele, STI,
