GI in Peds Lecture Powerpoint Flashcards
Encopresis
soiling of underwear with stool by children who are past the age of toilet training
Omphalocele***
Intestinal content herniation thru umbilical and supraumbilical portions of the abdominal wall IN A SAC* covered by peritoneum*, anterior abdominal wall defect with a covering hernia sac, occurs with high incidence of associated malformations, has unclear risk factors but does occur with older mothers (>35) and obese
Omphalocele/gastroschisis diagnosis (2) and treatment (1)
- maternal/fetal ultrasound
- physical exam
-surgery
Vacterl
Rarely used term that is a diagnosis for a newborn patient that has 3 of the following: vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, renal anomalies and radial aplasyia and limb abnormalities
Gastroschisis***
Herniation WITHOUT ***covering sac of peritoneum of a length of small intestine and occassionally part of the liver, abdominal wall defect located to right of umbilcal cord, more frequently occurs in chidlren born to young mothers (<20) and women who are very thin
Diaphragmatic hernia presentation
Respiratory stress, classic symptoms of cyanosis, dyspnea, and cardiac dextroposition 8-24 hours postnatally, typically herniation occurs into left lung
Diaphragmatic hernia treatment options (3)
- immediate tracheal intubation
- placement of gastric tube for decompression
- surgery
Meckel’s diverticulum
Diverticula that is vestigial remnant of omphalomesenteric duct that is about 2 inches in length located within 2 feet of ileocecal valve, presenting before the age of 2, may contain ectopic gastric mucosa (ulcers), only symptomatic in males even though both genders are effected and presents with painless anal bleeding, often occurs with other associated defects
Most common congenital anomaly of the GI tract
Meckel’s diverticulum
Meckel’s diverticulum presentations (3)**
- lower painless GI bleeding
- intestinal obstruction fro internal volvulus or intussusception
- local inflammation with or without perforation resembling acute appendicitis
Meckel’s diverticulum diagnosis (3) and treatment options (1)
- technetium 99 scan useful in detecting heterotopioc gastric mucosa has high sensitivity and accuracy
- ultrasound backup
- CT backup
-surgical resection (cut out diverticula and anastamose the intestines back together
Esophageal atresia
Rare congenital malformation conssting of lack of continuity between upper and lower esophageal pouches, associated frequently with tracheosophageal fistulas*** (make it hard to breath)
Esophageal atresia etiology (2)
- unknown thought to be multifactorial
- often occurs with trisomies
Esophageal atresia presentation (4)***
- blockage of NG tube from passing into stomach (diagnostic)
- excess oral secretions from infant
- difficulty breathing and maintaining airway, consistently choking when eating
- concurrent tracheomalacia (seal bark like cough)
Imperforate anus/anal atresia
Imperforate anus with dimple at anal opening without an obvious canal, anal atresia has an opening but canal is not patent or is underdeveloped
Imperforate anus/anal atresia presentation (2)
- physical exam findings
- delayed passage of meconium (>24-48 hours)
Imperforate anus/anal atresia diagnosis (1) and treatment (1)
- barium enema if no stool post 48 hours
- surgery
Hypertrophic pyloric stenosis
2ndary to hypertrophy and hyperplasia of muscular layers of the pylorus causing functional gastric outlet obstruction, can sometimes be palpated as an olive like mass
Most common cause of gastric outlet obstruction in infants
Hypertrophic pyloric stenosis
Hypertrophic pyloric stenosis causes (4)
- unknown mostly
- problems with myenteric plexus innervation
- cows milk protein allergy
- usually 1st born male child***
Hypertrophic pyloric stenosis presentation (3) and diagnosis (2) and treatment (1
-3rd or 4th week of life develop progressive projectile billous vomiting and with time lose weight
-olive shaped mass
palpable to right of umbilicus
-visible peristalsis
- ultrasound/barium studies
- IV hydration and pylormyotomy (remstedt procedure)
String sign on upper GI x ray is sign of…
….hypertrophic pyloric stenosis
Hirschsprungs disease (aganglionic megacolon) mech of action
Failure of enteric neurons to migrate caudally with vagal nerve fibers along intestine, arriving to the proximal colon normally by 8 weeks gestation and rectum by 12, arrest leads to an aganglionic segment often associated with downs and other anomaplies
Hirschsprungs disease diagnosis (2) and treatment
- plain radiograph with barium contrast enema
- rectal biopsy for definitive diagnosis
-treated with surgical resection
Malrotation of the intestine
Occurs when normaml embryonic sequence of bowel development and fixation is interrupted
Midgut volvulus treatment (2)
- surgery of volvulus untwisting
- appendix removed
Intussusception
Invagination of proximal bowel into distal segment, ileum passing into the cecum or colon passing thru the ileocecal valve
Intussusception causes (3)
- infections such as Rotavirus
- meckel’s diverticulum
- polyp
Intussusception presentation (3)**
- paroxysmal severe colicky pain and pallor at roughly 20 min intevals followed by lethargy and bilous vomiting
- sausage shaped mass palpable in the abdomen that does NOT squish
- passage of characteristic currant jelly stool
Intussuception diagnosis
- ultrasound
- abdominal radiographs
Intussuception treatment options (3)
- IV fluids
- NG suction then air contrast barium enema (diagnostic and therapeutic! Used majority of time)
- surgery if enema fails
Regurgitation vs vomiting
Regurgitation is not associated with nausea or retching, isn’t forceful unlike with vomiting
GERD in children
Results due to lack of functional maturity of LES, common in 1st year of life and presents with poor weight gain (failure to thrive), vomiting, stridor, chronic cough at night. Once solid foods introduced usually resolves but can occasionally continue in severe cases requiring endoscopy and proper treatment
GERD in children treatment (mild, moderate, and severe)
- in mild cases keep upright after feeding
- moderate/severe give a proton pump inhibitor
- surgery in severe
Acute appendicitis is very uncommon in age
3, teens
Constipation in children
Generally defined as infrequent defecation, painful defecation, or both, very common during weaning and toilet training, if continues rectum gradually accomodates and noraml urge to defectate gradually vanishes which can lead to fecal incontinence (encopresis)
Fecalith
Blockage of appendix opening with hardened stool, can be contributing to appendicitis
Complications of chronic constipation (4)
- rectal fissure
- UTI
- rectal prolapse
- bacterial overgrowth
Physical exam findings suggesting organic constipation (2), diagnosis (4) and treatment (5)
- abdominal distension
- lack of lumbosacral curve
- history
- thyroid tests
- plain abdominal radiographs
- barium enema
- increase dietary fluid and fiber
- stool softeners
- stimulant laxatives
- manual evacuation with enema
- dietary mods
100% of mothers with fetus having espohageal atresia without fistula have…
polyhydramnios
