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PED- TEST 3 > GI Lecture > Flashcards

GI Lecture Flashcards

1
Q

What is included in a history for GI disorders?

A
  1. fam h/o GI disorders (celiac disease, gallbladder, ulcers, H. Pylori
  2. past medical history of GI tract (illness surgery, celiac, IBS, cleft lip palate, esophageal problems.
  3. feeding habits
  4. appetite/thrist
  5. pain OLDCARTs
  6. bowel habits- constipation vs. diarrhea
  7. food intolerance/allergy
  8. nausea, vomitting, belching flatulance, heartburn
  9. apnea, asthma, odorous breath
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2
Q

Pain characteristics for GI can be?

A

-Pain characteristics (OLD CARTS)
- Epigastric
- Periumbilical
- Colonic,
- Suprapubic
Referred (shoulder, back, neck, groin)

Acute, Secondary ANS stimulation can cause s/s N/V, diaphoresis, pallor, anxiety

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3
Q

GI history good to?

A

Develop a rapport between parent & child
assess general appearance sick vs not sick appearing

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4
Q

What is included for a physical Exam for GI assessment?

A

Head to toe examination Height/Weight/BMI on growth charts General appearance

HEENT, Neck CV/Resp

Abdominal:
Inspect for visible peristalsis, rash/lesions, asymmetry, masses, pulsations
Auscultate BSs, abdominal bruits Percuss for masses, HSM
Palpate lightly then deeply for masses, HSM, CVA tenderness, rebound tenderness/Rosving’s sign, guarding, obturator/psoas signs Rectal exam when indicated

Gynecological exam when indicated (usually referred)
Skin: inspect hydration status

Have the child jump on one foot

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5
Q

DX Testing for GI?

A

Performed as indicated: Urinalysis
CBC w/ diff
CMP (includes LFTs), lipid profile, ESR, CRP, TSH, Free T4, H.Pylori IgG/IgM, EBV Panel Food intolerance/allergy testing
Stool Studies (O&P, WBC, culture, cryptosporidium, giardia, rotavirus, c. diff) Fecal fat collection
Pregnancy test Urine PCR for STIs

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6
Q

DX for GI radiology?

A

Radiological evaluation: Abdominal X-ray (KUB) Upper/Lower GI series Air contrast enema Bone Age
CXR
Ultrasound HIDA scan CT scan MRI

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7
Q

Think about things that can be
done in the office such as UA, blood glucose, CBC

A

DX testing for GI

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8
Q

For GI DX testing?

A

Special testing: barium swallow, pH probe, endoscopy, breath hydrogen test, sweat chloride test

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9
Q

What can be done to manage GI disorders?

A

Antibiotics Antifungals
Anthelmintics Antiemetics
Antidiarrheals (rarely used)
Stool softeners/laxatives
Antispasmodics
Corticosteroids

Reduction of pain Reduction of acidity Probiotics/Prebiotics Diet changes

Anti-reflux measures

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10
Q

What are some GI disorders?

A
  • Dysphagia
  • Vomiting/Dehydration
  • Cyclic Vomiting Syndrome
  • GERD
  • PUD
  • Colic
  • Appendicitis
  • Intussusception
  • Abdominal Pain/Migraine
  • IBS/Cohn’s/Ulcerative colitis
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11
Q

What are some types of malabsorption syndromes?

A
  • Malabsorption syndrome (Celiac disease, Lactose intolerance, Cow’s milk protein intolerance/allergy)
  • Polyps
  • Anal Fissure
  • Failure to Thrive (FTT)
  • Acute/Chronic Diarrhea
  • Parasite infection
  • H. Pylori infection
  • Constipation (w/ or w/o encopresis)
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12
Q

What is the most common cause of abdominal pain in children?

(Know!)

A
  • Abd pain of unknown cause
  • Gastroenteritis
  • Appendicitis
  • Constipation
  • UTI
  • Viral infection
  • Strep Pharyngitis
  • Sinusitis/Pharyngitis
  • Pneumonia
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13
Q

What is the most common GI complaint?

A

Constipation

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14
Q
  • Second most commonly referred condition in pediatric gastroenterology ?
A

Constipation

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15
Q

What is the rest common pediatric gastroenterology complaint?

A

generalized abd pain

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16
Q

What is constipation?

A
  • Decreased frequency of bowel movements or difficulty having a bowel movement for more than two weeks with associated distress the child.
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17
Q

Difficult to define by actual frequency of BMs alone because of factors such as?

A

passage of stool, consistency of stool, and volume of stool

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18
Q

What is some history info for constipation?

A
  • Age/Circumstance of onset
  • Meconium passage
  • Bowel pattern
  • Pain/bleeding with defecation
  • Withholding behaviors
  • Soiling
  • Abdominal pain
  • Diet
  • Weight loss
  • Vomiting
  • Medications
  • Toilet training history
  • Neurological problems
  • Urinary problems
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19
Q

Know the Bristol stool chart!

A
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20
Q

What should the physical exam be like to assess for constipation?

A
  • General Exam: growth and development
  • Neurological Assessment: tone, strength, DTR’s
  • Abdominal Exam: palpable stool, percussion
  • Perianal Exam: anal position, fissures, skin tags, hemorrhoids, anal wink, rash
  • Digital Rectal Exam: tone, size of rectum, fecal mass, stool occult
  • Spine: sacral dimple, tuft
21
Q

What are some red flags of constipation?

A
  • Anal stenosis
  • Blood mixed in stool/bloody diarrhea
  • Failure to thrive
  • Tight empty rectum
  • Sacral dimple
  • Atypical perianal exam
  • Prolapse of rectum
22
Q

When is functional constipation most commonly seen?

A

between 6 months and 4 years of age

23
Q

Functional constipation?

A
  • > 2 weeks of < 2 bowel movement s per week with hard, large or small stools in the absence of:

structural, endocrine, or metabolic abnormalities.

24
Q

Functional constipation?

A
  • Normal meconium passage
  • Onset during transition periods
  • No overtly distended abdomen
  • Normal growth
  • Overflow soiling
  • Improved with medical therapy
25
Q

Encopresis

A
26
Q

Encopresis

A
27
Q

What is the treatment for encopresis?

A
  • Diet: fiber and water!
  • Fiber
  • Whole grains, fruits, and vegetables
  • Rule of Thumb: age in years + 5 = goal of number of grams of fiber needed each day.
  • Water/fluid intake
  • About 2 oz per gram of fiber
  • Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass
28
Q

Rule of Thumb: age in years + 5 = goal of number of grams of fiber needed each day.

A

treatment for encopresis

29
Q

Encopresis treatment?

A
  • Clean out (2-3 days)
  • Maintenance medication (6 months-2 years)
  • Sitting on toilet regularly – reward system
  • Diet
  • Keys to success: adequate clean-out, consistent use of medications, regularly scheduled toileting and improved diet.
30
Q

Encopresis
Treatment continued (Medications)?

A
  • Stool softeners:
  • Miralax
  • Lactulose
  • Milk of magnesia
  • Colace
  • Stimulant Laxatives:
  • Senna syrup, tablets
  • Ex lax
  • Dulcolax
  • Enemas:
  • Milk and Molasses
  • Saline
  • Soap suds
31
Q

Hypertrophied Pyloric
Stenosis

What is it?

A

Caused from hypertrophy of the pylorus
muscle

32
Q
  • The lumen becomes obstructed by mucosa, resulting in a blockage of the lumen that extends from the stomach to the duodenum
A

Hypertrophied Pyloric Stenosis

33
Q
  • Unknown cause, associated with a failure of nitric oxide synthetase and decrease nitric oxide and an inability of the smooth muscle of the pylorus to relax
A

Hypertrophied Pyloric Stenosis

34
Q

Leads to several metabolic abnormalities, including metabolic alkalosis, hypochloremia and hypokalemia

A

Hypertrophied Pyloric Stenosis

35
Q

Hypertrophied Pyloric
Stenosis?

A
  • Occurs between1.4 and 4 per 10000 live births
  • More common in males than females
  • Possible genetic predisposition
  • Typical case is a first born male presenting with recurrent vomiting between 3-5 weeks of age
36
Q
  • Infant between 2-8 weeks
  • Presents with nonbilious projectile vomiting
  • Infant remains hungry after feedings
  • Generally not febrile or ill appearing unless the onset of dehydration produces lethargy

What is this clinical condition? (Know)

A

Hypertrophied Pyloric
Stenosis

37
Q

Hypertrophied Pyloric
Stenosis

  • Physical Examination?
A
  • Peristaltic wave in the RUQ
  • Pylorus palpable as a small, hard mass or “olive”
  • Weight loss and possible dehydration
  • Characteristic facies with furrowed brow, wrinkled appearance and prominent sucking pattern
38
Q

Hypertrophied Pyloric
Stenosis

  • Diagnosis?
A
  • Abdominal ultrasound has become the gold standard for diagnosis
  • Upper GI barium study can also be useful
39
Q

Treatment for Hypertrophied pyloric stenosis?

A
  • Treatment is correction of metabolic alkalosis and dehydration and then surgical correction
40
Q

Upper Gastrointestinal Disorder?
Dysphagia?

A
  • Difficulty or discomfort in swallowing
41
Q

Symptoms of Dysphagia may be?

A

be oral, pharyngeal or esophageal

42
Q
  • Structural Defects:? for dysphagia?
A
  • Esophageal narrowing
  • Extrinsic obstruction
43
Q

What are some nonstructural causes of dysphagia?

A
  • Motility disorders of oropharynx/esophagus
  • Prematurity/neurologic impairment from CP or other disorders
  • Mucosal injury – GERD, eosinophilic, esophagitis
44
Q

What history should you do for dysphagia?

A
  • Progressive dysfunction
  • Persistent drooling/cough
  • Pain
  • Picky or food refusal
  • Heartburn
  • Halitosis
  • Weight loss
  • Regurgitation
45
Q

What physical exam should you do for dysphagia?

A
  • Observe feeding
  • PE may appear normal
  • Diagnostic Studies
  • Lateral neck films
  • Barium swallow
  • Fiberoptic endoscopy/videofluroscopy
  • Manometry – measure of esophageal tone
  • MRI
  • Electromyography – evaluates sphincter tone
46
Q
  • Electromyography
A

evaluates sphincter tone

47
Q
  • Manometry
A
  • Manometry – measure of esophageal tone
48
Q

In dysphagia the physical exam may appear?

A

normal

49
Q

What are some differential dx for dysphagia?

A
  • Obstructive/compressive lesions – difficulty with solids
  • Physiologic dysfunction – systemic disorder
  • Psychological – dysfunctional feeding relationship
  • Management
  • Multidisciplinary Approach
  • Depends on source of disorder:
  • Physical
  • Cognitive
  • Developmental
  • Behavioral

PED- TEST 3 (22 decks)

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