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SD- Pediatrics > GI Lecture > Flashcards

GI Lecture Flashcards

1
Q

Causes:
Intro of solid foods into infants
Toilet training
Start of school, other stressful environments
Cows milk, Hirshprungs, CF, hypothyroid, lead poisoning, neuro/spinal D/O, infantile botulism, celiac

A

Constipation

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2
Q

First stool should occur by ____ hours of life

A

72 hours

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3
Q

Functional constipation can lead to…

A

voluntary stool withholding

(frightening, painful experience where kid wants to avoid repeating feeling of constipation)

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4
Q

Exam: abdominal distention, palpable stool mass, soiled underwear, impacted stool on rectal exam

Dx: plain abdominal xray

Tx:

infants. .glycerin suppository, sorbitol contianing juices
children. . polyethelene glycol, disimpaction, diet change

A

Constipation

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5
Q

Diarrhea is defined as passage of loose or watery stools ______ or more times a day

A

three

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6
Q

Is acute gastroenteritis in kids usually bacterial or viral?

A

Viral

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7
Q

Which virus is a common cause of diarrhea in peds but there is now a vaccine against?

A

Rotavirus

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8
Q

Tx of diarrhea in peds

A

Hydration

dehyradtion in peds with diarrhea is very common!!!

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9
Q

MC congenital craniofacial anomaly
4th MC birth defect

A

Cleft lip/palate

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10
Q

Abnormal opening secondary to development failure in utero
Genetic and environmental theories (seizure meds, methotrexate, smokng)

can be unilateral or bilateral

A

Cleft lip/palate

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11
Q

How many cleft lips/palates involve….

lip and palate?
palate alone?

A

2/3 involve lip and palate

1/3 involve palate alone

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12
Q

Difficulties with feeding
Nasal regurg

Tx: repair
audiogram testing
involves surgeons, speech therapist, dentists

A

Cleft lip/palate

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13
Q

Salmonella
Hemolytic Uremic Syndrome (E. Coli)
Intussuscpetion
Toxic megacolon

..can all cause?

A

Bloody diarrhea

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14
Q

Heartburn
Acid brash
Respiratory symp (chronic cough, wheezing, asthma, recurrent pneumona)
Vomiting
Sxs related to meals or not wanting solids

A

GERD sx in peds

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15
Q

Dx made with:

2-4 week trial of a PPI
Barium swallow contrast study to exlude anatomic abnormality
Endoscopy is symptoms persist after 2 years of tx

tx: lifestyle changes (weight loss, head of bed elevated)
PPIs or H2 blockers

A

GERD

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16
Q

Any dysphasgia or odynophagia symptoms need a barium contrast study and/or an endoscopy to exclude…

A

Infectious esophagitis or anatomical abnormalities

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17
Q

True or False..

Asthma and GERD are commonly connected

A

True

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18
Q

Congenital anomaly of the respiratory tract
incomplete separation of the trachea and esophagus

A

Tracheoesophageal fistula and Esophageal Atresia

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19
Q

Tracheoesophageal Fistual and Esophageal Atresia occur together what percentage of the time?

A

95%

(common in polyhydramnios pregnancies)

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20
Q

S/S:
Drooling, choking, respiratory distress, gastric distention from fistual betwen esophagus and trachea, unable to feed
Aspiration pneumonia

Dx: inability to pass an NG tube into stomach
**definitive test is an upper GI series with endoscopy for direct visualization

A

Tracheoesophageal fistula and Esophageal Atresia

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21
Q

Present when the passage of gastric contents into the esophagus causes troublesome symptoms or complications

A

GERD

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22
Q

passage of gastric contents into the esophagus, but this is a normal physiologic process in infants and children.

These episodes do NOT cause symptoms, esophageal injury or complication

resolves by 18 mos

A

Gastroesophageal Reflux (GER)

*NOT THE SAME AS GERD! this is normal, GERD is not

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23
Q

Treatment of Tracheoesophageal fistula and Esophageal Atresia

A

Surgery

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24
Q

Hypertrophy of the musculature around the pyloric sphincter resulting in gastric outlet obstruction

Common in families, and in first born male

Presents at 4-6 weeks of age

A

Pyloric stenosis

25
Q

S/S:

Projectile vomiting after feedings
Infant may have vigorous appetite and appear hungry, despite weight loss

Abdominal exam reveals olive shaped mass in the R upper/epigastric area

Peristaltic wave just prior to vomiting

A

Pyloric stenosis

26
Q

Dx:
Ultrasound
Barium swallow shows “string sign” at the pylorus

Tx: Surgery

A

Pyloric stenosis

27
Q

Malrotation and abnormal rotation in
utero which results in incomplete fixation of the small bowel.

Ladds Bands develop between the cecum and peritoneum, which compresses the duodenum and causes obstruction.

A

Volvulus

28
Q

Midgut Volvulus is twisting of the small bowel containing the _________ _________ artery, quickly leading to ischemia

A

Superior Mesenteric Artery

29
Q

S/S:
Sudden Onset Bilious Vomiting (Green vomit)

Severe Abdominal Pain and Inconsolable

Infant < 1 month typically

A

Volvulus

30
Q

Exam:
Abdominal tenderness and distention
Tachycardia with HTN

Dx:
Barium studies show Bird-Beak cut off and corkscrew of dudodenum

Abdominal plain films show double bubble sign with airfluid level in the stomach and duodenum only

A

Volvulus

31
Q

Will you see gas distally to duodenum on abdominal plain films in a volvulus pt?

A

NO!

air fluid levels in the stomach and duodenum only
NO GAS DISTALLY TO DUODENUM BECAUSE IT IS TWISTED

32
Q

Tx for volvulus?

A

Emergency surgery

33
Q

Motor disorder of the gut
congenital absence of ganglion cells in the distal rectum and colon
causes an aganglionic segment, which leads to obstruction

male:female ratio is 3:1
sometimes associated with down syndrome

A

Hirchsprungs disease

34
Q

S/S
Failure to pass Meconium (first stool) within 72 hours of life
Explosive expulsion of gas and stool after digital rectal exam (SQUIRT SIGN)

Signs of bowel obstruction:
Vomiting, bowel distention, failure to pass stool, megacolon, fever

A

Hirschsprungs Dz

35
Q

How do you diagnose Hirschsprungs disease?

A

Rectal biopsy!!

(supported by abdominal xrays, contrast enema or anorectal manometry)

36
Q

Tx= surgery

resect the affected bowel segment, bring normal ganglionic bowel down close to the anus to preserve sphincter function

A

Hirschsprungs disease

37
Q

MC congenital anomaly of SMALL INTESTINE*

incomplete obliteration of the vitelline duct, leading to a true diverticulum of the small intestine

(these are uncommon and often not picked up til adulthood)

A

Meckel’s Diverticulum

38
Q

Rule of 2s:

Occurs in 2% of population
Male:Female ratio of 2:1
Within 2 feet of iliocecal valve
Can be 2 inches long
Usually present before age 2

A

Meckel’s Diverticulum

39
Q

S/S:

Painless GI bleeding, due to ulceration of small bowel
Children with intussesception or recurrent intussesception
Signs of sm bowel obstruction- abdominal pain, vomiting

A

Meckel’s Diverticulum

(sometimes Meckel’s can cause intussuscpetion)

40
Q

How do you diagnose Meckel’s diverticulum?

How do you treat?

A

Meckel’s scan!! (nuclear medicine)

Tx with resection (surgery)

41
Q

Invagination of a part of the intestine itself
MC abdominal emergency in children under 2 yo
**Causes a bowel obstruction and ischemia

A

Intussesception

42
Q

S/S:

Suddent onset of intermittent severe abdominal pain epsiodes
inconsolable crying
*DRAWING LEGS/KNEES TOWARD THE ABDOMEN

A

Intussuscpetion

43
Q

Recent studies have shown a viral influence as a cause-

Rotavirus, URIs, etc

A

Intussusception

44
Q

Exam:

Sausage shaped abdominal mass on the R side of the colon
Currant-jelly stools (mix of blood and mucus)

Ultrasound: “target sign” or “bulls eye”

A

Intussuscpetion

45
Q

Dx and Tx of Intussuscpetion

A

Barium or Air enema (diagnostic and tx)

*surgery if unstable or with perforation

46
Q

Birth defect when the anus is malformed
Opening to the anus is missing or blocked
Obvious defect at birth on exam

Low lesions: colon close to the skin (stenosis or blind pouch)
High lesions: May be fistula connecting rectum to bladder or vagina

A

Imperforate anus

47
Q

Dx made with exam, ultrasound, xray

Tx: surgery to open passage (sometimes colostomy needed)

A

Imperforate anus

48
Q

MC condition in children requiring emergency abdominal surgery

Caused by nonspecific obstruction of the appendiceal lumen
Fecal material, undigested food, lymphoid follicles, twist of the tissue

*twist causes inflammation, ischemia, gangrene

A

Appendicitis

49
Q

Typically occurs before 10 yo

S/S:
Anorexia, periumbilical pain (early), migration to the RLQ, comiting, fever, RLQ pain, peritonitis

guarding
+Rosving sign
+Obturator sign
+Psoas sign
Rebound tenderness at McBurney’s point

A

Appendicitis

50
Q

Tenderness at 1/3 distance from anterior superior iliac spine to umbilicus (McBurneys Point)

Dx: Increased WBCs and CrP

IMAGE OF CHOICE= CT

A

Appendicitis

51
Q

Image of choice for Appendicitis?

A

CT

52
Q

Which hernia…

Common surgical condition in children. High incidence in African-Americans.
Most will close by 4-5 years of age.

A

Umbilical hernia

53
Q

Which hernia…

Developmental defect in the diaphragm, allowing abdominal viscera to herniate into the chest, compromising normal lung development. Respiratory distress in the first few hours of life.
Diagnose with a chest x-ray.

Treatment is Surgery.

A

Diaphragmatic hernia

54
Q

Which hernia….

1-5% of all newborns. M>F

Infants at risk due to anatomic alignment- the inguinal canal is shorter, and more perpendicular

Indirect- Pass through the inguinal canal (most common)

Direct- Do not go through inguinal canal (rare)

A

Inguinal hernia

55
Q

Which type of inguinal hernia is more common, indirect or direct?

A

Indirect

56
Q

Air fluid levels in chest cavity seen with what type of hernia?

A

Diaphragmatic hernia

57
Q

Immune-mediated inflammation of the small intestine caused by sensitivity to gluten and related proteins (wheat, barley, rye) in genetically sensitive patients.

Occurs in 0.5-1% of population

A

Celiac dz

58
Q

S/S:
Malabsorption (diarrhea, steatorrhea, weight loss, vitamin deficient)
Failure to thrive

Dx: Serum Celiac-Antigen Testing
(if positive, endoscopy for biopsy!)

Tx: gluten free diet

A

Celiac Disease

59
Q

How do you dx lactose intolerance?

A

Lactose breath hydrogen test

SD- Pediatrics (11 decks)

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