GI Lecture Flashcards by Cassidy Ruocco

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

Constipation

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First stool should occur by ____ hours of life

72 hours

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Functional constipation can lead to…

voluntary stool withholding

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

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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

Constipation

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

three

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Is acute gastroenteritis in kids usually bacterial or viral?

Viral

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

Rotavirus

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Tx of diarrhea in peds

Hydration

dehyradtion in peds with diarrhea is very common!!!

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MC congenital craniofacial anomaly
4th MC birth defect

Cleft lip/palate

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

can be unilateral or bilateral

Cleft lip/palate

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How many cleft lips/palates involve….

lip and palate?
palate alone?

2/3 involve lip and palate

1/3 involve palate alone

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Difficulties with feeding
Nasal regurg

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

Cleft lip/palate

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

..can all cause?

Bloody diarrhea

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

GERD sx in peds

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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

GERD

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

Infectious esophagitis or anatomical abnormalities

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True or False..

Asthma and GERD are commonly connected

True

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

Tracheoesophageal fistula and Esophageal Atresia

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

95%

(common in polyhydramnios pregnancies)

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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

Tracheoesophageal fistula and Esophageal Atresia

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

GERD

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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

Gastroesophageal Reflux (GER)

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

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Treatment of Tracheoesophageal fistula and Esophageal Atresia

Surgery

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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

Pyloric stenosis

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

Pyloric stenosis

Dx: Ultrasound **Barium swallow shows "string sign" at the pylorus** Tx: Surgery

Pyloric stenosis

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.

Volvulus

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

Superior Mesenteric Artery

S/S: Sudden Onset Bilious Vomiting (Green vomit) Severe Abdominal Pain and Inconsolable Infant \< 1 month typically

Volvulus

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

Volvulus

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

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

Tx for volvulus?

Emergency surgery

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

Hirchsprungs disease

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

Hirschsprungs Dz

How do you diagnose Hirschsprungs disease?

**Rectal biopsy!!** (supported by abdominal xrays, contrast enema or anorectal manometry)

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

Hirschsprungs disease

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)

Meckel's Diverticulum

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

Meckel's Diverticulum

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

Meckel's Diverticulum (sometimes Meckel's can cause intussuscpetion)

How do you diagnose Meckel's diverticulum? How do you treat?

**Meckel's scan!! (nuclear medicine)** Tx with resection (surgery)

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

Intussesception

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

Intussuscpetion

Recent studies have shown a viral influence as a cause- Rotavirus, URIs, etc

Intussusception

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**"

Intussuscpetion

Dx and Tx of Intussuscpetion

Barium or Air enema (diagnostic and tx) \*surgery if unstable or with perforation

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

Imperforate anus

Dx made with exam, ultrasound, xray Tx: surgery to open passage (sometimes colostomy needed)

Imperforate anus

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

Appendicitis

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**

Appendicitis

Tenderness at 1/3 distance from anterior superior iliac spine to umbilicus (McBurneys Point) Dx: Increased WBCs and CrP **IMAGE OF CHOICE= CT**

Appendicitis

Image of choice for Appendicitis?

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

Umbilical hernia

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.

Diaphragmatic hernia

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)

Inguinal hernia

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

Indirect

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

Diaphragmatic hernia

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

Celiac dz

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

Celiac Disease

How do you dx lactose intolerance?

Lactose breath hydrogen test