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PED- TEST 3 > GI Lecture- Part 2 > Flashcards

GI Lecture- Part 2 Flashcards

1
Q

Regurgitation?

A

Regurgitation – passive reflux of gastric contents into oropharynx

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2
Q

forceful emptying of gastric contents?

A

vomiting

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3
Q

What is one of the most common sx’s in children?

A

vomiting

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4
Q

Projectile vomiting often arises from the?

A

CNS

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5
Q

Non-projectile is often seen in?

A

GER

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6
Q
  • obstructive lesions, repeated vomiting
A

bilious

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7
Q
  • Non-bilious?
A

infection, inflammation, metabolic, neuro., psych.

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8
Q
  • Bloody?
A

active upper GI bleeding

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9
Q

Dehydration

A

loss of water and extracellular fluid

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10
Q

What are the statistics for dehydration?

A
  • Mild – <3% older children; <5% infants
  • Moderate – 6% older children; 10% infants
  • Severe – >9% older children; >15% infants
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11
Q

What are the different types of dehydration?

A
  • Isonatremic/isotonic – sodium concentrations maintained
  • Hypernatremic/hypertonic – greater water loss than salt
  • Hyponatremic/hypotonic – greater sodium loss than water
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12
Q

Isonatremic/isotonic

A

sodium concentrations maintained

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13
Q

Hypernatremic/hypertonic

A

greater water loss than salt

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14
Q

Hyponatremic/hypotonic

A

greater sodium loss than water

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15
Q

What history should you perform for vomiting and dehydration

A
  • Symptoms with onset; duration, nausea?, quantity of vomitus, how many/most recent episode, description
  • Recent exposure to illness, food, injury, stress, others ill
  • Medications – new, continued, discontinued
  • Assoc. symptoms – diarrhea, fever, ear pain, constipation
  • Past history
  • Mental status/thirst
  • Parental concerns about tearing, urination (# of wet diapers)
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16
Q

What physical exam should you perform for vomiting and dehydration?

A
  • Growth parameters/vital signs – Wt, tachycardia, temp, B/P
  • Neurologic examination – nuchal rigidity, LOC, behavior
  • Abdominal examination – BS, distention, rebound, masses
  • Respiratory examination – aspiration?, tachypnea
  • Assessment of dehydration- turgor, saliva, tears, cap refill
    <2 sec
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17
Q

What diagnostic tests should you do for vomiting and dehydration?
Labs?

A
  • Laboratory studies – CBC/cultures, electrolytes, CRP, ESR, UA/culture, toxicology, stool cultures, rapid strep/culture, HCG test
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18
Q

What imaging studies should you do for vomiting & dehydration?

A
  • Imaging – radiographs, U/S, barium swallow/enema, CT or MRI
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19
Q

What other studies should you do for vomiting and dehydration?

A

endoscopy, esophageal pH, electroencephalogram

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20
Q

What are some differential dx for vomiting and diarrhea?

A
  • Gastroenteritis
  • GERD
  • Gastritis
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21
Q

What are some forms of toxic ingestion for vomiting and diarrhea?

A
  • Toxic ingestion: Lead, iron, or vitamins A and D
22
Q

What are some systemic dx for vomiting and diarrhea?

A
  • Systemic infection: UTI or pyelonephritis; pneumonia; hepatitis
  • Pertussis syndrome
  • Otitis media, sinusitis, strep.
  • Appendicitis, small bowel obstruction,
    pregnancy
  • migraine
23
Q
  • Medication: Ipecac, digoxin, theophylline, etc. that can cause
A

vomiting and diarrhea

24
Q

How do you manage vomiting and diarrhea?

A
  • Vomiting
  • identify/alleviate cause; antiemetics if indicated; refer for persistent or recurrent vomiting
  • Dehydration
  • Oral Rehydration Solution (ORS)( Pedialyte, Infalyte, ReVital , etc.) for mild/moderate dehydration
25
Q

Management for vomiting and diarrhea?

A
  • Refeeding should begin as soon as possible
  • If a breastfeeding infant vomits, continue to breastfeed
26
Q

Management for vomiting and diarrhea?

A
  • Formula - offer ½ - 1 oz. of ORS every 15 minutes for 2-3 hrs.

If vomiting reoccurs, wait 30 minutes and try again.

If vomiting improves, resume feeding with full strength infant formula

27
Q
  • Antiemetics
  • Ondonsetron - 8 to 15 kg: 2 mg/dose once; >15 to 30 kg: 4 mg/dose once;
    >30 kg: 8 mg/dose once
A

antiemetics

28
Q
  • Promethazine - Not in children < 2yrs. old; caution in children > 2yrs old;

0.25 to 1 mg/kg/dose q 4 to 6 hours PRN max 25 mg/dose.

A

antiemetics

29
Q

How to manage vomiting and dehydration?

A
  • Older children – not necessary to restrict child’s diet to clear liquids or BRAT diet (bananas, rice, applesauce, toast).

These and similar foods might be recommended to decrease diarrhea, but do not contain enough nutrients for a child.

30
Q

How to manage vomiting and dehydration?

A
  • Include a combination of complex carbohydrates (rice, wheat, potatoes, bread), lean meats, yogurt, fruits, and vegetables
31
Q

How to manage vomiting and dehydration?

A
  • Avoid. high fat and high sugar foods (including Gatorade).
  • Treat fever; monitor urine output
  • Refer if toxic, severe, projectile vomiting, or if blood, bile, fecal matter present
32
Q

What are some complications of vomiting and dehydration?

A
  • Dehydration
  • Fluid/electrolyte imbalance
  • Aspiration pneumonia
  • Hemorrhage/esophageal tear
33
Q

What should the pt. and fam edu be?

A
  • Written information for ORS
  • Information about signs to report (dehydration, etc.)
34
Q

Cyclic Vomiting
Syndrome?

A
  • Recurrent, discrete, self-limited episodes with symptom-free intervals
  • Often associated with abdominal migraines
35
Q

Cyclic Vomiting
Syndrome?

A
  • Intense nausea/unremitting vomiting – median of 6/hour; often with bilious emesis
  • Episodes last hours to days; remission is weeks to years
36
Q

Cyclic Vomiting
Syndrome?

A
  • Substantial morbidity/medical costs
  • Etiology unknown; associated with headaches, mitochondrial, endocrine, allergy, metabolic disorders
  • Presentation usually at age 3 years
37
Q

What are the red flags for cyclic vomiting syndrome?

A
  • Bilious vomiting, abdominal tenderness/severe pain, hematemesis
38
Q

What are some triggers for cyclic vomiting syndrome?

A
  • Triggers (e.g., fasting, high-protein meal, or intercurrent illness)
39
Q
  • Abnormal neuro exam (e.g., severely altered mental status, abnormal eye movements, papilledema, motor asymmetry, and/or gait abnormality [ataxia])
  • Progressively worsening episodes or conversion to a continuous or chronic pattern

What does this pt. most likely have?

A

cyclic vomiting syndrome

40
Q

What history should be included with cyclic vomiting syndrome?

A
  • Family history of migraine headache
  • Prodromal period
  • Episodes begin/end abruptly
  • Identifiable trigger common in children
  • Intense nausea unrelieved by vomiting
  • Headache, motion sickness, photophobia, vertigo
41
Q

True or False the PE is usually normal for cyclic vomiting syndrome?

A

True

42
Q

What dx can be done for cyclic vomiting syndrome?

A
  • Screening labs to exclude other causes
  • Electrolytes, upper GI, abdominal US
  • Rule out Addison disease
43
Q

What are some differential dx for cyclic vomiting syndrome?

A
  • Diagnosis of exclusion
  • Metabolic disorder
  • Increased ICP
  • Munchausen by proxy
44
Q

How should you manage cyclic vomiting syndrome?

A
  • Well phase: prevention/prophylaxis
  • Lifestyle changes to decrease frequency
  • Daily prophylactic therapy if abortive therapy consistently fails
  • Episode: acute interventions
  • Supportive measures
  • Referral – if red flag symptoms occur
45
Q

Well phase of cyclic vomiting syndrome?

A

prevention/prophylaxis

46
Q

episode of cyclic vomiting syndrome?

A

acute interventions

47
Q

cyclic vomiting syndrome pharm children <5 y/o?

A
  • Children < 5 Years * Cyproheptadine (1st choice): 0.25 to
    0.5 mg/kg/day divided bid or tid. (max dosage 2– 6 yr: 12 mg/24 hr)
48
Q

cyclic vomiting syndrome pharm children 2nd choice?

A

0.25 to 1 mg/kg/day, often 10 mg bid - tid

49
Q

Children >5 1st choice cyclic vomiting syndrome?

A
  • Children > 5 Years* Amitriptyline (1st choice): 0.1 to 0.25 mg/kg at HS, incr. weekly by 0.1–0.25 until max of 2 mg/kg/24 hr or
    75 mg.
  • Monitor ECG before starting and 10 days after peak dose.
50
Q

What is the 2nd choice for children >5 y/o for cyclic vomiting syndrome?

A
  • Propranolol (2nd choice): see dosages above
  • Complementary modalities

PED- TEST 3 (22 decks)

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