GI- Lecture Part 3 Flashcards
Abdominal Migraine
- Part of continuum of migraine/cyclic vomiting
- More typical in children
What is the Rome III criteria for functional GI disorders?
all must be present:
* Paroxysmal episodes of intense periumbilical pain for 1-72 hrs
* Intervening periods of usual health (weeks-months)
* Pain interfering with normal activities
* Pain assoc. with >2: N/V, anorexia, H/A, photophobia, pallor
* No evidence of inflammatory, anatomic, metabolic, neoplastic process
* Must be present >2 times in previous 12 months
What is the Rome III migraine history?
- Family history of migraine/motion sickness
- History of motion sickness
- Aura not frequent
- Headache absent/minimal
- Prodrome of fatigue/drowsiness
- Abdominal Migraine
Abd migraine physical exam?
unremarkable unless during acute abdominal migraine
What are the dx tests for abdominal migraine?
Diagnostic studies – no definitive test; labs if needed to exclude other conditions
Differential diagnosis
obstructive GI/renal processes; biliary tract disease, recurrent pancreatitis, etc
Abd migraine management?
Management – identify/avoid triggers; sleep may relieve symptoms; antiemetics to abort; migraine prophylactic therapy
Prognosis for abd h/a?
migraine headaches later in life
GERD- watch YouTube videos!!
Eosinophillic
Esophagitis
- Isolated inflammation of esophagus by eosinophils
related to food ingestion - Young children – feeding refusal, FTT
- School-age children – recurrent vomiting, abdominal pain
- Older children – dysphagia, choking, food impaction
History and physical examination
similar history and exam to GERD
Eosinophillic
Esophagitis
dx studies?
- upper endoscopy/biopsy
Management for Eosinophillic
Esophagitis?
- Referral to pediatric GI
- 6-food elimination diet: milk, soy, egg, wheat, peanut/tree nuts, and fish/shellfish
- Allergy testing and targeted elimination diet
- PPIs; topical swallowed steroids (See chart on last page)
What is the 6 food elimination diet?
6-food elimination diet: milk, soy, egg, wheat, peanut/tree nuts, and fish/shellfish
What is peptic ulcer disease?
- Gastric and duodenal ulcers – gastritis to ulceration
What is primary peptic ulcer disease?
- Most duodenal with no underlying cause
- Tend to recur; more common in adolescents
What is secondary peptic ulcer disease?
- More often gastric; usually more acute
- Associated with ulcerogenic events
- Head trauma, severe burns, corticosteroid and NSAID use
- Idiopathic ulcers
- Occur in HP-negative children with no history of NSAIDs
- Zollinger-Ellison syndrome
rare; refractory PUD caused by gastric hypersecretion from autonomous secretion by neuroendocrine tumor
What is the history for peptic ulcer disease?
- Vague, dull abdominal pain most common
- Symptoms may wax and wane
- Pain with eating; can awaken from sleep
- GI tract bleeding
- Poor feeding, slow growth in infants
- Poorly localized pain in older children
- Iron deficiency anemia
- Family history of PUD
- Predisposing factors
What should you do for physical exam in peptic ulcer disease?
- Growth parameters, vital signs
- Assessment of perfusion, hydration
- Mouth inspection for ulcers
- Respiratory assessment – wheezing with GERD
- Abdominal, rectal, pelvic examination
What dx studies should you do for peptic ulcer disease?
- CBC, ESR, CRP, and HP
- Stool for guaiac
What should you do for severe peptic ulcer disease?
- Other studies in severe presentation – iron, coagulation studies, electrolytes, renal studies
- Histologic exam/culture biopsies
- C-urea breath tests – non-invasive
- Stool monoclonal antibody test
- Serum IgG antibody titer
What is the imaging studies for peptic ulcer disease?
- Abdominal and/or chest radiograph
- Upper GI series or angiography
- Esophagogastroduodenoscopy (EGD)
What differential dx for peptic ulcer disease?
- Goals: ulcer healing, elimination of primary cause, relief of symptoms, prevention of complications
- Medications
- H2RAs or PPIs as first-line therapy
- Antacids 1-3 hours after eating and before bed
- Eradication therapy for HP; empiric therapy not recommended
- Referral if lack of improvement, blood loss, weight loss
- Idiopathic ulcers – H2RAs or PPIs
- ZES – Referral; PPIs are mainstay; should be started promptly
What are the complications for peptic ulcer disease?
Complications -Acute hemorrhage, chronic blood loss, penetration of ulcer into abdominal cavity
Infantile colic
- Persistent crying in infants <3 months old
Infantile colic
- Crying >4 hours/day
- “Rule of threes” – >3 hours/day; >3 days/week; >3 or more weeks
- No specific cause identified; multiple independent factors may contribute
- Organic causes
- Psychosocial factors
What is the history for infantile colic?
- Symptoms fit rule of threes
- Demands frequent feeding/fussy while feeding
- Excessive gas
- Inconsolable; “tense” or “tight”
What are the red flags for infantile colic?
- Red flags – apnea, cyanosis, difficulty breathing, excessive spitting/vomiting, stool retention
What will you find on a physical exam for infantile colic?
- Growth parameters, vital signs
- Full body exam – signs of abuse
- Abdominal exam – distention, masses, tenderness, bowel sounds
- Stool for blood/mucus
Infantile colic dx studies?
None indicated if weight gain appropriate
Differential dx for infantile colic?
- Differential diagnosis – all other causes of abdominal pain, UTI
What is the management for infantile colic?
- No treatment proven effective; lots of homeopathic suggestions
- Review strategies; offer suggestions
- Allow parents to talk about effects on family
- Acknowledge challenges; follow-up
Infantile colic puts the child at risk for?
CRYING PUTS THE INFANT/CHILD AT SIGNIFICANTLY INCREASED RISK OF CHILD ABUSE!
What are some complications of infantile colic?
- Poor parent-child interaction
- Early termination of breastfeeding, postpartum depression, shaken baby syndrome
- Unnecessary treatment for GERD
- Patient and family education for infantile colic?
Period of PURPLE Crying” –
Peak
Unpredictability
Resistance to soothing,
Pain-like expression
Long crying bouts
Evening clustering
What are the most common objects for foreign body?
- Coins and small toy objects most common
foreign body?
- Most FBs pass through gut without problems
Age of children that have foreign bodies?
- Most occur between 6 months and 3 years
Esophageal foreign bodies
- Thoracic inlet, mid-esophagus, LES most common
Esophageal foreign bodies sx’s?
- Choking, gagging, coughing initially
- Excessive salivation, dysphagia, food refusal, emesis, pain
- Stridor, wheezing, cyanosis, dyspnea may occur (aspiration)
Foreign body EMERGENCY
Disk batteries cause severe erosion* – emergency endoscopy essential
Abdominal foreign bodies
- Most FB reaching stomach will pass through
Abdominal foreign bodies
- If >5 cm diameter, 2 cm thickness, >10 cm long, may need to be retrieved
Abdominal foreign bodies
- Open safety pins/sharp objects should be retrieved
- Perforation occurs near sphincters, areas of angulation, malformations, areas of previous surgery
Abdominal foreign bodies
- Coins with nickel, multiple small magnets, lead, batteries may cause other significant problems
Rectal foreign bodies
- Blunt objects usually pass through
- Sharp/large objects should be retrieved
Foreign Body Ingestion
History – complete history of preceding events
Physical examination – HEENT to anus
Laboratory studies – specific findings unusual; labs not indicated
Imaging studies – most FB radiopaque
Foreign Body Ingestion Management
- Suction if drooling
- Esophageal FB should be considered impacted
- Disk batteries and magnets removed emergently
- Stomach/lower GI tract usually pass through – not magnets
- Send to ED for evaluation
Foreign Body complications?
- Perforation
- Systemic reactions to allergy/toxins
- Bacterial infection
