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

GI- Lecture Part 3 Flashcards

1
Q

Abdominal Migraine

A
  • Part of continuum of migraine/cyclic vomiting
  • More typical in children
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2
Q

What is the Rome III criteria for functional GI disorders?

A

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

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3
Q

What is the Rome III migraine history?

A
  • Family history of migraine/motion sickness
  • History of motion sickness
  • Aura not frequent
  • Headache absent/minimal
  • Prodrome of fatigue/drowsiness
  • Abdominal Migraine
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4
Q

Abd migraine physical exam?

A

unremarkable unless during acute abdominal migraine

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5
Q

What are the dx tests for abdominal migraine?

A

Diagnostic studies – no definitive test; labs if needed to exclude other conditions

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6
Q

Differential diagnosis

A

obstructive GI/renal processes; biliary tract disease, recurrent pancreatitis, etc

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7
Q

Abd migraine management?

A

Management – identify/avoid triggers; sleep may relieve symptoms; antiemetics to abort; migraine prophylactic therapy

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8
Q

Prognosis for abd h/a?

A

migraine headaches later in life

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9
Q

GERD- watch YouTube videos!!

A
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10
Q

Eosinophillic
Esophagitis

A
  • 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
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11
Q

History and physical examination

A

similar history and exam to GERD

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12
Q

Eosinophillic
Esophagitis
dx studies?

A
  • upper endoscopy/biopsy
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13
Q

Management for Eosinophillic
Esophagitis?

A
  • 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)
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14
Q

What is the 6 food elimination diet?

A

6-food elimination diet: milk, soy, egg, wheat, peanut/tree nuts, and fish/shellfish

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15
Q

What is peptic ulcer disease?

A
  • Gastric and duodenal ulcers – gastritis to ulceration
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16
Q

What is primary peptic ulcer disease?

A
  • Most duodenal with no underlying cause
  • Tend to recur; more common in adolescents
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17
Q

What is secondary peptic ulcer disease?

A
  • More often gastric; usually more acute
  • Associated with ulcerogenic events
  • Head trauma, severe burns, corticosteroid and NSAID use
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18
Q
  • Idiopathic ulcers
A
  • Occur in HP-negative children with no history of NSAIDs
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19
Q
  • Zollinger-Ellison syndrome
A

rare; refractory PUD caused by gastric hypersecretion from autonomous secretion by neuroendocrine tumor

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20
Q

What is the history for peptic ulcer disease?

A
  • 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
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21
Q

What should you do for physical exam in peptic ulcer disease?

A
  • Growth parameters, vital signs
  • Assessment of perfusion, hydration
  • Mouth inspection for ulcers
  • Respiratory assessment – wheezing with GERD
  • Abdominal, rectal, pelvic examination
22
Q

What dx studies should you do for peptic ulcer disease?

A
  • CBC, ESR, CRP, and HP
  • Stool for guaiac
23
Q

What should you do for severe peptic ulcer disease?

A
  • 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
24
Q

What is the imaging studies for peptic ulcer disease?

A
  • Abdominal and/or chest radiograph
  • Upper GI series or angiography
  • Esophagogastroduodenoscopy (EGD)
25
Q

What differential dx for peptic ulcer disease?

A
  • 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
26
Q

What are the complications for peptic ulcer disease?

A

Complications -Acute hemorrhage, chronic blood loss, penetration of ulcer into abdominal cavity

27
Q

Infantile colic

A
  • Persistent crying in infants <3 months old
28
Q

Infantile colic

A
  • 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
29
Q

What is the history for infantile colic?

A
  • Symptoms fit rule of threes
  • Demands frequent feeding/fussy while feeding
  • Excessive gas
  • Inconsolable; “tense” or “tight”
30
Q

What are the red flags for infantile colic?

A
  • Red flags – apnea, cyanosis, difficulty breathing, excessive spitting/vomiting, stool retention
31
Q

What will you find on a physical exam for infantile colic?

A
  • Growth parameters, vital signs
  • Full body exam – signs of abuse
  • Abdominal exam – distention, masses, tenderness, bowel sounds
  • Stool for blood/mucus
32
Q

Infantile colic dx studies?

A

None indicated if weight gain appropriate

33
Q

Differential dx for infantile colic?

A
  • Differential diagnosis – all other causes of abdominal pain, UTI
34
Q

What is the management for infantile colic?

A
  • No treatment proven effective; lots of homeopathic suggestions
  • Review strategies; offer suggestions
  • Allow parents to talk about effects on family
  • Acknowledge challenges; follow-up
35
Q

Infantile colic puts the child at risk for?

A

CRYING PUTS THE INFANT/CHILD AT SIGNIFICANTLY INCREASED RISK OF CHILD ABUSE!

36
Q

What are some complications of infantile colic?

A
  • Poor parent-child interaction
  • Early termination of breastfeeding, postpartum depression, shaken baby syndrome
  • Unnecessary treatment for GERD
37
Q
  • Patient and family education for infantile colic?
A

Period of PURPLE Crying” –

Peak
Unpredictability
Resistance to soothing,
Pain-like expression
Long crying bouts
Evening clustering

38
Q

What are the most common objects for foreign body?

A
  • Coins and small toy objects most common
39
Q

foreign body?

A
  • Most FBs pass through gut without problems
40
Q

Age of children that have foreign bodies?

A
  • Most occur between 6 months and 3 years
41
Q

Esophageal foreign bodies

A
  • Thoracic inlet, mid-esophagus, LES most common
42
Q

Esophageal foreign bodies sx’s?

A
  • Choking, gagging, coughing initially
  • Excessive salivation, dysphagia, food refusal, emesis, pain
  • Stridor, wheezing, cyanosis, dyspnea may occur (aspiration)
43
Q

Foreign body EMERGENCY

A

Disk batteries cause severe erosion* – emergency endoscopy essential

44
Q

Abdominal foreign bodies

A
  • Most FB reaching stomach will pass through
45
Q

Abdominal foreign bodies

A
  • If >5 cm diameter, 2 cm thickness, >10 cm long, may need to be retrieved
46
Q

Abdominal foreign bodies

A
  • Open safety pins/sharp objects should be retrieved
  • Perforation occurs near sphincters, areas of angulation, malformations, areas of previous surgery
47
Q

Abdominal foreign bodies

A
  • Coins with nickel, multiple small magnets, lead, batteries may cause other significant problems
48
Q

Rectal foreign bodies

A
  • Blunt objects usually pass through
  • Sharp/large objects should be retrieved
49
Q

Foreign Body Ingestion

A

History – complete history of preceding events

Physical examination – HEENT to anus

Laboratory studies – specific findings unusual; labs not indicated

Imaging studies – most FB radiopaque

50
Q

Foreign Body Ingestion Management

A
  • 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
51
Q

Foreign Body complications?

A
  • Perforation
  • Systemic reactions to allergy/toxins
  • Bacterial infection

PED- TEST 3 (22 decks)

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