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PED- TEST 3 > GI-Lecture part 4 > Flashcards

GI-Lecture part 4 Flashcards

1
Q

What is appendicitis?

A
  • Inflammation of appendix leading to necrosis, perforation, peritonitis, abscess
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2
Q

What age is affected the most by appendicitis?

A
  • Average age 6-10 years; perforation more common in children <5 years
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3
Q

What is the history of appendicitis?

A
  • Sequence of symptoms
  • Pain shifting to RLQ
  • Nausea/vomiting after pain
  • Anorexia in 50% of children
  • Stool low volume with mucus
  • Fever neither sensitive nor specific
  • Scoring system useful (see box)
  • Perforation leads to lessening of symptoms
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4
Q

Score for appendicits? >5= yes

A
  • Nausea (2 points)
  • Focal RLQ pain (2 pts)
  • Migration of pain (1 pt)
  • Difficulty walking (1 pt)
  • Rebound tenderness and/ or pain with percussion (2 pts)
  • Absolute neutrophil count more than 6.75 × 103/µL (6 pts)
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5
Q

<5 score for appendicitis?

A

most likely not having appendicitis

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6
Q

Appendicitis Physical Exam?

A
  • Involuntary guarding, RLQ rebound tenderness; maximal pain at McBurney point
  • Heel-drop jarring test
  • Positive psoas sign, Rovsing sign
  • Tenderness, possible mass with rectal exam
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7
Q

True or False there will be a positive psoas sign and rovings sign for appendicitis?

A

True

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8
Q

DX studies for appendicitis?

A
  • CBC with differential
  • Amylase, lipase, liver enzymes to rule out other causes
  • UA, stool examination
  • US – enlargement of appendix; CT has highest accuracy
  • hCG to rule out pregnancy
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9
Q

Differential dx for appendicitis?

A
  • Gastroenteritis
  • Constipation
  • UTI
  • Pregnancy
  • PID
  • Intestinal obstruction
  • Peritonitis
  • Intussusception
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10
Q

Appendicitis Management?

A
  • Surgical consultation for appendectomy
  • Follow-up 2-4 weeks postoperatively
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11
Q

Appendicitis Complications?

A

Complications – perforation, peritonitis, abscess, ileus, obstruction, sepsis, shock, death

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12
Q

What is the most frequent cause of intestinal obstruction in children?

A

Intussusception

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13
Q
  • Invagination of bowel into colon, usually at ileocecal valve
    What is this?
A

Intussusception

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14
Q

Intussusception

A
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15
Q

Intussusception

A
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16
Q

Intussusception history & what is the classic triad?

A
  • Classic triad:
    1. intermittent colicky pain
    2. vomiting
    3. bloody mucous stools
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17
Q

Intussusception?

A
  • History of URI common
  • Lethargy common
  • Fever usually late sign of infarction/gangrene
  • Severe prostration possible
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18
Q

What do you see on physical exam with intussception?

A
  • Glassy-eyed, groggy between episodes
  • Sausage-like mass in RUQ
  • Distension, tenderness of abdomen
  • Grossly bloody or guaiac-positive stools
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19
Q

What are some dx tests for intussception?

A
  • Abdominal flat-plate radiograph may appear normal
  • Abdominal US very accurate
  • Air contrast enema both diagnostic and treatment modality
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20
Q

What are some differential dx for intussception?

A
  • Incarcerated hernia
  • Testicular torsion
  • Acute gastroenteritis
  • Appendicitis
  • Intestinal obstruction
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21
Q

What is the management for intussception?

A
  • Emergency consultation with pediatric radiologist and pediatric surgeon
  • Rehydration/stabilization; gastric decompression
  • Surgery if perforation/peritonitis
  • IV antibiotics prophylaxis
  • Observation after radiologic reduction
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22
Q

What are the complications for intussception?

A
  • Swelling, hemorrhage, incarceration, necrosis of bowel
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23
Q

Childhood Functional
Abdominal Pain (FAP)?

A
  • Recurrent abdominal pain with no specific organic etiology
  • More common than organic etiology
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24
Q
  • Rome III criteria (applies to multiple GI disorders):
    Childhood Functional
    Abdominal Pain (FAP)?
A
  • FAP at least once/week for at least 2 months:
  • Episodic or continuous abdominal pain
  • Insufficient criteria for other disorders
  • No evidence of inflammatory, anatomic, metabolic, neoplastic process
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25
Q

Childhood Functional
Abdominal Pain (FAP)

  • Cause?
A

Cause unclear; pain is genuine

26
Q

Childhood Functional
Abdominal Pain (FAP)

A
  • No evidence of visceral hypersensitivity in rectum, as with IBS
  • Involuntary predisposition for physiologic pain, temperament/personality, perfectionism increase FAP incidence
  • Positive/negative reinforcement can modify pain
27
Q

Childhood Functional
Abdominal Pain (FAP)
History?

A
  • Complete review of systems
  • Parental history of FAP
  • Psychosocial history
  • Associated symptoms
  • Comorbidity of anxiety/
  • depression
  • Alarm symptoms/red flags
  • Report of pain with dramatic
  • reaction
  • Symptoms worse in morning!
  • Pain medications do not alleviate pain
  • Illicit drug use, sexual activity
28
Q

Childhood Functional
Abdominal Pain (FAP)
Red Flags?

A
  • Localization of pain away from umbilicus, especially RUQ or LUQ
  • Pain associated with change in bowel habits: chronic, severe diarrhea; constipation; or nocturnal bowel movements
  • Pain assoc. with night wakening
  • Repetitive, significant emesis, especially if bilious
29
Q

Childhood Functional
Abdominal Pain (FAP)
Red Flags?
* Constitutional symptoms?

A

loss of appetite / energy, recurrent fever

30
Q
  • Recurrent abdominal pain in a child younger than 4 years
A

Childhood Functional
Abdominal Pain (FAP)
Red Flags?

31
Q

Childhood Functional
Abdominal Pain (FAP)
Physical examination

A
  • Growth parameters
  • Abdominal examination
  • Perianal/rectal examination
  • Neurologic examination
  • Pelvic examination if indicated
  • Skin and joints
32
Q

Childhood Functional
Abdominal Pain (FAP)
Alarm findings

A
  • Unexplained fever
  • Unintentional loss of weight or decline in height velocity
  • Organomegaly
  • Localized abdominal tenderness, particularly removed from the umbilicus
  • Perirectal abnormalities (e.g., fissures, ulceration, or skin tags)
  • Joint swelling, redness, heat, or discoloration
  • Ventral hernias of abdominal wall
33
Q

Childhood Functional
Abdominal Pain (FAP)
Diagnostic studies

A
  • Reserve testing if alarm symptoms present – CBC, ESR, CRP, UA, HP, serum IgA, IgG, iTg, US, endoscopy, esophageal pH
  • Initial approach to Diagnostic studies
  • CBC, ESR, amylase, lipase, UA, abdominal US
  • Three-day trial of lactose-free diet
  • Further testing not needed if results negative
  • Fecal calprotectin assay if changes in stool habits
34
Q

Childhood Functional
Abdominal Pain (FAP)
differential dx?

A

Differential diagnosis - All organic causes of abdominal pain

35
Q

How do you manage FAP?

A
  • Establish therapeutic parent-child-practitioner relationship
  • Explain brain-gut interaction
  • Use medications judiciously
  • Encourage return to school/normal activities
  • Consider CAM approaches
  • Explore psychological triggers
  • Identify, treat, refer for significant psychological issues
  • Discuss alarm symptoms
36
Q

What is the prognosis for FAP?

A

Can be lifelong/chronic

37
Q

Irritable Bowel
Syndrome (IBS)
What is it?

A
  • Chronic or functional abdominal pain (FAP) with altered bowel habits/bloating
  • Functional GI disorder
38
Q

What is the IBS Rome III criteria?

A
  • IBS Rome III criteria at least once/week for at least 2 months
  • Abdominal discomfort associated with >2 of the following
    >25% of time
  • Improved with defecation
  • Onset with change in frequency/form of stool
  • No evidence of inflammatory, anatomic, metabolic, neoplastic process
39
Q

IBS

A
  • Rome criteria
  • Abnormal stool frequency (>4/day or <2/week)
  • Abnormal stool form (watery or hard)
  • Abnormal stool passage (straining, urgency)
  • Passage of mucus
  • Bloating/distension
  • Dyspepsia
  • Potential triggering event/psychosocial factors
  • Family history of IBS
  • Psychosocial history
  • Nutrition history
40
Q

IBS

A

Physical examination
* Normal exam
* Absence of alarm signals
Diagnostic studies - None specific
Differential diagnosis – Same as FAP

41
Q

IBS Management?

A
  • Modify severity of symptoms
  • Antidepressants not widely used in children
  • Goals include improving quality of life – dietary changes, probiotics, drug therapy, biopsychosocial therapy
42
Q

IBS goals for management?

A

Goals include improving quality of life – dietary changes, probiotics, drug therapy, biopsychosocial therapy

43
Q

Celiac Disease (malabsorption syndrome)

A

immune-mediated; triggered by exposure to gluten, barley, rye

44
Q
  • Lactose intolerance (malabsorption syndrome)
A

abdominal pain, diarrhea, nausea, flatulence, bloating after ingestion of lactose- containing foods

45
Q
  • Cow’s Milk Protein Intolerance (CMPI) and cow’s-milk allergy
A

hypersensitivity to cow’s milk protein – cow’s milk allergy is antigen mediated

46
Q

Common history for malabsorption syndromes?

A
  • Careful histories/complete dietary history
  • Growth failure/delayed puberty
  • Voracious appetite or particular food avoidance
  • Chronic diarrhea/excessive flatus/distension
  • Pallor, fatigue, hair/skin abnormalities, clubbing, dizziness, cheilosis, glossitis, peripheral neuropathy
47
Q

Malabsorption Syndromes Physical Exam?

A
  • Growth parameters
  • Skinfold thickness/lean body mass
  • Delayed growth/puberty/Tanner staging
48
Q

Physical exam celiac disease?

A

FTT, iron-deficiency anemia, abdominal distension

49
Q

Physical exam for lactose intolerance?

A
  • Lactose intolerance – abdominal distension
  • CMPI or CMA – anaphylaxis, oral swelling, urticaria, rash, angioedema, nasal pruritis, rhinitis, wheezing, nausea/vomiting, diarrhea, bloody stool
50
Q

Dx testing for celiac disease?

A

serologic testing

51
Q

Dx testing for lactose intolerance?

A

lactose hydrogen breath test; trial of lactose-free diet

52
Q
  • CMPI/CMA dx testing?
A
  • CMPI/CMA – elimination diet; skin patch allergy tests, serum IgE
53
Q

What would a differential dx be for malabsorption syndromes?

A

organic and inorganic FTT; colic, short stature, chronic diarrhea, CF, immunodeficiency, cholestatic liver disease, GERD, IBD

54
Q

Management for celiac disease?

A
  • Celiac disease – strict GFD for life
55
Q

Management for lactose intolerance?

A

reduce lactose exposure and add lactase supplements

56
Q

Management for CMPI/CMA?

A
  • Breastfeed; restrict milk from diet of breastfeeding mothers
  • Extensively hydrolyzed soy formula
  • After 2 years, daily calcium intake of 600 to 800 mg
  • EpiPen
57
Q

What is a complication of celiac disease?

A

growth failure

58
Q

What is a complication of lactose intolerance?

A

bone density loss if inadequate calcium/Vit. D

59
Q

CMPI?

A
  • CMPI – usually resolves by age 3 years
60
Q

CMA?

A
  • CMA – cannot be reversed; high likelihood of other food allergies

PED- TEST 3 (22 decks)

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