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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
Childhood Functional Abdominal Pain (FAP) * Cause?
Cause unclear; pain is genuine
26
Childhood Functional Abdominal Pain (FAP)
* 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
Childhood Functional Abdominal Pain (FAP) History?
* 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
Childhood Functional Abdominal Pain (FAP) Red Flags?
* 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
Childhood Functional Abdominal Pain (FAP) Red Flags? * Constitutional symptoms?
loss of appetite / energy, recurrent fever
30
* Recurrent abdominal pain in a child younger than 4 years
Childhood Functional Abdominal Pain (FAP) Red Flags?
31
Childhood Functional Abdominal Pain (FAP) Physical examination
* Growth parameters * Abdominal examination * Perianal/rectal examination * Neurologic examination * Pelvic examination if indicated * Skin and joints
32
Childhood Functional Abdominal Pain (FAP) Alarm findings
* 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
Childhood Functional Abdominal Pain (FAP) Diagnostic studies
* 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
Childhood Functional Abdominal Pain (FAP) differential dx?
Differential diagnosis - All organic causes of abdominal pain
35
How do you manage FAP?
* 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
What is the prognosis for FAP?
Can be lifelong/chronic
37
Irritable Bowel Syndrome (IBS) What is it?
* Chronic or functional abdominal pain (FAP) with altered bowel habits/bloating * Functional GI disorder
38
What is the IBS Rome III criteria?
* 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
IBS
* 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
IBS
Physical examination * Normal exam * Absence of alarm signals Diagnostic studies - None specific Differential diagnosis – Same as FAP
41
IBS Management?
* Modify severity of symptoms * Antidepressants not widely used in children * Goals include improving quality of life – dietary changes, probiotics, drug therapy, biopsychosocial therapy
42
IBS goals for management?
Goals include improving quality of life – dietary changes, probiotics, drug therapy, biopsychosocial therapy
43
Celiac Disease (malabsorption syndrome)
immune-mediated; triggered by exposure to gluten, barley, rye
44
* Lactose intolerance (malabsorption syndrome)
abdominal pain, diarrhea, nausea, flatulence, bloating after ingestion of lactose- containing foods
45
* Cow’s Milk Protein Intolerance (CMPI) and cow’s-milk allergy
hypersensitivity to cow’s milk protein – cow’s milk allergy is antigen mediated
46
Common history for malabsorption syndromes?
* 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
Malabsorption Syndromes Physical Exam?
* Growth parameters * Skinfold thickness/lean body mass * Delayed growth/puberty/Tanner staging
48
Physical exam celiac disease?
FTT, iron-deficiency anemia, abdominal distension
49
Physical exam for lactose intolerance?
* Lactose intolerance – abdominal distension * CMPI or CMA – anaphylaxis, oral swelling, urticaria, rash, angioedema, nasal pruritis, rhinitis, wheezing, nausea/vomiting, diarrhea, bloody stool
50
Dx testing for celiac disease?
serologic testing
51
Dx testing for lactose intolerance?
lactose hydrogen breath test; trial of lactose-free diet
52
* CMPI/CMA dx testing?
* CMPI/CMA – elimination diet; skin patch allergy tests, serum IgE
53
What would a differential dx be for malabsorption syndromes?
organic and inorganic FTT; colic, short stature, chronic diarrhea, CF, immunodeficiency, cholestatic liver disease, GERD, IBD
54
Management for celiac disease?
* Celiac disease – strict GFD for life
55
Management for lactose intolerance?
reduce lactose exposure and add lactase supplements
56
Management for CMPI/CMA?
* 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
What is a complication of celiac disease?
growth failure
58
What is a complication of lactose intolerance?
bone density loss if inadequate calcium/Vit. D
59
CMPI?
* CMPI – usually resolves by age 3 years
60
CMA?
* CMA – cannot be reversed; high likelihood of other food allergies

PED- TEST 3 (22 decks)

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