Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PED- TEST 3 > GI-Lecture part 5 > Flashcards

GI-Lecture part 5 Flashcards

1
Q

What is IBS?

A

Dysregulated immune response of intestinal mucosa to microbes in genetically susceptible persons

  • Crohn disease (CD)
  • Ulcerative colitis (UC)
  • Unclassified IBD (IBDU)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Crohn disease

A
  • Any part of GI tract; terminal ileum/colon most common
  • Esophageal disease in 20%; perianal disease common
  • Inflammation usually transmural – fissures and fistulas occur
  • “Skip” areas are unaffected areas of intestine
  • Environmental exposure may trigger abnormal immune reaction in genetically susceptible individual
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What condition has “Skip” areas are unaffected areas of intestine?

A

Chrons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should be included in the history of Chron’s disease?

A
  • Fever, weigh loss
  • Delayed growth velocity, short stature, delayed bone age
  • Arthralgias/arthritis in large joints
  • Obstructive symptoms associated with meals
  • Pain in umbilical region and RLQ
  • Anorexia
  • Malabsorption/lactose intolerance
  • Diarrhea, pain with stooling
  • Jaundice
  • Oral aphthous ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should be included on physical exam of Chron’s Disease?

A
  • Growth parameters
  • Abdominal exam – RLQ tenderness, inflammation
  • Perianal skin tags, deep anal fissures, perianal fistulas
  • Clubbing of digits may be present
  • Erythema nodosum common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnostic studies – Chron Disease?

A
  • Inflammatory markers
  • Nutritional labs
  • CBC, liver enzymes
  • Stool O&P, culture, fecal alpha 1-antitrypsin, fecal calprotectin assay
  • Bone age, bone density, abdominal films
  • Ileocolonoscopy, esophagoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differential diagnosis- Chron Disease?

A
  • RA, SLE, hypopituitarism, appendicitis, PUD, obstruction, lymphoma, anorexia, chronic granulomatous disease, sarcoidosis, growth failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management – Chron Disease?

A
  • Control disease
  • Prevent relapse
  • Achieve normal nutrition, growth, lifestyle
  • Pharmacologic, nutritional, surgical, psychosocial
  • Refer to pediatric gastroenterologist for colonoscopy, endoscopy, diagnosis, consultation
  • Corticosteroid management most common in U.S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management – Crohn Disease (Cont.)

A
  • Medications – prescribed by Pediatric GI
  • Corticosteroids
  • 5-Aminosalicylates
  • Immunomodulator agents
  • Biologic agents
  • Antibiotics for acute infections
  • Adjunctive therapy – growth hormone
  • Hospitalization, TPN, surgery when severe
  • Monitor growth, pubertal changes
  • Ophthalmologic exam
  • Nutritional counseling
  • Encourage participation in social activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications of Crohn Disease?

A
  • Intestinal obstruction/scarring
  • Growth failure
  • Fistula/abscess
  • Primary sclerosing cholangitis, pancreatitis, pericarditis, arthritis, peripheral neuropathy
  • Increased risk of lymphoma/colon cancer
  • Increased risk for opportunistic infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prevention and prognosis – Chron Disease

A
  • Follow therapy to prevent sequelae
  • Progressive; no cure, with remissions
  • Child-onset disease more severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ulcerative Colitis?

A
  • Chronic disease; diffuse inflammation of rectal/colonic mucosa
  • Involves rectum in 95% of cases
  • Multifactorial basis – heredity, diet, environment, immunologic, ineffective mucosal integrity
  • Incidence increased in developing nations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

History – Ulcerative colitis?

A
  • Fever
  • Anorexia / Weight loss
  • Delayed growth/sexual maturation
  • Diarrhea
  • Lower abdominal cramping
  • Pain increased before stooling/flatus
  • Bright red blood/mucus in stool
  • Nocturnal stooling
  • Oral aphthous ulcers
  • Skin lesions – erythema nodosum, pyoderma gangrenosum, diffuse papulonecrotic eruptions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Physical examination - Ulcerative Colitis

A
  • Growth parameters
  • Complete physical exam
  • Abdominal rebound tenderness if severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnostic studies – Ulcerative colitis?

A
  • CBC, iron-binding capacity, total protein, albumin, ESR, CRP
  • Stool for WBC, blood, culture
  • Bone age
  • Colonoscopy
  • Perinuclear neutrophil cytoplasmic antigen
  • Fecal calprotectin assay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Differential diagnosis – Ulcerative Colitis?

A
  • Shigella, Salmonella, Yersinia, Campylobacter, E. coli, C. difficile, IBS, self-limited colitis, Crohn disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management – Ulcerative Colitis?

A
  • Control disease
  • Prevent relapses
  • Achieve normal nutrition, growth, lifestyle
  • Refer for colonoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pharmacologic treatment options – individualized –
Ulcerative Colitis?

A
  • Mild-moderate: topical mesalamine, oral 5-ASAs, or topical steroids
  • Moderate-severe: systemic steroids
  • Thiopurines -immunosuppressive drugs; fight inflammation
  • Biologic agents
  • Hydrocortisone rectal for tenesmus (cramping rectal pain)
  • Cyclosporin monotherapy
  • Probiotics as adjunctive therapy
  • Curcumin to maintain inactive disease – Antioxidant/ anti-inflammatory
  • Iron supplementation to correct anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management – Ulcerative Colitis

A
  • Nutrition
  • High in protein/carbohydrate, normal fat, decreased roughage
  • Lactose poorly tolerated
  • Parenteral/enteral supplements
  • Refer for nutritional therapy
  • Monitor growth
  • Surgery – complete proctocolectomy curative
  • Ophthalmologic examination
  • Psychosocial therapy
  • Immunization status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Complications – Ulcerative colitis

A
  • Growth failure, toxic megacolon, intestinal perforation, liver disease, sepsis, colon cancer
  • Arthritis, uveitis, malnutrition, behavior problems
23
Q

Causes of Failure to
Thrive

Endo/Metabolic

A
  • Hypothyroidism
  • Diabetes mellitus
  • Adrenal insufficiency or excess
  • Parathyroid disorders
  • Pituitary disorders
  • Growth hormone deficiency
  • Inborn errors of metabolism
23
Q

Prevention and prognosis – Ulcerative Colitis

A
  • Follow therapy to optimize remission
  • Prognosis good - mild disease/those responding well to initial therapy
23
Q

Failure to Thrive

A
  • Lack of weight gain proportional to age
  • Disruptions in biologic, psychosocial, environmental factors contributing to growth and development

Three basic causes:
1. Inadequate caloric intake
2. Inadequate caloric absorption
3. Excessive caloric expenditure
* Onset between 2-4 months – usually congenital disorders
* Onset between 4-8 months – associated with feeding problems

23
Q

Causes of Failure to
Thrive

Gastrointestinal

A
  • GER
  • Crohn disease
  • Pyloric stenosis
  • Cleft palate / lip
  • Lactose intolerance
  • Hirschsprung disease
  • Hepatitis
  • Cirrhosis
  • Pancreatic insufficiency
  • Biliary disease
  • IBD
  • Malabsorption
23
Q

Pulmonary Failure to Thrive

A
  • Asthma
  • Bronchopulmonary dysplasia
  • CF
  • anatomic abnormalities of upper airway
  • OSA
  • Recurrent infected adenoids and tonsils
23
Q

Neurologic failure to thrive?

A
  • Mental retardation
  • Cerebral hemorrhage
  • Degenerative disorders
  • Cerebral palsy
24
Q

Cardiac failure to thrive?

A

Cardiac: Cardiac diseases leading to CHF

24
Q

Failure to Thrive
Clinical findings and risk factors

A
  • Poor weight gain associated with poor intake
  • Vomiting, food refusal, food fixation, abnormal feeding practices, anticipatory gagging, irritability
  • Chronic physical problems, psychosocial problems
  • Distinguish non-organic from organic etiology
  • Prenatal – maternal health, obstetric complications
  • Perinatal – birth weight, congenital anomalies, neurologic insults, NB screening results, weight for gestational age
  • Neonatal –intraventricular hemorrhage ( IVH), seizures, hypoxia, extreme hyperbilirubinemia, infection
  • Postnatal health – illness, hospitalization, chronic health, stooling/voiding history,
    ROS
  • Developmental trajectory/temperament
  • Family/psychosocial history
24
Q

Renal: failure to thrive?

A
  • UTI
  • Renal tubular acidosis
  • Diabetes insipidus
  • CKD
24
Q

Failure to Thrive
Diagnostic studies

A
  • Basic metabolic profile, vitamin D (calcidiol), lead, zinc, iron screening, albumin for protein status (severe FTT)
  • CBC/ESR, BMP, serum electrolytes (include total CO2 to rule out renal tubular acidosis), UA and culture, sweat test, stool studies for fat, reducing substances, O&P, and culture
  • Review of newborn metabolic screening tests
  • Extremity radiographs if indicated (e.g., rickets)
  • TSH, Chest radiograph, Renal ultrasound and voiding cystourethrography
  • HIV screening, Karyotype (especially in small girls for Turner syndrome), Bone age, Developmental testing, Growth hormone (expensive, often done later in workup)
24
Q

Causes of Failure to
Thrive

A

Infectious
* GI parasitic or bacterial infections
* TB
* HIV

Congenital - Many genetic abnormalities

Malignancy/immune
* Cancers of childhood
* Collagen-vascular disease
* JIRA

Nutritional - Lack of calories/micronutrients: Vit A, Zn, Fe

24
Q

Causes of Failure to
Thrive

A

Hematologic - Sickle cell disease and others

Prenatal - Small for gestational age, perinatal infection

Psychosocial
* Depression
* Anorexia nervosa, bulimia
* Maternal depression
* Child abuse or neglect
* ADHD
* Autism
* Chronic pain
Environmental - toxins

24
Q

Failure to Thrive
Physical examination

A
  • Weight, height, BMI, head circumference
  • Skinfold measurements
  • Vital signs
  • Hydration status
  • Dysmorphic features
  • Skin, hair, nails, mucous membranes
  • Evidence of abuse/neglect
  • Oral findings
  • Respiratory, cardiovascular, abdominal, endocrine, neurologic exam
24
Q

Failure to Thrive

Diagnostic studies

A
  • Feeding assessment
  • Developmental assessment
  • Laboratory/imaging
  • Failure to Thrive Evaluation
  • Complete dietary history
  • Complete psychosocial evaluation
24
Q

Failure to Thrive
Management??

A
  • Interdisciplinary team
  • Manage treatable causes
  • Restore nutritional intake
  • Provide nutritional rehabilitation
  • Parent education/support
  • Treat underlying chronic condition
  • Evaluate for weight gain every 1-3 weeks
  • Hospitalize if needed
25
Q

Failure to Thrive

Prognosis?

A
  • Most achieve expected growth/development
  • Severe effects on development and social/emotional health because of effects on brain in first 6 months
26
Q

Acute-Chronic Diarrhea

A
  • Altered intestinal mechanisms as result of:
  • Nonabsorbable solutes in GI tract; fluids exceed transport capacity
  • Invasion, inflammation, release of toxins by bacteria/viruses
  • Mutations in ion transport proteins
  • Altered anatomy of intestinal surface
  • Change in intestinal motility
  • Altered immune function
27
Q

Acute Diarrhea

A
  • Disruption of normal intestinal net absorption versus secretory mechanisms
  • Excessive loss of fluids into intestinal lumen
  • Dehydration, electrolyte imbalance, death may occur
  • Viruses, viral enterotoxin (rotavirus)
  • Bacteria, parasites, bacterial endotoxins, cytotoxins
  • 20% of child deaths worldwide
28
Q

Acute Diarrhea Organisms

A
  • Nontyphoidal Salmonella, Shigella, Campylobacter, E. coli, rotavirus, norovirus, enteric adenovirus, Giardia, Cryptosporidium, Strongyloides cause most disease
  • Dysentery – specific strains of Salmonella, Shigella
  • Cryptosporidium, E. coli O157:H7, Giardia, Listeria, Salmonella, Shigella, V. cholerae must be reported to CDC
29
Q

Acute Diarrhea

History

A
  • Pattern of diarrhea: onset, volume, frequency
  • Appearance of stool
  • Associated symptoms: pain, fever, vomiting
  • Number of wet diapers/voids in past 24 hours
  • Diet/changes in diet
  • Response to ORT
  • Food allergies
30
Q

Acute Diarrhea

History continued:

A
  • Family members/friends with similar symptoms
  • Day care, school, other exposure
  • Travel history, picnics
  • Recent weight/growth
  • Medications
  • Chemotherapy
  • Surgeries
31
Q

Acute Diarrhea

Physical examination?

A
  • Complete physical examination
  • Assess for dehydration
32
Q

Diagnostic studies for diarrhea?

A
  • Stool examination
  • Stool pH, reducing substances
  • Stool cultures for bloody/prolonged diarrhea
  • Electrolytes if indicated
  • CBC for serious disease
33
Q

Acute Diarrhea

Differential diagnosis

A
  • Gastroenteritis, antibiotic use most common
  • Systemic infection in infants/children
  • Food poisoning in older children/adolescents
  • Primary disaccharidase deficiency, Hirschsprung toxic colitis, adrenogenital syndrome, neonate opiate withdrawal, toxins
34
Q

Acute Diarrhea

Management

A
  • Maintain nutrition
  • Prescribe antibiotics prudently
  • Treat related conditions
  • Antidiarrheals – not recommended generally
  • Probiotics – treat acute diarrhea and ameliorate the risk of antibiotic-associated diarrhea
  • Oral enteric peppermint oil may cause smooth muscle relaxation
35
Q

Acute Diarrhea Complications?

A

dehydration, electrolyte imbalance, chronic diarrhea, etc

36
Q

Prevention of Diarrhea?

A
  • Good handwashing
  • Good sanitation/removal of soiled clothing and diapers
  • Avoid contaminated sources
  • Exclusive breastfeeding first 6 months
  • Vitamin A/zinc (used in developing nations)
  • Avoid unnecessary antibiotic usage
  • Rotavirus vaccine
37
Q

Chronic Diarrhea?

A
  • Loose stools of >10 mL/kg/day in infants; >200 g/day in older children
  • Result of intraluminal/mucosal factors affecting cellular mechanisms of GI tract
38
Q

What is the history for chronic diarrhea?

A
  • > 3 watery stools/day > 2 weeks
  • “Toddler’s diarrhea” – 10/day
  • Dietary history
  • Stool consistency, blood, mucus, food particles
  • Stool incontinence
  • Exposure to illness
  • Teething
  • Prior treatments for diarrhea
  • Recent travel
39
Q

What are the red flags for chronic diarrhea?

A

hematochezia/melena, persistent fever, weight loss, anemia

40
Q

What is the physical exam for chronic diarrhea?

A
  • Hydration status
  • Weight/height/growth retardation
  • Skin and hair
  • Vital signs
  • Thyroid enlargement
  • Respiratory symptoms
  • Clubbing of fingers
  • Abdominal examination/rectal examination
41
Q

Chronic Diarrhea Diagnostic Evaluation?

A
  • Stool – culture, O&P, pH, reducing substances, occult blood, leukocytes, fat/fecal elastase
  • CBC, electrolytes, albumin
  • UA, culture
  • ESR, CRP
  • Hormonal studies if secretory tumors suspected
  • Breath hydrogen test for lactose intolerance
  • Viral serologies
  • Sweat chloride test
  • Endoscopy, barium studies
42
Q

Chronic Diarrhea
Management

A
  • Treat underlying cause
  • Toddler’s diarrhea: normalize diet, remove offending
    fluids/foods, eliminate sorbitol, fructose, reduce fluid intake to
    <90 mL/kg/day
  • Treat carbohydrate malabsorption
  • Predigested formula for infants with post-gastroenteritis malabsorption syndrome
  • Refer: newborns with diarrhea in first hours of life; patients with growth delay or failure abnormal physical findings, or those with severe illness
43
Q

What are the complications of chronic diarrhea?

A
  • Malnutrition, growth failure

PED- TEST 3 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions