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Pediatrics - clinical > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

What is Rovsing sign

A

RLQ pain with palpation of the LLQ
- sign of appendicitis

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1
Q

what is Obturator sign

A

RLQ pain with internal rotation of the hip
- sign of appendicitis

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2
Q

what is the psoas sign

A

RLQ painw ith hip extension
- sign of appendicitis

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3
Q

What are clinical imaging options used for dx of appendicitis

A

US or Abdominal CT scan

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4
Q

what lab test results support appendicitis diagnosis

A

CBC with neutrophilia

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5
Q

what is the treatment of appendicitis

A

appendecotmy

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6
Q

what is Colic

A

severe and paryoxysmal crying in later afternoon and evening

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7
Q

what age does Colic Peak and typically end

A

peaks around 2-3 months and ends around 4 months

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8
Q

what are the Rule of 3s with Colic

A

Cry > 3 hours/day, 3days/week, for 3 weeks

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9
Q

what is the treatment for Colic

A

parent education and reassurance

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10
Q

what are the most common triggers for constipation in children

A

transitioning to solid foods
potty training
starting school

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11
Q

in children, what is the most accurate sign of moderate or severe dehydration

A

prolonged capillary refill
poor skin turgor
abnormal breathing

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12
Q

what scales are used to assess for dehydration

A

WHO scale for dehydration - 1mo- 5yo
Gorelick scale for dehydration - 1mo to 5 yo

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13
Q

what is duodenal atresia

A

congenital absence or complete closure of a portion of the lumen of the duodenum
causing an increase level of amniotic fluid during pregnancy and intestinal obstruction in newborn babies

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14
Q

What congenital syndrome is associated with duodenal atresia

A

down syndome

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15
Q

how is duodenal atresia diagnosed

A

often made prenatally
XR: double bubble
Malrotation: corckscrew

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16
Q

what is the treatment for duodenal atresia

A

suction/drain secretions - respiratory
elevate head, IV glucose, fluids and aBX
definitive: surgery

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17
Q

what is encopresis

A

fecal incontinence (voluntary or involuntary) in kids 4yo+

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18
Q

What is encopresis almost always associated with

A

severe constipation
- liquid stool leaks around hard, retained stool mass and is involuntarily released through distended anorectal canal

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19
Q

what are signs/symptoms of encopresis

A

abdominal pain, fecal mass
dilated rectum packed with stool
urinary frequency

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20
Q

how is encoporesis diagnosed

A

Rectal exam and KUB

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21
Q

what is the acute treament for encoporesis

A

PEG/Miralax
glycerin suppository for intacnts up to 3days

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22
Q

what is the chronic treatment for encoporesis

A

elimination of all cow’s millk (1-2wk trial)
maintenance laxatives for 6mo-1yr
high fiber diet and increase fluids
toilet sitting same time 5-10 min after meals

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23
Q

What are complications of foreign body aspirations

A

bowel perforation
bowel obstruction

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24
what are symptoms of esophageal foreign body
bloody saliva, coughing, drooling, dysphagia, failure to thrive, decreased feeding, gagging, irritability, neck/throat/chest pain, recurrent aspiration pneumonia, respiratory distress, stridor, tachypnea, vomiting, wehezing
25
what are common locations of GI obstructions?
cricopharyngeal middle 1/3 espoghagus lower esophageal spincter pylorus ileocecal valve
26
what foreign body objects always require surgical removal
button/disc batteries ## Footnote risk of causing corrosive burns/tissue damage
27
What is gastroenteritis
aka infectious diarrhea inflammation of GI tract that involves stomach and small intestine
28
what are signs/symptoms of gastroenteritis
diarrhea, anorexia, vomiting and abdominal pain fever, lack of energy, myalgia, and dehydration
29
what are possible exposure causes of gastroenteritis
foreign travel, playing in a creek, daycare, poultry (usually caused by virus)
30
what is the most common cause of viral gastroenteritis
Rotavirus in kids with severe disease noroviurs m/c in adults, adenovirus and enterovirus
31
what is the most common parasitic cause of gastroenteritis
giardia
32
what is the most common cause of bacterial gastroenteritis
campylobacter or e/coli
33
how is gastroenteritis diagnosed
typically clinically stool cultures Labs: electrolytes, kidney functions
34
What pathogen is associated with traveler's diarrhea
E-coli
35
what pathogen is associated with diarrhea after a picnic and egg salad?
Staphlyococcus Aureus
36
what pathogen is associated with diarrhea from shellfilsh
vibrio cholerae
37
what pathogen is associated with diarrhea from poultry or pork
salmonella
38
what pathogen is associated with diarrhea in a pt after antibiotics
C.difficile
39
what pathogen is associated with diarrhea in poorly canned home foods
C. perfringens
40
what pathogen is associated with diarrhea breakout in daycare center
Rotavirus
41
what pathogen is associated with diarrhea on cruise ship
Norovirus - vomitting and horrible muscle cramps
42
xwhat pathogen is associated with diarrhea after drinking from mountain stream water
Giardia lamblia
43
what is the treatment of viral gastroenteritis
symptomatic, fluids (kids with rotavirus typically fully recover in 3-8days)
44
what is the treatment of bacterial gastroenteritis
abx recommended for kids with fever and bloody diarrhea - cipro, doxy, azithro, bactrim
45
what are complications of GERD in kids
FTT, aspiration pneumonia, esophagitis, choking/apneic episodes, hematemesis, anemia, fussiness
46
what is one of the most common causes of GERD in kids
overfeeding
47
What is Neonatal hepatitis
idiopathic hepatic inflammation during neonatal period
48
what is the presentation of neonatal hepatitis
transient jaundice, acholic stools, liver failure, cirrhosis and portal HTN. hepatomegally.
49
how is neonatal hepatitis diagnosed
clinical presentation, liver biopsy and exlusion of other causes of cholestasis
50
what is the treatment for neonatal hepatitis
Supportive - increase in nurtritional support - bile acid (ursodeoxycholic acid) - liver transplant for severe liver failure
51
what are the common viral hepatitis's seen in children and adolescents
Hepatitis A and B
52
what are clinical signs of acute hepatitis
anorexia, nauea, malaise, vomiting, jaundice, dark urine, abdominal pain and low-grade fever
53
how are viral hepatitis diagnosed
Liver enzymes Anti-HAV IgM antibody (confirms Hep A) HCV antibody (acute and chronic) PCR
54
what is the treatment for viral hepatitis
immunizations (HAV rec for all children, HBV series recommended for all infants in US)
55
What is Hirschsprung disease
congenital aganglionic bowel disease caused by lack of caudal migration of the ganglipon cells from the neural crest Produces contraction of distal segment of colon causing obstruction with proximal dilation
56
What are the first signs of Hirschsprungs disease
babys inability to pass mecuonium, 48hours post partum (constipation, vomiting and abdominal distention)
57
how is Hirschsprung disease diagnosed
rectal suction biopsy - revealing the absence or paucity of ganglion cells Barium assisted radiography DRE
58
what is the treatment of Hirschprungs disease
resection of affected segment or colostomy
59
What is the most common inguinal hernia in children
indirect inguinal hernia
60
what is an indirect inguinal hernia
passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrutum.
61
what is a direct inguinal hernia
passage of intestine through external inguinal ring at Hesselbachs triangle, rarely enters scrotum
62
what is the treatment of inguinal hernias
indirect: referral for elective repair direct: monitor, surgical repair if preferred
63
what is intussusception
telescoping or invagination of a more proximal portion of the intestine into a more distal portion
64
what age is the peak incidence for intussusception
5-9 months most common cause of bowel obstruction after neonatal period in infants less than 2yo
65
what is the presentation of stool for those with intussusception
normal or have a blood, "currant jelly" appearance
66
how is intussusception diagnosed/treated
barium enema
67
what will be seen on abdominal x-ray with intussusception
Crescent sign or a Bulls' eye/target sign/coiled spring lesion
68
at what level does neonatal jaundice appear
total bilirubin above 2 miligrams/dL
69
how is lactose intolerance definitively diagnosed
Lactose hydrogen breath test value rises greater than 20ppm over baseline measurement
69
how is jaundice diagnosed
Coombs test - positive: Rh or ABO incompatability - neg: check hemoglobin levels AST/ALT Alk Phos
70
what vitamin is Niacin
Vitamin B3
71
what is Niacin deficiency
B3 deficiency causing pellegra characterized by a photosensitive pigmented dermatitis, diarrhea, and demnetia
72
what is Pellagra
a systemic disease caused by a severe deficiency of niacin (vitamin B3). It affects the whole body and can eventually lead to death. Primary pellagra is caused by a lack of niacin in your diet.
73
What are the 4Ds mneumonic for manifestations of niacin deficiency
Dermatitis - photosensitive, pigmented Diarrhea - potentially vomiting Dementia - anxiety, disorientation Death - untreated pellagra potentially fatal
74
what is the Niacin replacement recommendations for children and adults
Children: 6-12mg daily Adult males: 16mg daily non-pregnant female: 14mg daily
75
what is pyloric stenosis
congenital condition leading to obstruction of pyloric valve causing vomiting as well as dehydration and metabolic alkalosis
76
how do you diagnose pyloric stenosis
Ultrasound - double-track Barium studies - string sign/shoulder sign labs: hypochloremic, hypokalemic metabolic alkalosis
77
what is the treatment for pyloric stenosis
surgical correction - pyloromyotomy (Ramstedt's procedure)
78
when does the umbilical ring typically completely close in children
by age 5+
79
what is the treatment of umbilical hernias
typically resolve on their own and rarely need intervention refer for surgery if it persists >2years of life.
80
what does Vitamin A deficiency impair
immunity hematopoiesis
81
what does vitamin A deficiency cause
rashes (dry skin) typical ocular effects (dry eyes and night blindness)
82
what common foods are high in Vitamin A (retinols)
Liver, kidney, egg yolk and butter
83
where can provitamin A (beta-carotene) be found
green leafy vegetables, sweet potatoes and carrots
84
how is vitamin A deficiency diagnosed
usually clinical findings and supported with serum retinol levels (less than 30micrograms/dL suggests deficiency)
85
deficiency in what is responsible for Scurvy
Vitamin C (asorbic acid) deficiency
86
what is the presentation of scurvy
swollen gums, brusing, petechiae, hermarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages and corscrew hair
87
what are risk factors for scurvy
food insecurity feeding infants evaporated/boiled cows milk
88
Deficiency in what vitamin can cause rickets
Vitamin D
89
what is Rickets
softening of bones - bowed legs, fractures, costochondral thickening, dental concerns

Pediatrics - clinical (13 decks)

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