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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
Q

what are symptoms of esophageal foreign body

A

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

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25
Q

what are common locations of GI obstructions?

A

cricopharyngeal
middle 1/3 espoghagus
lower esophageal spincter
pylorus
ileocecal valve

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26
Q

what foreign body objects always require surgical removal

A

button/disc batteries

risk of causing corrosive burns/tissue damage

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27
Q

What is gastroenteritis

A

aka infectious diarrhea
inflammation of GI tract that involves stomach and small intestine

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28
Q

what are signs/symptoms of gastroenteritis

A

diarrhea, anorexia, vomiting and abdominal pain
fever, lack of energy, myalgia, and dehydration

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29
Q

what are possible exposure causes of gastroenteritis

A

foreign travel, playing in a creek, daycare, poultry
(usually caused by virus)

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30
Q

what is the most common cause of viral gastroenteritis

A

Rotavirus in kids with severe disease
noroviurs m/c in adults, adenovirus and enterovirus

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31
Q

what is the most common parasitic cause of gastroenteritis

A

giardia

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32
Q

what is the most common cause of bacterial gastroenteritis

A

campylobacter or e/coli

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33
Q

how is gastroenteritis diagnosed

A

typically clinically
stool cultures
Labs: electrolytes, kidney functions

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34
Q

What pathogen is associated with traveler’s diarrhea

A

E-coli

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35
Q

what pathogen is associated with diarrhea after a picnic and egg salad?

A

Staphlyococcus Aureus

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36
Q

what pathogen is associated with diarrhea from shellfilsh

A

vibrio cholerae

37
Q

what pathogen is associated with diarrhea from poultry or pork

A

salmonella

38
Q

what pathogen is associated with diarrhea in a pt after antibiotics

A

C.difficile

39
Q

what pathogen is associated with diarrhea in poorly canned home foods

A

C. perfringens

40
Q

what pathogen is associated with diarrhea breakout in daycare center

A

Rotavirus

41
Q

what pathogen is associated with diarrhea on cruise ship

A

Norovirus - vomitting and horrible muscle cramps

42
Q

xwhat pathogen is associated with diarrhea after drinking from mountain stream water

A

Giardia lamblia

43
Q

what is the treatment of viral gastroenteritis

A

symptomatic, fluids
(kids with rotavirus typically fully recover in 3-8days)

44
Q

what is the treatment of bacterial gastroenteritis

A

abx recommended for kids with fever and bloody diarrhea
- cipro, doxy, azithro, bactrim

45
Q

what are complications of GERD in kids

A

FTT, aspiration pneumonia, esophagitis, choking/apneic episodes, hematemesis, anemia, fussiness

46
Q

what is one of the most common causes of GERD in kids

A

overfeeding

47
Q

What is Neonatal hepatitis

A

idiopathic hepatic inflammation during neonatal period

48
Q

what is the presentation of neonatal hepatitis

A

transient jaundice, acholic stools, liver failure, cirrhosis and portal HTN.
hepatomegally.

49
Q

how is neonatal hepatitis diagnosed

A

clinical presentation, liver biopsy and exlusion of other causes of cholestasis

50
Q

what is the treatment for neonatal hepatitis

A

Supportive
- increase in nurtritional support
- bile acid (ursodeoxycholic acid)
- liver transplant for severe liver failure

51
Q

what are the common viral hepatitis’s seen in children and adolescents

A

Hepatitis A and B

52
Q

what are clinical signs of acute hepatitis

A

anorexia, nauea, malaise, vomiting, jaundice, dark urine, abdominal pain and low-grade fever

53
Q

how are viral hepatitis diagnosed

A

Liver enzymes
Anti-HAV IgM antibody (confirms Hep A)
HCV antibody (acute and chronic)
PCR

54
Q

what is the treatment for viral hepatitis

A

immunizations
(HAV rec for all children, HBV series recommended for all infants in US)

55
Q

What is Hirschsprung disease

A

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
Q

What are the first signs of Hirschsprungs disease

A

babys inability to pass mecuonium, 48hours post partum
(constipation, vomiting and abdominal distention)

57
Q

how is Hirschsprung disease diagnosed

A

rectal suction biopsy - revealing the absence or paucity of ganglion cells
Barium assisted radiography
DRE

58
Q

what is the treatment of Hirschprungs disease

A

resection of affected segment or colostomy

59
Q

What is the most common inguinal hernia in children

A

indirect inguinal hernia

60
Q

what is an indirect inguinal hernia

A

passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrutum.

61
Q

what is a direct inguinal hernia

A

passage of intestine through external inguinal ring at Hesselbachs triangle, rarely enters scrotum

62
Q

what is the treatment of inguinal hernias

A

indirect: referral for elective repair
direct: monitor, surgical repair if preferred

63
Q

what is intussusception

A

telescoping or invagination of a more proximal portion of the intestine into a more distal portion

64
Q

what age is the peak incidence for intussusception

A

5-9 months
most common cause of bowel obstruction after neonatal period in infants less than 2yo

65
Q

what is the presentation of stool for those with intussusception

A

normal or have a blood, “currant jelly” appearance

66
Q

how is intussusception diagnosed/treated

A

barium enema

67
Q

what will be seen on abdominal x-ray with intussusception

A

Crescent sign or a Bulls’ eye/target sign/coiled spring lesion

68
Q

at what level does neonatal jaundice appear

A

total bilirubin above 2 miligrams/dL

69
Q

how is lactose intolerance definitively diagnosed

A

Lactose hydrogen breath test
value rises greater than 20ppm over baseline measurement

69
Q

how is jaundice diagnosed

A

Coombs test
- positive: Rh or ABO incompatability
- neg: check hemoglobin levels
AST/ALT
Alk Phos

70
Q

what vitamin is Niacin

A

Vitamin B3

71
Q

what is Niacin deficiency

A

B3 deficiency causing pellegra characterized by a photosensitive pigmented dermatitis, diarrhea, and demnetia

72
Q

what is Pellagra

A

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
Q

What are the 4Ds mneumonic for manifestations of niacin deficiency

A

Dermatitis - photosensitive, pigmented
Diarrhea - potentially vomiting
Dementia - anxiety, disorientation
Death - untreated pellagra potentially fatal

74
Q

what is the Niacin replacement recommendations for children and adults

A

Children: 6-12mg daily
Adult males: 16mg daily
non-pregnant female: 14mg daily

75
Q

what is pyloric stenosis

A

congenital condition leading to obstruction of pyloric valve causing vomiting as well as dehydration and metabolic alkalosis

76
Q

how do you diagnose pyloric stenosis

A

Ultrasound - double-track
Barium studies - string sign/shoulder sign
labs: hypochloremic, hypokalemic metabolic alkalosis

77
Q

what is the treatment for pyloric stenosis

A

surgical correction - pyloromyotomy
(Ramstedt’s procedure)

78
Q

when does the umbilical ring typically completely close in children

A

by age 5+

79
Q

what is the treatment of umbilical hernias

A

typically resolve on their own and rarely need intervention
refer for surgery if it persists >2years of life.

80
Q

what does Vitamin A deficiency impair

A

immunity
hematopoiesis

81
Q

what does vitamin A deficiency cause

A

rashes (dry skin)
typical ocular effects (dry eyes and night blindness)

82
Q

what common foods are high in Vitamin A (retinols)

A

Liver, kidney, egg yolk and butter

83
Q

where can provitamin A (beta-carotene) be found

A

green leafy vegetables, sweet potatoes and carrots

84
Q

how is vitamin A deficiency diagnosed

A

usually clinical findings and supported with serum retinol levels
(less than 30micrograms/dL suggests deficiency)

85
Q

deficiency in what is responsible for Scurvy

A

Vitamin C (asorbic acid) deficiency

86
Q

what is the presentation of scurvy

A

swollen gums, brusing, petechiae, hermarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages and corscrew hair

87
Q

what are risk factors for scurvy

A

food insecurity
feeding infants evaporated/boiled cows milk

88
Q

Deficiency in what vitamin can cause rickets

A

Vitamin D

89
Q

what is Rickets

A

softening of bones - bowed legs, fractures, costochondral thickening, dental concerns

Pediatrics - clinical (13 decks)

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