GI/Nutrition Flashcards
What is Rovsing sign
RLQ pain with palpation of the LLQ
- sign of appendicitis
what is Obturator sign
RLQ pain with internal rotation of the hip
- sign of appendicitis
what is the psoas sign
RLQ painw ith hip extension
- sign of appendicitis
What are clinical imaging options used for dx of appendicitis
US or Abdominal CT scan
what lab test results support appendicitis diagnosis
CBC with neutrophilia
what is the treatment of appendicitis
appendecotmy
what is Colic
severe and paryoxysmal crying in later afternoon and evening
what age does Colic Peak and typically end
peaks around 2-3 months and ends around 4 months
what are the Rule of 3s with Colic
Cry > 3 hours/day, 3days/week, for 3 weeks
what is the treatment for Colic
parent education and reassurance
what are the most common triggers for constipation in children
transitioning to solid foods
potty training
starting school
in children, what is the most accurate sign of moderate or severe dehydration
prolonged capillary refill
poor skin turgor
abnormal breathing
what scales are used to assess for dehydration
WHO scale for dehydration - 1mo- 5yo
Gorelick scale for dehydration - 1mo to 5 yo
what is duodenal atresia
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
What congenital syndrome is associated with duodenal atresia
down syndome
how is duodenal atresia diagnosed
often made prenatally
XR: double bubble
Malrotation: corckscrew
what is the treatment for duodenal atresia
suction/drain secretions - respiratory
elevate head, IV glucose, fluids and aBX
definitive: surgery
what is encopresis
fecal incontinence (voluntary or involuntary) in kids 4yo+
What is encopresis almost always associated with
severe constipation
- liquid stool leaks around hard, retained stool mass and is involuntarily released through distended anorectal canal
what are signs/symptoms of encopresis
abdominal pain, fecal mass
dilated rectum packed with stool
urinary frequency
how is encoporesis diagnosed
Rectal exam and KUB
what is the acute treament for encoporesis
PEG/Miralax
glycerin suppository for intacnts up to 3days
what is the chronic treatment for encoporesis
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
What are complications of foreign body aspirations
bowel perforation
bowel obstruction
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
what are common locations of GI obstructions?
cricopharyngeal
middle 1/3 espoghagus
lower esophageal spincter
pylorus
ileocecal valve
what foreign body objects always require surgical removal
button/disc batteries
risk of causing corrosive burns/tissue damage
What is gastroenteritis
aka infectious diarrhea
inflammation of GI tract that involves stomach and small intestine
what are signs/symptoms of gastroenteritis
diarrhea, anorexia, vomiting and abdominal pain
fever, lack of energy, myalgia, and dehydration
what are possible exposure causes of gastroenteritis
foreign travel, playing in a creek, daycare, poultry
(usually caused by virus)
what is the most common cause of viral gastroenteritis
Rotavirus in kids with severe disease
noroviurs m/c in adults, adenovirus and enterovirus
what is the most common parasitic cause of gastroenteritis
giardia
what is the most common cause of bacterial gastroenteritis
campylobacter or e/coli
how is gastroenteritis diagnosed
typically clinically
stool cultures
Labs: electrolytes, kidney functions
What pathogen is associated with traveler’s diarrhea
E-coli
what pathogen is associated with diarrhea after a picnic and egg salad?
Staphlyococcus Aureus
what pathogen is associated with diarrhea from shellfilsh
vibrio cholerae
what pathogen is associated with diarrhea from poultry or pork
salmonella
what pathogen is associated with diarrhea in a pt after antibiotics
C.difficile
what pathogen is associated with diarrhea in poorly canned home foods
C. perfringens
what pathogen is associated with diarrhea breakout in daycare center
Rotavirus
what pathogen is associated with diarrhea on cruise ship
Norovirus - vomitting and horrible muscle cramps
xwhat pathogen is associated with diarrhea after drinking from mountain stream water
Giardia lamblia
what is the treatment of viral gastroenteritis
symptomatic, fluids
(kids with rotavirus typically fully recover in 3-8days)
what is the treatment of bacterial gastroenteritis
abx recommended for kids with fever and bloody diarrhea
- cipro, doxy, azithro, bactrim
what are complications of GERD in kids
FTT, aspiration pneumonia, esophagitis, choking/apneic episodes, hematemesis, anemia, fussiness
what is one of the most common causes of GERD in kids
overfeeding
What is Neonatal hepatitis
idiopathic hepatic inflammation during neonatal period
what is the presentation of neonatal hepatitis
transient jaundice, acholic stools, liver failure, cirrhosis and portal HTN.
hepatomegally.
how is neonatal hepatitis diagnosed
clinical presentation, liver biopsy and exlusion of other causes of cholestasis
what is the treatment for neonatal hepatitis
Supportive
- increase in nurtritional support
- bile acid (ursodeoxycholic acid)
- liver transplant for severe liver failure
what are the common viral hepatitis’s seen in children and adolescents
Hepatitis A and B
what are clinical signs of acute hepatitis
anorexia, nauea, malaise, vomiting, jaundice, dark urine, abdominal pain and low-grade fever
how are viral hepatitis diagnosed
Liver enzymes
Anti-HAV IgM antibody (confirms Hep A)
HCV antibody (acute and chronic)
PCR
what is the treatment for viral hepatitis
immunizations
(HAV rec for all children, HBV series recommended for all infants in US)
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
What are the first signs of Hirschsprungs disease
babys inability to pass mecuonium, 48hours post partum
(constipation, vomiting and abdominal distention)
how is Hirschsprung disease diagnosed
rectal suction biopsy - revealing the absence or paucity of ganglion cells
Barium assisted radiography
DRE
what is the treatment of Hirschprungs disease
resection of affected segment or colostomy
What is the most common inguinal hernia in children
indirect inguinal hernia
what is an indirect inguinal hernia
passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrutum.
what is a direct inguinal hernia
passage of intestine through external inguinal ring at Hesselbachs triangle, rarely enters scrotum
what is the treatment of inguinal hernias
indirect: referral for elective repair
direct: monitor, surgical repair if preferred
what is intussusception
telescoping or invagination of a more proximal portion of the intestine into a more distal portion
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
what is the presentation of stool for those with intussusception
normal or have a blood, “currant jelly” appearance
how is intussusception diagnosed/treated
barium enema
what will be seen on abdominal x-ray with intussusception
Crescent sign or a Bulls’ eye/target sign/coiled spring lesion
at what level does neonatal jaundice appear
total bilirubin above 2 miligrams/dL
how is lactose intolerance definitively diagnosed
Lactose hydrogen breath test
value rises greater than 20ppm over baseline measurement
how is jaundice diagnosed
Coombs test
- positive: Rh or ABO incompatability
- neg: check hemoglobin levels
AST/ALT
Alk Phos
what vitamin is Niacin
Vitamin B3
what is Niacin deficiency
B3 deficiency causing pellegra characterized by a photosensitive pigmented dermatitis, diarrhea, and demnetia
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.
What are the 4Ds mneumonic for manifestations of niacin deficiency
Dermatitis - photosensitive, pigmented
Diarrhea - potentially vomiting
Dementia - anxiety, disorientation
Death - untreated pellagra potentially fatal
what is the Niacin replacement recommendations for children and adults
Children: 6-12mg daily
Adult males: 16mg daily
non-pregnant female: 14mg daily
what is pyloric stenosis
congenital condition leading to obstruction of pyloric valve causing vomiting as well as dehydration and metabolic alkalosis
how do you diagnose pyloric stenosis
Ultrasound - double-track
Barium studies - string sign/shoulder sign
labs: hypochloremic, hypokalemic metabolic alkalosis
what is the treatment for pyloric stenosis
surgical correction - pyloromyotomy
(Ramstedt’s procedure)
when does the umbilical ring typically completely close in children
by age 5+
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.
what does Vitamin A deficiency impair
immunity
hematopoiesis
what does vitamin A deficiency cause
rashes (dry skin)
typical ocular effects (dry eyes and night blindness)
what common foods are high in Vitamin A (retinols)
Liver, kidney, egg yolk and butter
where can provitamin A (beta-carotene) be found
green leafy vegetables, sweet potatoes and carrots
how is vitamin A deficiency diagnosed
usually clinical findings and supported with serum retinol levels
(less than 30micrograms/dL suggests deficiency)
deficiency in what is responsible for Scurvy
Vitamin C (asorbic acid) deficiency
what is the presentation of scurvy
swollen gums, brusing, petechiae, hermarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages and corscrew hair
what are risk factors for scurvy
food insecurity
feeding infants evaporated/boiled cows milk
Deficiency in what vitamin can cause rickets
Vitamin D
what is Rickets
softening of bones - bowed legs, fractures, costochondral thickening, dental concerns
