GI, nutrition and surgery Flashcards
Pancreatitis
when to start feeds
- within 48-72hrs once hemodynamically stable
monitor: hyperglycemia, pain - contraindications: ileus, complex fistulae, abdominal compartment syndrome
1st line therapy for H. pylori
PAM or PAC:
= PPI, amoxil, metronidazole
= PPI, amoxil, clarithromycin
1st steps for surgical abdomen after calling surger
- IV fluid bolus and antibiotics
Carbohydrates malabsorption causes
primary causes: enzyme deficiencies (rare)
- e,g, sucrase-isomaltase, trehalase, lactase
Dietary causes: saturation of normal enzyme levels e.g. toddler’s diarrhea
Syndromes associated with increased risk of celiac disease
- down syndrome
- turner syndrome
- Williams syndrome
- Type 1 diabetes
- IgA deficiency
- other autoimmune
- 1st degree relative with celiac
celiac disease extraintestinal manifestations
- dermatitis herpetiformis
- dental enamel hypoplasia
- osteopenia/osteoporosis
- short stature
- delayed puberty
- iron defiicency anemia
- hepatitis
- arthritis
- epilepsy with occipital lobe calcifications
Celiac test if < 2 yrs old
deaminaded gliadin peptide (DGP)
Difference vs. UC and Crohns
- rectum
- distribution
- terminal ileum
UC: rectum involved, difffuse distribution, TI not involved
CD: variable rectum involvement, segmental/diffuse distrubition, thick/stenosed TI
Difference UC vs. Crohns
- bowel wall
- mucosa
- stricture
- fistula
UC: bowel wall normal, hemorrhagic mucosa, rarely strictures or fistulas
CD: thickened bowel walls, cobblestones/deep ulcers of mucosa and common strictures and fistulas
UC vs Crohns
- erythema nodosum
- uveitis
- PSC
- granuloma
UC: rare erythema nodosum, common uveitis and PSC, NO granulomas
CD: common erythema nodosum, common uveitis, rare PSC, yes granulomas
IBD medications to INDUCE remission
- Tube feeds (Crohns only)
- 5-ASA (mild - UC only)
- steroids (common)
- biologics (severe)
IBD meds to maintain remisison
- tube feeds (Crohns only)
- 5-ASA (mild, UC only)
- Azathioprine (moderate)
- MTX (moderate)
- biologics (severe)
DDX of terminal ileitis
- Crohns
- lymphoma
- yersinia infection
- TB
- CGD
- severe eosinophilic gastroenteropathy
- lymphonodular hyperplasia (normal finding)
Organic constipation causes
- hypothyroidism
- celiac disease
- lead poisoning
- medications
- CF
- HYPERcalcemia
- HYPOkalemia
- Hirschprung
- CP
- NTD
Treatment guidelines for GER
- Infants: first trial hydrolyzed protein, AA based formula
- acid blockage (H2RB or PPI) for 8 weeks
- if no resolution, OR recurrence after weaning meds move to endoscopy and 24hr pH/impedance probe
Bloody diarrhea causes
- salmonella
- shigella
- yersinia
- campylobacter
- e.coli
To treat or not treat
Diarrheal infections
Dont treat: e.coli, shigella, salmonella
Support: cholera, yersinia
Consider: campylobacter
Treat: C. diff, parasites
Infantile colic definition
- episodes > 3hrs per day for 3days per week for > 1 week
- infant < 5 months of age
Irritable bowel syndrome features
Abdo pain at least 4x/month with at least 1 of the following symptoms:
- timing related to defecation
- change in frequency of stool
- change in form of stool
Common causes of neonatal cholestasis
- infections - UTI, e.coli, TORCH, sepsis, adenovirus
- biliary atresia
- choledochal cyst
- Alpha-1-antityrpsin deficiency
- hypothyroidism
- galactosemia
- mitochondrial
- PFIC
Hep B vaccine and immunoclobulin timing
- HBV within 12 hrs
- HBIG within 12 hours (max 7 days)
Treating children with Hep B if…
- HBsAG + for > 6 months
- ALT > 2x normal AND
- evidence of viral replication
OR - chronic hepatitis on liver biopsy
(treat with IFN-alpha or lamivudine)
alpha 1-antitrypsin
for protein losing enteropathy
fecal elastase
pancreatic insufficiency
Alvarado score (8 items)
- migratory R iliac fossa pain pain
- N+V
- anorexia
- tenderness in R iliac fossa
- rebound tenderness
- elevated temp
- leukocytosis
- left shift
Pyloric stenosis
lab findings
- metabolic alkalosis, hypochloremic
- paradoxical urine aciduria (mediated by aldosterone)
Intussusception non-op management and contraindications
non-op:
- hydrostatic reduction, pneumatic reduction
contraindications: peritoninitis, persistent hypotension, free air/pneumoperitoneum
Meckel’s diverticulum - rule of 2s
2% of population 2:1: male to female 2-6% symptomatic, complicated most symptoms by age 2 yrs within 2 feet of ileocecal valve 2 inches long
Meckel’s bleed
- painless, episodic, massive LGIB
- diagnose with 99Tc (Meckel’s) scan
Management CDH
antenatal diagnosis
- intubation on first breath
- NG tube to decompress stomach
- may need: mechanical ventilation, HFV, intropes, iNO, ECLS
- rule out other anomalies: cardiac echo, chromosomal anomalies
attempt repair if stable over initial 24-48hrs, or after ECLS decannulation
Most frequent associated major anomaly with EA-TEF
- cardiac
and needs work up for VACTERL
Bilious emesis in neonate DDX
- Hirschprung disease
- malrotation + midgut volvulus
- intestinal atresia
- ileus
Most common cardiac malformation associated with omphalocele
- Tetralogy of Fallot!
Gastroschisis vs. omphalocele
Gastroschisis: defect R of umbilicus, usually small, angry bowel, 10% associated with atresia and volvulus, prolonged ileus/GI dysfunction
Omphalocele: defect through umbilicus, can be giant, peritoneal sac, 50% associated with other anomalies esp cardiac, prompt recover of bowel function
Inguinal hernias
- surgiccal indications and timing
- all hernias should be repaired soon after diagnosis (median 2 weeks) (2x risk of incarceration if wait longer than 30 days)
- bilateral exploration if infant was prem
Cryptorchidism
- treatment
Main indication for tx = fertility
- surgical referral by 6-9 months of age