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Pediatric EOR > GI / Nutritional > Flashcards

GI / Nutritional Flashcards

1
Q

Most common causes of appendicitis

A
  1. Fecalith (MC)
  2. Inflammation
  3. Malignancy
  4. Foreign Body
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2
Q

Vomiting usually occurs ________ pain in appendicitis

A

After

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3
Q

RLQ with LLQ palpation

A

Rovsing Sign

Appendicitis

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4
Q

RLQ pain with internal and external hip rotation with flexed knee

A

Obturator Sign

Appendicitis

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5
Q

RLQ pain with right hip flexion/extension (right leg against resistance)

A

Psoas Sign

Appendicitis

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6
Q

Diagnosis for appendicitis

A
  1. CT scan
  2. Ultrasound
  3. Leukocytosis
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7
Q

Otherwise healthy infant aged 2-3 months seems to be in pain, cries for more than 3 hours a day for more than 3 days a week, for more than 3 weeks

A

Colic

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8
Q

Severe paroxysmal crying that occurs mainly in late afternoon

A

Colic

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9
Q

Transient relaxation of LES leading to esophageal mucosal injury

A

GERD

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10
Q

Complications of GERD (4)

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
  4. Esophageal carcinoma
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11
Q

Sign/symptoms of GERD

A
  1. Heartburn (hallmark) - sometimes retrosternal and postprandial
  2. Regurgitation (acidic taste)
  3. Dysphagia, cough at night
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12
Q

Alarm symptoms of GERD

A
  1. Dysphagia
  2. Odynophagia
  3. Weight loss
  4. Bleeding (suspect malignancy)
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13
Q

Diagnosis of GERD

A

Clinical diagnosis

  1. Endoscopy often first
  2. Esophageal manometry
  3. 24 hour ambulatory pH monitoring - gold standard
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14
Q

Lifestyle modifications for GERD

A 
Elevation of head of bed by six inches
Avoid recumbency for three hours after eating
Eat small meals
Avoid certain foods
Decrease fat and EtOH intake
Weight loss
smoking cessation
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15
Q

Pharmacological therapy for GERD

A
  1. Antacids and OTC H2 receptor antagonists
  2. PPI and prokinetic agents (cisapride)
  3. Nissen fundoplication if refractory
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16
Q

Dyssynergic defecation, slow transit, and IBS-constipation type

A

Primary causes of constipation

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17
Q

DM, hypothyroid, hypercalcemia, intestinal mass, Parkinson’s disease, anal stricture, and medications

A

Secondary causes of constipation

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18
Q

Alarm symptoms of constipation

A
  1. Hematochezia
  2. Weight loss
  3. Fam hx of colon CA
  4. Anemia
  5. Heme positive stools
  6. Severe persistent constipation
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19
Q

Diagnosis of constipation

A
  1. Rectal exam - r/o masses, fissures, sphincter tone

2. Colonoscopy if alarm sx

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20
Q

Treatment of constipation

A
  1. Increase fluids, exercise, develop bowel pattern
  2. Fiber of 25 g daily
  3. Bulk/osmotic laxatives
  4. Prunes are an alternative
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21
Q

Hypertrophy and hyperplasia of the muscular layers of the pylorus

A

Pyloric Stenosis

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22
Q

Most common cause of intestinal obstructioni n infancy

A

Pyloric stenosis

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23
Q

95% of pyloric stenosis present in the first ___________ of life, and the condition rarely presents after ____________

A

3-12 weeks

> 6 months

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24
Q

Physical exam signs of pyloric stenosis

A

Signs of dehydration/malnutrition
Hypochloremic metabolic acidosis
Jaundice
Olive-shaped, nontender, mobile, hard pyloric

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25
Diagnosis of pyloric stenosis
1. Ultrasound - first line | 2. Upper GI contrast (string sign)
26
Treatment of pyloric stenosis
1. Rehydration | 2. PYloromyotomy
27
Intestinal segment invaginates/telescopes into adjoining intestinal lumen, leading to bowel obstruction
Intussusception
28
Most patients with intussusception are between ______________ of age
6-18 months
29
Intussusception most commonly occurs at the:
Ileocolic junction
30
Intussusception often occurs after:
Viral infection
31
Lead points for intussusception
1. Meckel diverticulum 2. Enlarged mesenteric lymph node 3. Hyperplasia of peyer's patches 4. Benign/malignant tumor 5. Henoch-schonlein purpura 6. Foreign body
32
Classic triad of intussusception
1. Vomiting 2. Abdominal pain 3. Passage of blood per rectum "currant jelly stool"
33
Physical exam of intussusception
"Dance's Sign" | Sausage-shaped mass in RUQ or hypochondrium and emptiness in RLQ
34
Diagnosis of intussusception
Barium contrast enema (often diagnostic and therapeutic) | Radiographs - lack of gas in the bowels
35
Management of intussusception
Barium or air insufflation Hydration (IV fluids) Surgical resection if refractory
36
Congenital absence of ganglion cells leading to functional obstruction
Hirschsprung disease
37
Hirschsprung disease occurs most commonly in the:
Distal colon and rectum (75%)
38
Increased incidence of hirschsprung disease in:
Males and down syndrome
39
Pathophysiology behind hirschsprung disease
1. Absence of enteric ganglion cells: failure of complete neural crest migration 2. Functional obstruction due to failure of relaxation of aganglionic segment. 3. Enterocolitis - vomiting, diarrhea signs of toxic megacolon
40
Signs/symptoms of hirschsprung disease
1. Neonatal intestinal obstruction - failure of meconium passage > 48 hours 2. Bilious vomiting, abdominal distention, failure to thrive 3. Enterocolitis - vomiting, diarrhea, signs of toxic megacolon 4. Chronic constipation
41
Diagnosis of hirschsprung disease
1. Anorectal manometry - lack of relaxation of internal sphincter with balloon rectal distention. Often used as initial screening test 2. Contrast enema 3. Abdominal radiographs 4. Rectal biopsy - definitive - shows absence of ganglion cells
42
Management of hirschsprung disease
Surgical resection of the affected bowel
43
Repeated passage of stool into inappropriate places by child chronologically or developmentally > 4 years
Encopresis
44
>90% of cases of encopresis result from
Constipation
45
Diagnosis of encopresis
Rectal exam | Abdominal XR
46
Treatment of encopresis
Oral laxatives or enema Treatment can be monitored by abdominal XRs Establish bowel regimen
47
Inflammation of the liver caused by 5 different viruses
Viral hepatitis
48
Hepatitis __, __, and __ are transmitted through bodily fluids, while __ and __ are transmitted through the fecal-oral route
BCD | AE
49
Hepatitis __ requires co-infection with hepatitis __
D | B
50
Signs/symptoms of viral hepatitis
1. Fever, fatigue 2. N/V 3. Abd pain 4. Dark discolored urine (secondary to conjugated hyperbilirubinemia) 5. Jaundice
51
Hepatitis __ and __ will usually be asymptomatic
B and C
52
Diagnosis of hepatitis
1. Elevated LFTs 2. Elevated PT (if developed cirrhosis) 3. Antibody testing (IgM and IgG)
53
In hepatitis testing, __ is for acute infection and __ is for chronic infection
IgM IgG This does not apply to Hep B and Hep C
54
Test for check for active Hepatitis C infection
Hep C virus RNA
55
If there is positive Hep C antibody, but negative RNA
Pt has cleared Hep C infection
56
If there is positive Hep C antibody and positive Hep C RNA
Pt has active Hep C infection
57
Hepatitis B screening: 1. HbsAg (-) 2. anti-HBc (-) 3. anti-HBs (-)
Hepatitis B susceptible
58
Hepatitis B screening: 1. HbsAg (-) 2. anti-HBc (+) 3. anti-HBs (+)
Immune due to natural infection
59
Hepatitis B screening 1. HbsAg (-) 2. anti-HBc (-) 3. anti-HBs (+)
Immune due to vaccination
60
Hepatitis B screening: 1. HbsAg (+) 2. anti-HBc (+) 3. IgM anti-HBc (+) 4. anti-HBs (-)
Acutely infected
61
Hepatitis B screening: 1. HbsAg (+) 2. anti-HBc (+) 3. IgM anti-HBc (-) 4. anti-HBs (-)
Chronically infected
62
Treatment for hepatitis A and E
Self-resolve, are not associated with chronic liver disease
63
Treatment for acute hepatitis B
Supportive care
64
Treatment for chronic hepatitis B or positive e-antigen
Interferon or Nucleoside analogs (entecavir, tenofovir, lamivudine, adefovir, telbivudine)
65
Treatment for hepatitis pts with cirrhosis
Transplant required
66
Treatment for hepatitis C
Ledipasvir-sofosbuvir OR sofosbuvir and velpatasvir
67
Usually due to increased indirect (unconjugated) bilirubin (the immature liver of a newborn is unstable to efficiently conjugate bilirubin due to decreased UGT enzyme activity)
Jaundice
68
Increased indirect bilirubin may be physiologic or pathologic. However, increased direct is always ________
Pathologic
69
Bilirubin > 20 mg/dL can lead to:
Kernicterus and neurotoxicity
70
Cerebral dysfunction and encephalopathy as a result of bilirubin deposition in the brain tissues (seizures, lethargy, irritability, hearing loss and mental development disorders). Infants are at risk when bilirubin is > ________
Kernicterus | > 20-25 mg/dL
71
Management of jaundice in newborns
Phototherapy used in all types | Exchange transfusion used in severe cases, ABO incompatibility, RH isoimmunization and hemolysis
72
Complete absence of closure of portion of duodenum leading to gastric outlet obstruction
Duodenal atresia
73
Signs/symptoms of duodenal atresia
Intestinal obstruction shortly after birth, leading to abdominal distention and bilious vomiting
74
Diagnosis of duodenal atresia
Abd XR - causes the double bubble sign
75
Treatment of duodenal atresia
Decompression of GI tract - NG tube Fluid replacement Surgical repair
76
Hernia that occurs lateral to the inferior epigastric artery
Indirect inguinal hernia
77
Indirect hernias are often congenital and occur due to a __________ _________ _________ ___________
Persistent patent process vaginalis
78
Most common overall type of hernias in women and men
Indirect inguinal hernia
79
Hernia that occurs medial to the inferior epigastric arteries within Hesselbach's triangle
Direct inguinal hernia
80
Signs/symptoms of a strangulated hernia
Incarcerated hernia with systemic toxicity. Compromised blood supply - ischemic Severely painful bowel movement
81
Management of inguinal hernias
Often require surgical repair | Strangulated are surgical emergencies
82
Management of umbilical hernias
Observation, will usually resolve by 2 years old | Surgical repair if still persistent in children > 5 y/o
83
Niacin (Vitamin B3) deficiencies are often due to:
Diets high in corn or diets which lack tryptophan
84
The three D's of niacin deficiency:
Diarrhea Dementia Dermatitis
85
Risk factors for vitamin A deficiency:
Patients with liver disease, EtOHics, fat free diets
86
Signs/symptoms of vitamin A deficiency:
1. Visual changes (night blindness), xerophthalmia (dry eyes) 2. Impaired wound healing, dry skin, poor bone growth, taste loss 3. Squamous metaplasia - Bitot's spots
87
Bitot's Spots
White spots on the conjunctiva due to squamous metaplasia of the corneal epithelium Vitamin A Deficiency
88
Risk factors for vitamin C deficiency
Diets lacking raw fruits and green vegetables, smoking, alcoholism, malnourished individuals, elderly
89
Signs/Symptoms of vitamin C deficiency
Scurvy (3 H's): 1. Hyperkeratosis 2. Hemorrhage (vascular fragility) 3. Hematologic - anemia, glossitis, malaise, weakness
90
Risk factors for vitamin D deficiency
Breastfeeding without vitamin D supplementation | Lack of fortified milk or sun exposure
91
Signs/symptoms of vitamin D deficiency
1. Rickets - bowed legs, fractures, costochondral thickening, dental problems 2. Osteomalacia (adults): body pains, muscle weakness
92
Management of vitamin D deficiency
Ergocalciferol (vitamin D)
93
Loose stools, abdominal pain, and flatulence after ingestion of milk or milk containing products
Lactose intolerance
94
White children typically develop signs/symptoms of lactose intolerance ____________ hispanics or blacks
After
95
Diagnosis of lactose intolerance
Hydrogen breath test - hydrogen produced when colonic bacteria ferment undigested lactose Usually performed after trial of lactose free diet
96
Treatment of lactose intolerance
Lactase enzyme preparations Lactaid - prehydrolyzed mlk Lactose free diet

Pediatric EOR (10 decks)

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