GI/nutritional system Flashcards
a 14-year-old boy with nausea, vomiting, constipation, and periumbilical pain that has settled in the lower right quadrant. The patient’s mom gave him a piece of toast and some water about 5 hours ago but he vomited 30 minutes after eating. On physical exam, he has tenderness and guarding in the lower right quadrant, pain upon flexion and internal rotation of right lower extremity, RLQ pain with right hip extension, and RLQ pain with palpation of the LLQ. Blood tests reveal leukocytosis with a shift to the left.
What is the most likely diagnoses?
Appendicitis
When someone is having appendicitis, will they have an appetite? will they be nauseas?
They will not have an appetite and most likely be nauseas with a low grade fever or vomiting
What is the rovsing sign?
RLQ pain with palpation of LLQ
What is obturator sign?
RLQ pain with internal rotation of the hip
What is psoas sign?
RLQ pain with hip extension
What type of imaging would you get of appendicitis if clinical dx is difficult?
ultrasound or abdominal CT
What on a CBC would support the Dx of appendicitis?
neutrophilia
a 23 day old newborn that is brought to the emergency department with a chief complaint of extreme fussiness. His parents think he has abdominal pain as he is “gassy” and pulls his legs up as if he is trying to stool. He passes a lot of gas from his rectum and his parents can hear his stomach gurgling a lot. Tonight’s episode has lasted for 4 hours with intractable crying, and his parents are very distraught. They have tried feeding, a pacifier, rocking, burping, changing the diaper, and inserting a rectal suppository but nothing has relieved the crying. He is currently feeding a standard cow’s milk formula with iron without vomiting or diarrhea. Further questioning reveals this is the fourth day in a row that this has happened on a daily basis, usually in the evening, but the baby usually cries for about 2 to 3 hours.
This child would be diagnosed with what?
Colic
What is the rule of 3’s for colic?
Cry 3hr/day, 3day/wk, for 3 weeks
When does colic in a child peak? when does it usually resolve?
peaks around 2-3 months of age, usually resolves around 4 months
What description would make you think of colic?
unexplained paroxysms of irritability, fussing, crying that my develop into agonized screaming, infant may also draw up knees to abdomen
Tx for colic?
Do not shake the baby
a 5-year-old boy with no significant medical history. His mother explains to you that since starting kindergarten earlier in the year, he has been having progressively worse periodic abdominal pain. When he has this pain he is cranky, refuses to eat, and has even vomited on a few occasions. She also explains that since starting school he has been having regular soiling accidents despite successfully potty training over a year ago.
What is the likely Dx
Constipation
What is encopresis?
poop in the rectum, loose stool leaks
What classifies as constipation?
<2 bowel movements per week
>episode of encopresis
What are some of the Rome III diagnostic criteria for functional constipation in a child with a developmental age less than 4?
- two or fewer bowl movements a week
- at least one episode of incontinence per week after toileting skills
- history of excessive stool retention
- history of painful or hard bowel movements
- presence of large fecal mass in rectum
- history of large diameter stools that may obstruct toilet
Will need at least 2 of these
how bout the rome III criteria for child with developmental age greater than 4
- two or fewer bowl movements a week
- at least one episode of incontinence per week
- history of retentive posturing or excessive voluntary stool retention
- history of painful or hard bowel movements
- presence of large fecal mass in rectum
- history of large diameter stools that may obstruct toilet
What is the imaging of choice to Dx constipation?
abdominal x-ray
What is the treatment of constipation in children?
- increase fiber to 11-24g/day
- Mineral oil 15 to 30ml per year of age per day
- miralax 1.5g per kg per day
- lactulose 1ml per kg per day once or twice a day
a previously healthy 11-year-old boy presents to the emergency department with a 3-day history of nausea, anorexia, weakness, abdominal pain, and an episode of vomiting. He has no history of fever, diarrhea, constipation, respiratory or urinary symptoms, or use of laxatives or diuretics. Physical examination reveals a thinly built boy with signs of sunken eyes, slightly dry mucous membranes, and generalized skin hyperpigmentation. He is afebrile, with a capillary refill time of less than 2 seconds, blood pressure of 94/68 mm Hg, and a heart rate of 116 beats/min. His weight is 32 kg (70.5 lb) (weight loss of 6% in the previous 3 days).
This child is suffering from what?
Dehydration
What percent of weight loss is mild dehydration? moderate? severe?
3-5% for mild
6-9% for moderate
>10% for severe
What are the most accurate signs of moderate to severe dehydration in children?
prolonged capillary refill
poor skin turgor
abnormal breathing
a 2-day-old preterm (33 weeks), weighing 1.3 kg neonate with upper abdominal fullness. A nasogastric tube drains bilious aspirate. The external genitalia and anal opening are normal. Further evaluation by X-ray flat plate abdomen shows a “double-bubble appearance” with total absence of distal bowel gas
what is the Dx?
duodenal atresia
What is duodenal atresia?
this is a congenital absence or complete closure of a portion of the lumen of the duodenum