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Peds Rotation > GI part 1 > Flashcards

GI part 1 Flashcards

1
Q

What are viral causes of gastroenteritis in children?

A

Rotaviruses
Calciviruses
Astroviruses
Enteric adenoviruses

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2
Q

What is the most frequent cause of diarrhea during the winter months?

A

Rotavirus

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3
Q

Progression of rotavirus

A

Vomiting may last 3-4 days

Diarrhea may last 7-10 days

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4
Q

Transmission of Salmonella

A

Contact with infected animals or from contaminated food products (dairy products, eggs, poultry)

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5
Q

Transmission of Shiga

A

Person-to-person contact or by ingestion of contaminated food

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6
Q

What can occur in addition to diarrhea with Shiga?

A

High fever

Febrile seizures

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7
Q

What causes 40-60% of traveler’s diarrhea?

A

Enterotoxigenic (ETEC) E. coli

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8
Q

Transmission of C. jejuni

A

Person-to-person contact

Contaminated water, especially poultry, raw milk, and cheese

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9
Q

Systemic findings of gastroenteritis

A

Fever
Lethargy
Abdominal pain

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10
Q

Presentation of viral diarrhea

A

Watery stools with no blood or mucous
Vomiting may be present
Dehydration may be prominent
Low-grade fever

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11
Q

Presentation of typhoid fever

A

Bacteremia and fever that usually precede the final enteric phase
Fever, HA, and abdominal pain worsen over 48-72 hrs with nausea, decreased appetite, and constipation

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12
Q

What is the MCC of dysentery?

A

Shigella

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13
Q

Labs of dysentery

A 
Electrolytes
BUN
Creatinine
UA
Stool specimens
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14
Q

Tx of gastroenteritis

A

Correcting dehydration and ongoing fluid and electrolyte deficits
Oral rehydration solution
Ondansetron
PO 3rd-gen cephalosporin: shigella
C. diff: PO metronidazole or vancomycin
E. histolytica: metronidazole with a luminal agent
G. lamblia: albendazole, metronidazole, furazolidone, or quinacrine

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15
Q

Presentation of mild dehydration

A 
Infants and young children are thirst, alert, restless
Older children: thirsty and alert
Tachycardia: Absent
Palpable pulses: present
BP nl
Cutaneous perfusion nl
Skin turgor nl
Fontanelle nl
Moist mucous membranes
Tears are present
Nl respirations
Nl urine output
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16
Q

Presentation of moderate dehydration

A 
Infants and young children: Thirsty, restless or lethargic, irritable
Older children: thirst, alert (usually)
Tachycardia present
Palpable pulses are weak
Orthostatic hypotension
Cutaneous perfusion is nl
Slight reduction in skin turgor
Fontanelles slightly depressed
Dry mucous membranes
Tears are present or absent
Respirations are deep, maybe rapid
Oliguria
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17
Q

Presentation of severe dehydration

A 
Infants and young children: Drowsy, limp, cold, sweaty, cyanotic extremities, may be comatose
Older children: Usually conscious (but at reduced level), apprehensive, cold sweaty, cyanotic extremities, wrinkled skin on fingers and toes, muscle cramps
Tachycardia
Palpable pulses decreased
Hypotension
Cutaneous perfusion reduced and mottled
Skin turgor reduced
Sunken fontanelles
Very dry mucous membranes
Absent tears
Deep and rapid respirations
Anuria and severe oliguria
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18
Q

Labs for dehydration

A

BUN and creatinine
Urine specific gravity
UA
Hematocrit and hemoglobin

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19
Q

How to calculate fluid deficit

A

Percentage of dehydration x the pt’s weight

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20
Q

Tx of dehydration

A

Begin with 20 mL/kg of nl saline over 20 mins for more severe cases
Mild to moderate: oral rehydration solution

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21
Q

Causes of hyponatremic dehydration

A

Children who have diarrhea and consume a hypotonic fluid (water or diluted formula)

22
Q

Causes of hypernatremic dehydration and presentation

A 
Inability to take in fluid
Lethargic and irritable
May cause:
Fever
Hypertonicity
Hyperreflexia
Seizures
23
Q

Peak of ages in appendicitis

A

Between 10 and 12 yrs

24
Q

Presentation of appendicitis

A

Begins with visceral pain, localized to the periumbilical region
Nausea and vomiting
Pain then localizes to the RLQ
Tender RLQ
Voluntary guarding then rigidity then rebound tenderness with rupture and peritonitis

25
Q

Labs for appendicitis

A 
WBC count >10K
UA
KUB, abdominal X-rays
Amylase, lipase, and liver enzymes
CT scan when studies are inconclusive
26
Q

Tx of appendicitis

A

Surgical

27
Q

Dx of colic

A

Crying for more than 3 hrs/day, at least days per week, for more than 3 wks
Colicky crying is often described as paroxysmal and may be characterized by facial grimacing, leg flexion, and passing flatus

28
Q

What hx questions should be asked in regards to colic?

A

Description of the crying, including duration, frequency, intensity, and modifiability
Onset, diurnal pattern, any changes in quality, and triggers or activities that relieve crying

29
Q

PE of colic

A

Check vital signs, weight, length, and head circumference

ID possible skin lesions, corneal abrasions, hair tourniquets, skeletal infections, or signs of child abuse

30
Q

Tx of colic

A

Education and demystification
-The mean crying duration begins to decrease at 6 wks of age and decreases by half by 12 wks of age
-Techniques for calming infants
-Avoidance of dangerous soothing techniques
-Coaching to learn to read infant’s cues
Avoidance of medications and dietary changes

31
Q

When is physiologic gastroesophageal reflux nl?

A

In infants younger than 8-12 mos old

32
Q

Presentation of GERD in older children

A 
Heartburn
Cough
Epigastric abdominal pain
Dysphagia
Wheezing
Aspiration pneumonia
Hoarse voice
Failure to thrive
Recurrent otitis media or sinusitis
33
Q

Presentation of GERD in infants

A

Poor growth
Pain
Breathing difficulty

34
Q

Labs of GERD

A

Indicated if there are persistent sx or complications or if other sx suggest possibility of GER in absence of regurgitation
Barium upper GI series
24 hr esophageal pH probe monitoring
Endoscopy

35
Q

Tx of GERD

A

For infants with complications: an h2 blocker or PPI
Feeding jejunostomy
In older children, discuss lifestyle changes:
-Cessation of smoking
-Weight loss
-Not eating before bed or exercise
-Limiting intake of caffeine, carbonation, and high-fat foods
Proton pump inhibitor therapy

36
Q

Definition of constipation

A

Two or fewer stools per week or passage of hard, pellet-like stools for at least 2 wks

37
Q

Parental concerns about constipation

A 
Straining with defecation
Hard stool consistency
Large stool size
Decreased stool frequency
Fear of passing stools
Any combination of these
38
Q

Retentive posturing

A

Standing or sitting with legs extended and stiff or crossed legs- part of constipation

39
Q

Tx of constipation

A

Prolonged course of stool softener therapy to alleviate fear of defecation
Sitting on the toilet in the morning and immediately after meals
Use of positive reinforcement

40
Q

Presentation of pyloric stenosis

A

Vomiting that is frequent and projectile in nature
Vomit never contains bile
Ravenous hunger early in the course, but becomes more lethargic with increasing malnutrition and dehydration
Peristaltic waves in the LUQ
Hypertrophied pylorus may be palpated

41
Q

Labs of pyloric stenosis

A 
Hypochloremic hypokalemic metabolic alkalosis
Elevated BUN
Plain abdominal X-rays
U/s
Barium upper GI series: string sign
42
Q

Tx of pyloric stenosis

A

IV fluid and electrolyte resuscitation followed by surgical pyloromyotomy

43
Q

At what age do most intussusceptions occur?

A

1-2 yrs old

44
Q

What type of intussusception of common in young children?

A

Ileocolonic

45
Q

Presentation of intussusception

A 
Infant's knees draw up
Pallor with a colicky pattern occurring every 15-20 minutes
Feedings are refused
Bilious vomiting
Third space fluid losses
"Currant jelly" stools
Lethargy
Sausage-shaped mass in the RUQ or epigastrum
46
Q

Labs of intussusception

A

Abdominal u/s

Pneumatic or contrast enema- can ID and treat the dz

47
Q

Tx of intussusception

A

Fluid resuscitation

Surgical consultation

48
Q

Pathophys of Hirschsprung disease

A

Results from the absence of enteric neurons within the myenteric and submucosal plexus of the rectum and/or colon

49
Q

Presentation of Hirschsprung disease

A

Infants can present with abdominal distention, failure of passage of meconium within the 1st 48 hrs of life, and repeated vomiting
Malnutrition resulting from early satiety, abdominal discomfort, and distention
Chronic constipation
Empty rectal vault

50
Q

Labs of Hirschsprung dz

A

CBC

51
Q

Imaging of Hirschsprung dz

A

Single contrast barium enema
Plain abdominal radiography
Rectal manometry
Suction rectal bx or transanal wedge resection

52
Q

Tx of Hirschsprung dz

A

S/sx of high-grade intestinal obstruction: IV hydration, withholding of enteral intake, and intestinal and gastric decompression
Surgery

Peds Rotation (12 decks)

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