GI part 1 Flashcards
What are viral causes of gastroenteritis in children?
Rotaviruses
Calciviruses
Astroviruses
Enteric adenoviruses
What is the most frequent cause of diarrhea during the winter months?
Rotavirus
Progression of rotavirus
Vomiting may last 3-4 days
Diarrhea may last 7-10 days
Transmission of Salmonella
Contact with infected animals or from contaminated food products (dairy products, eggs, poultry)
Transmission of Shiga
Person-to-person contact or by ingestion of contaminated food
What can occur in addition to diarrhea with Shiga?
High fever
Febrile seizures
What causes 40-60% of traveler’s diarrhea?
Enterotoxigenic (ETEC) E. coli
Transmission of C. jejuni
Person-to-person contact
Contaminated water, especially poultry, raw milk, and cheese
Systemic findings of gastroenteritis
Fever
Lethargy
Abdominal pain
Presentation of viral diarrhea
Watery stools with no blood or mucous
Vomiting may be present
Dehydration may be prominent
Low-grade fever
Presentation of typhoid fever
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
What is the MCC of dysentery?
Shigella
Labs of dysentery
Electrolytes BUN Creatinine UA Stool specimens
Tx of gastroenteritis
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
Presentation of mild dehydration
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
Presentation of moderate dehydration
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
Presentation of severe dehydration
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
Labs for dehydration
BUN and creatinine
Urine specific gravity
UA
Hematocrit and hemoglobin
How to calculate fluid deficit
Percentage of dehydration x the pt’s weight
Tx of dehydration
Begin with 20 mL/kg of nl saline over 20 mins for more severe cases
Mild to moderate: oral rehydration solution
Causes of hyponatremic dehydration
Children who have diarrhea and consume a hypotonic fluid (water or diluted formula)
Causes of hypernatremic dehydration and presentation
Inability to take in fluid Lethargic and irritable May cause: Fever Hypertonicity Hyperreflexia Seizures
Peak of ages in appendicitis
Between 10 and 12 yrs
Presentation of appendicitis
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
Labs for appendicitis
WBC count >10K UA KUB, abdominal X-rays Amylase, lipase, and liver enzymes CT scan when studies are inconclusive
Tx of appendicitis
Surgical
Dx of colic
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
What hx questions should be asked in regards to colic?
Description of the crying, including duration, frequency, intensity, and modifiability
Onset, diurnal pattern, any changes in quality, and triggers or activities that relieve crying
PE of colic
Check vital signs, weight, length, and head circumference
ID possible skin lesions, corneal abrasions, hair tourniquets, skeletal infections, or signs of child abuse
Tx of colic
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
When is physiologic gastroesophageal reflux nl?
In infants younger than 8-12 mos old
Presentation of GERD in older children
Heartburn Cough Epigastric abdominal pain Dysphagia Wheezing Aspiration pneumonia Hoarse voice Failure to thrive Recurrent otitis media or sinusitis
Presentation of GERD in infants
Poor growth
Pain
Breathing difficulty
Labs of GERD
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
Tx of GERD
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
Definition of constipation
Two or fewer stools per week or passage of hard, pellet-like stools for at least 2 wks
Parental concerns about constipation
Straining with defecation Hard stool consistency Large stool size Decreased stool frequency Fear of passing stools Any combination of these
Retentive posturing
Standing or sitting with legs extended and stiff or crossed legs- part of constipation
Tx of constipation
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
Presentation of pyloric stenosis
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
Labs of pyloric stenosis
Hypochloremic hypokalemic metabolic alkalosis Elevated BUN Plain abdominal X-rays U/s Barium upper GI series: string sign
Tx of pyloric stenosis
IV fluid and electrolyte resuscitation followed by surgical pyloromyotomy
At what age do most intussusceptions occur?
1-2 yrs old
What type of intussusception of common in young children?
Ileocolonic
Presentation of intussusception
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
Labs of intussusception
Abdominal u/s
Pneumatic or contrast enema- can ID and treat the dz
Tx of intussusception
Fluid resuscitation
Surgical consultation
Pathophys of Hirschsprung disease
Results from the absence of enteric neurons within the myenteric and submucosal plexus of the rectum and/or colon
Presentation of Hirschsprung disease
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
Labs of Hirschsprung dz
CBC
Imaging of Hirschsprung dz
Single contrast barium enema
Plain abdominal radiography
Rectal manometry
Suction rectal bx or transanal wedge resection
Tx of Hirschsprung dz
S/sx of high-grade intestinal obstruction: IV hydration, withholding of enteral intake, and intestinal and gastric decompression
Surgery
