GI part 2 Flashcards
Sx of GI foreign body
Choking Gagging Drooling Coughing Wheezing Dysphagia Dyspnea Dysphonia Fever Hematochezia Neck, chest or abdominal pain
Sx of button battery ingestion
Refusal to take fluids Drooling with black flecks in the saliva Dysphagia Vomiting Hematemesis
Indications for endoscopic or surgical exploration and removal of ingested foreign bodies
Retention in the same location of esophagus for more than 12 hrs
Signs of airway compromise
Complete esophageal obstruction
A diseased esophagus obstructed by food boluses
Sharp or pointed objects >4 cm in length, 2 cm in diameter, or with no movement at 3 days after ingestion
Button batteries
Symptomatic pt at any time
Objects causing acute abdominal findings
The majority of foreign bodies that pass the level of ________ proceed through the remainder of the gut without complication
Lower esophageal sphincter
Imaging studies for GI foreign body
Plain radiography
Flat plate radiography of the abdomen/pelvis in older child or teenager
Barium swallow or upper GI contrast study if FB is radiolucent
What foreign bodies should be able to be passed through without incident?
Coins
Small toys
Buttons
Marbles
Tx of GI foreign body
Flexible endoscopy
Rigid endoscopy
Foley catheter removal
Surgery
S/sx of encopresis
Hx of constipation (sometimes very remote) or painful defecation
Inability to differentiate passing gas and passing feces
Soiling episodes usually occurring during the daytime
With retentive encopresis, intermittent passage of extremely large bowel movements
PE of encopresis
Palpable stool throughout the distribution of the colon, esp in the LLQ
Stool smeared around the anus
Lax and patulous anal sphincter
Rectum enlarged and filled with soft stool that yields negative results on fecal occult blood testing
Workup for encopresis
Plain abdominal radiography
Anorectal manometry
Biopsy
Tx of encopresis
Demystification and education Colonic disimpaction followed by routine laxative therapy Toilet training Meds: Polyethylene glycol Sodium phosphate Magnesium citrate Enemas
What is the most common hepatitis in children?
A
Major risk factors for hep B and C
Injectable drug use
Frequent exposure to blood products
Prenatal transmission from maternal infection
Preicteric phase of hepatitis
Lasts approximately 1 wk HA Anorexia Malaise Abdominal discomfort N/V
Extra presentation of preicteric phase in infants of hepatitis B
Immune complexes accompanied by urticaria nd arthritis
Icteric phase of hepatitis
Jaundice
Tender hepatomegaly
What can be common be common with hep A, B, and C, esp in young children?
Asymptomatic or mild, nonspecific illness without icterus
Labs of hepatitis
Elevated alanine aminotransferase and aspartate aminotransferase
PT
Serologic testing
Maternal HBsAg status in children <1 yo
Tx of hepatitis
Largely supportive:
-Rest
-Hydration
-Adequate nutrition
Hospitalization
Chronic HBV: interferon alfa-2b or lmivudine
HCV: interferon alpha alone or in combination with ribavirin
When should hospitalization occur for hepatitis?
Severe vomiting and dehydration
Prolonged PT
Signs of hepatic encephalopathy
Presenting s/sx of duodenal atresia
Onset of vomiting within hrs of birth
Most often bilious, but may be nonbilious
Dehydration
Weight loss
Electrolyte imbalance
Hypochloremic/hypokalemic metabolic alkalosis
Labs for duodenal atresia
Serum electrolytes
UA
Chromosome analysis
Imaging for duodenal atresia
Prenatal u/s in polyhydramnios
Erect and recumbent plain radiography of the abdomen
Cardiac and/or renal u/s
Tx of duodenal atresia
Pre-surgical -IV hydration -TPN -Gastric decompression Surgery
Hx of niacin deficiency
Tends to be seasonal and occurs during spring and early summer Poor appetite Nausea Epigastric discomfort Increased salivation Gastritis Glossitis Diarrhea Dermatitis Lethargy Apathy Depression Anxiety Irritability Poor concentration Delirium
Tx of niacin deficiency
Nicotinamide or PO niacin
Diet high in protein and adequate in calories
-Addition of meats, milk, peanuts, leafy green vegetables, whole or enriched grains, and brewers’ dry yeast
PE of vitamin A deficiency
Bitot spots- areas of abnormal squamous cell proliferation and keratinization Blindness Poor adaptation to darkness Dry skin and hair Pruritis Broken fingernails Keratomalacia Xerophthalmia Corneal perforation Follicular hyperkeratosis
Labs for vitamin A deficiency
Serum retinol study Serum RBP study Iron panel Albumin levels CBC with diff if anemia, infection or sepsis is a possibility Electrolytes Liver function studies
Imaging for vitamin A deficiency
Radiographic films of long bones
Tx of vitamin A deficiency
Consume more: -Liver -Beef -Chicken -Eggs -Fortified milk -Carrots -Mangoes -Sweet potatoes -Leafy green vegetables Daily oral supplements
What are the 4 Hs of vitamin C deficiency?
Hemorrhage
Hyperkeratosis
Hypochondriasis
Hematologic abnormalities
Sx of vitamin C deficiency
Initial: Malaise Lethargy Loss of appetite Ill-tempered Poor wt gain Diarrhea Tachypnea Fever Later: Irritability Pain and tenderness of the legs Pseudoparalysis Swelling over the long bones Hemorrhage
Early clinical manifestations of infantile vitamin C deficiency
Pallor
Irritability
Poor wt gain
Advanced infantile vitamin C deficiency
Major manifestation is extreme pain and tenderness of the arms and legs
Frog leg posture
Wasted and edematous body
Petechiae and ecchymoses
What circulatory features are observed late in vitamin C deficiency?
Hypotension
Cardiac enlargement
EKG changes
Anemia
