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aa Step 2CK: Internal & Peds > GI- pediatrics > Flashcards

GI- pediatrics Flashcards

1
Q

Characteristics of GI Malformation: pyloric stenosis

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-3 months
  • Emesis: nonbilious, projectile.
  • Findings: Male» female. Olive shaped mass in the epigastrium, Low CL/ Low K metabolic alkalosis
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2
Q

Characteristics of GI Malformation: Intestinal atresia

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-1 week
  • Emesis: Bilious
  • Findings: “Double-bubble” sign, Down syndrome
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3
Q

Characteristics of GI Malformation: TE fistula

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-2 week
  • Emesis: food regurgitation
  • Findings: respiratory compromise with feeding, aspiration pneumonia, inability to pass NGT into stomach, gastric distention
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4
Q

Most common variant of TE fistula

A

esophageal atresia with a fistula from the bronchus to the distal esophagus. Gastric distention as each breach transmits air to the GI tract.

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5
Q

Characteristics of GI Malformation: Hirschsprung Disease

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-1yr
  • Emesis: feculent
  • Findings: abdominal distentions, obstipation, no nerve ganglia seen on rectal biopsy, males»females
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6
Q

Characteristics of GI Malformation: anal atresia

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-1 wk
  • Emesis: Late, feculent
  • Findings: Detected on initial exa, in nursery, Males> females
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7
Q

Characteristics of GI Malformation: Choanal atresia

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-1wk
  • Emesis: none
  • Findings: cyanosis with feeding that improves with crying. inability to pass a NGT through nose.
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8
Q

Characteristics of Peds GI condition: Intussusception

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 3mo-2yr
  • Emesis: Bilious
  • Findings: Currant-jelly stools (blood &mucus), palpable sausage-shaped mass,
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9
Q

Tx Intussesception

A

pneumatic or hydrostatic enema guided by fluoro or U/S (diagnostic and therapeutic)

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10
Q

Characteristics of Peds GI condition: Necrotizing enterocolitis

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-2 months
  • Emesis: Bilious
  • Findings: premature baby, fever, rectal bleeding, air in bowel wall.
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11
Q

Tx Nectrotizing enterocolitis

A

NPO, orogastric tube, IV fluids, abx

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12
Q

Characteristics of Peds GI condition: Meconium ileus

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-1wk
  • Emesis: feculent, late
  • Findings: cystic fibrosis manifestation (as is rectal prolapse)
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13
Q

Characteristics of Peds GI condition: Midgut Volvulus

  • Presenting age
  • vomit description
  • other findings
A
  • Age: 0-2yr
  • Emesis: Bilious
  • Findings: sudden onset pain, distention, rectal bleeding, peritonitis, “bird beak” abd X-ray
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14
Q

S&S of Meckel Diverticulum

A 
-Age: 0-2yr
Rule of 2s, 
Painless GI bleed
Anemia 
Remnant of Vitelline (omphalomesenteric) duct
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15
Q

Characteristics of Peds GI condition: Strangulated hernia

  • Presenting age
  • vomit description
  • other findings
A
  • Age: any age
  • Emesis: bilious
  • Findings: bowel loops in inguinal canal
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16
Q

What is the Rule of 2s for Meckle Diverticulum

A 
2% of the population
2 inches long
2 feet from the Ileocolic junction
presents at 2yo
2x more likely in boys
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17
Q

Complications of Meckles

A

Present with abd pain:

Intussusception
Obstruction
Volvulus
Diverticulitis (mimics appendicitis)

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18
Q

What GI malformation primarily causes respiratory problems?

Signs and symptoms

A

Diaphargmatic Hernia

Males
Left sided (common) herniation through a diaphragmatic defect 
Pulmonary Hypoplasia
Respiratory distress
Bowel sounds in chest
Bowel loops in thorax on Xray
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19
Q

Differentiate between omphalocele and gastroschisis

A

Omphalocele: midline, hernia sac with multiple organs, absent umbilical ring, other anomalies present

Gastroschisis: right of midline, small bowel exposed, no true hernia sac, umbilical ring present, other anomalies rare.

20
Q

What is Henoch-Schonlein purpura?

A

Vasculitis that may present with GI bleeding and abdominal pain.

Hx of URI, rash on legs and buttocks, swelling hands and feet, hematuria/ proteinuria.

21
Q

T or F: children may develop inflammatory bowel disease and irritable bowel sydnrome

A

TRUE
Diarrhea, fever, bloody stool, poor growth are concerning for OBD.

GI complaints may be psychosomatic; watch for separation anxiety, depression or child abuse.

22
Q

What is the first step in evaluation neonatal jaundice?

A

to determine whether jaundice is physiologic or pathologic.

Measure total, direct, and indirect bilirubin.

23
Q

Why is jaundice of concern in a neonate?

A

Main concern is Bilirubin-Induced Neurologic Dysfunction (BIND).

Due to unconjugated bilirubin deposit in basal ganglia.

24
Q

Symptoms of BIND and sequelae

A 
Poor feeding
Seizures
Flaccidity
Opisthotonos
Apnea

Kernicterus is chronic and permanent sequelae of BIND.

25
Q

What are the causes of physiologic jaundice?

A

Caused by normal neonatal changes in bilirubin metabolism: Increased bilirubin production, decreased clearance and increased enterohepatic circulation.
Mostly low risk unconjugated (indirect) bilirubin because of incomplete liver function.

More prevalent in premature infants.

26
Q

How is severe hyperbilirubinemia recognized?

A
  • Jaundice that is recognized in the first 24hrs of life.
  • T Bili higher than the hour specific 95%
  • Rate of rising T Bili >0.2mg/dl per hour
  • Direct bili more then 20% of T bili
27
Q

What are causes of neonatal Jaundice?

A 
Breast-feeding jaundice
Breast Milk jaundice 
Illness
Hemolysis
Metabolic disorders
Biliary Atresia
Medications
28
Q

What is Breast-feeding jaundice?

A

An exaggerates physiologic jaundice to insufficient milk intake with leads to fluid and weightless and an inadequate number of bowel movement to remove bilirubin from body. 1st week of life

29
Q

What is great milk jaundice?

A

3-5 days of life
Results from direct effect of breast mild as human milk promotes an increase in intestinal absorption of bilirubin.

Can continue breastfeeding as long as Bili levels stay safe

30
Q

What is the cause of hemolysis jaundice in a new born?

A

Rh incompatibility or congenital red cell disease.

look for anemia, peripheral smear abnormalities, higher unconjugated bilirubin

31
Q

What metabolic disorders can cause neonatal jaundice?

A

Crigler-Najjar syndrome
Roter syndome
Dublin-Johnson syndrome

32
Q

Presentation and treatment of biliary atresia

A

Full term infant
clay or gray collide stool
high conjugated bilirubin

Tx: surgery

33
Q

What medication can cause neonatal jaundice?

A

Sulfa drugs.

avoid in neonates, they displace bilirubin from albumin and may precipitate kernicterus

34
Q

How is sever hyperbilirubinemia treated?

A

Phototherapy. Converts unconjugated bilicurib to a water soluble form that can be excreted.

35
Q

What should you do is an infant is born to a mother with active hepatitis B?

A

They should receive the first immunization and hep B globulin at birth

36
Q

What should you watch for in children after diarrhea?

A

Hemolytic uremic syndrome (HUS).

Thrombocytopenia
Hemolytic anemia (schistocytes and fragment cells)
acute renal failure.

37
Q

S&S infant physiologic gastroesophageal reflux (GER)

A 
In the first 6 months of life (peak 4mo)
Spit-up/ vomiting partially digested milk 
Feed eagerly
Normal weight gain 
Normal examination 
↑ risk with tobacco smoke exposure
38
Q

Differentiate between pathological GER and physiological

A

Pathologic GER: irritable, poor feeding, weight loss

Physiologic: “happy spitters”

39
Q

Management of Pathologic GER

A

Thicken formula feeds
Switch to extensively hydrolyzed formula
Remove cow’s milk and soy protein from mothers diet.

Resistant: acid-suppression therapy

40
Q

Management of physiologic GER

A 
Preventative measures (upright positioning)
Reassurance
41
Q

Nutritional supplement for breastfeeding

A

Breast milk has inadequate vit D with poor bioavailability.

Cholecalciferol supplementation for ALL breastfed infants

42
Q

Management of children with dehydration

A

Determin severity. Oral or IV resuscitation to prevent endometrial organ damage.

Isotonic crystalloid bolus.

43
Q

Moderate dehydration

A 
↓ skin turgor 
Dry MM
Tachycardia 
Irritability
Delayed Capillary refill 
↓ Urine output
44
Q

Severe dehydration

A 
Cool, clammy skin
Delayed cap refill (>3sec)
Cracked lips 
Dry MM
Sunken eyes/ Sunken fontanelle 
Minimal/ no urine output
45
Q

Diagnosis of MEckel diverticulum

A

Technetium-99m pertechneate scan.
AKA: Nuclear Scintigraphy

Increased uptake by gastric mucosa, shows atopic tissue.

46
Q

Features that suggest a pathologic lead point for intussusception

A

Recurrent episodes
Atypical locations (SB into SB)
Atypical age
Persistent rectal bleedings despite reduction

MCC: Meckels –> anemia/ occult blood

aa Step 2CK: Internal & Peds (71 decks)

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