GI- pediatrics Flashcards
Characteristics of GI Malformation: pyloric stenosis
- Presenting age
- vomit description
- other findings
- Age: 0-3 months
- Emesis: nonbilious, projectile.
- Findings: Male» female. Olive shaped mass in the epigastrium, Low CL/ Low K metabolic alkalosis
Characteristics of GI Malformation: Intestinal atresia
- Presenting age
- vomit description
- other findings
- Age: 0-1 week
- Emesis: Bilious
- Findings: “Double-bubble” sign, Down syndrome
Characteristics of GI Malformation: TE fistula
- Presenting age
- vomit description
- other findings
- Age: 0-2 week
- Emesis: food regurgitation
- Findings: respiratory compromise with feeding, aspiration pneumonia, inability to pass NGT into stomach, gastric distention
Most common variant of TE fistula
esophageal atresia with a fistula from the bronchus to the distal esophagus. Gastric distention as each breach transmits air to the GI tract.
Characteristics of GI Malformation: Hirschsprung Disease
- Presenting age
- vomit description
- other findings
- Age: 0-1yr
- Emesis: feculent
- Findings: abdominal distentions, obstipation, no nerve ganglia seen on rectal biopsy, males»females
Characteristics of GI Malformation: anal atresia
- Presenting age
- vomit description
- other findings
- Age: 0-1 wk
- Emesis: Late, feculent
- Findings: Detected on initial exa, in nursery, Males> females
Characteristics of GI Malformation: Choanal atresia
- Presenting age
- vomit description
- other findings
- Age: 0-1wk
- Emesis: none
- Findings: cyanosis with feeding that improves with crying. inability to pass a NGT through nose.
Characteristics of Peds GI condition: Intussusception
- Presenting age
- vomit description
- other findings
- Age: 3mo-2yr
- Emesis: Bilious
- Findings: Currant-jelly stools (blood &mucus), palpable sausage-shaped mass,
Tx Intussesception
pneumatic or hydrostatic enema guided by fluoro or U/S (diagnostic and therapeutic)
Characteristics of Peds GI condition: Necrotizing enterocolitis
- Presenting age
- vomit description
- other findings
- Age: 0-2 months
- Emesis: Bilious
- Findings: premature baby, fever, rectal bleeding, air in bowel wall.
Tx Nectrotizing enterocolitis
NPO, orogastric tube, IV fluids, abx
Characteristics of Peds GI condition: Meconium ileus
- Presenting age
- vomit description
- other findings
- Age: 0-1wk
- Emesis: feculent, late
- Findings: cystic fibrosis manifestation (as is rectal prolapse)
Characteristics of Peds GI condition: Midgut Volvulus
- Presenting age
- vomit description
- other findings
- Age: 0-2yr
- Emesis: Bilious
- Findings: sudden onset pain, distention, rectal bleeding, peritonitis, “bird beak” abd X-ray
S&S of Meckel Diverticulum
-Age: 0-2yr Rule of 2s, Painless GI bleed Anemia Remnant of Vitelline (omphalomesenteric) duct
Characteristics of Peds GI condition: Strangulated hernia
- Presenting age
- vomit description
- other findings
- Age: any age
- Emesis: bilious
- Findings: bowel loops in inguinal canal
What is the Rule of 2s for Meckle Diverticulum
2% of the population 2 inches long 2 feet from the Ileocolic junction presents at 2yo 2x more likely in boys
Complications of Meckles
Present with abd pain:
Intussusception
Obstruction
Volvulus
Diverticulitis (mimics appendicitis)
What GI malformation primarily causes respiratory problems?
Signs and symptoms
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
Differentiate between omphalocele and gastroschisis
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.
What is Henoch-Schonlein purpura?
Vasculitis that may present with GI bleeding and abdominal pain.
Hx of URI, rash on legs and buttocks, swelling hands and feet, hematuria/ proteinuria.
T or F: children may develop inflammatory bowel disease and irritable bowel sydnrome
TRUE
Diarrhea, fever, bloody stool, poor growth are concerning for OBD.
GI complaints may be psychosomatic; watch for separation anxiety, depression or child abuse.
What is the first step in evaluation neonatal jaundice?
to determine whether jaundice is physiologic or pathologic.
Measure total, direct, and indirect bilirubin.
Why is jaundice of concern in a neonate?
Main concern is Bilirubin-Induced Neurologic Dysfunction (BIND).
Due to unconjugated bilirubin deposit in basal ganglia.
Symptoms of BIND and sequelae
Poor feeding Seizures Flaccidity Opisthotonos Apnea
Kernicterus is chronic and permanent sequelae of BIND.
