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.
What are the causes of physiologic jaundice?
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.
How is severe hyperbilirubinemia recognized?
- 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
What are causes of neonatal Jaundice?
Breast-feeding jaundice Breast Milk jaundice Illness Hemolysis Metabolic disorders Biliary Atresia Medications
What is Breast-feeding jaundice?
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
What is great milk jaundice?
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
What is the cause of hemolysis jaundice in a new born?
Rh incompatibility or congenital red cell disease.
look for anemia, peripheral smear abnormalities, higher unconjugated bilirubin
What metabolic disorders can cause neonatal jaundice?
Crigler-Najjar syndrome
Roter syndome
Dublin-Johnson syndrome
Presentation and treatment of biliary atresia
Full term infant
clay or gray collide stool
high conjugated bilirubin
Tx: surgery
What medication can cause neonatal jaundice?
Sulfa drugs.
avoid in neonates, they displace bilirubin from albumin and may precipitate kernicterus
How is sever hyperbilirubinemia treated?
Phototherapy. Converts unconjugated bilicurib to a water soluble form that can be excreted.
What should you do is an infant is born to a mother with active hepatitis B?
They should receive the first immunization and hep B globulin at birth
What should you watch for in children after diarrhea?
Hemolytic uremic syndrome (HUS).
Thrombocytopenia
Hemolytic anemia (schistocytes and fragment cells)
acute renal failure.
S&S infant physiologic gastroesophageal reflux (GER)
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
Differentiate between pathological GER and physiological
Pathologic GER: irritable, poor feeding, weight loss
Physiologic: “happy spitters”
Management of Pathologic GER
Thicken formula feeds
Switch to extensively hydrolyzed formula
Remove cow’s milk and soy protein from mothers diet.
Resistant: acid-suppression therapy
Management of physiologic GER
Preventative measures (upright positioning) Reassurance
Nutritional supplement for breastfeeding
Breast milk has inadequate vit D with poor bioavailability.
Cholecalciferol supplementation for ALL breastfed infants
Management of children with dehydration
Determin severity. Oral or IV resuscitation to prevent endometrial organ damage.
Isotonic crystalloid bolus.
Moderate dehydration
↓ skin turgor Dry MM Tachycardia Irritability Delayed Capillary refill ↓ Urine output
Severe dehydration
Cool, clammy skin Delayed cap refill (>3sec) Cracked lips Dry MM Sunken eyes/ Sunken fontanelle Minimal/ no urine output
Diagnosis of MEckel diverticulum
Technetium-99m pertechneate scan.
AKA: Nuclear Scintigraphy
Increased uptake by gastric mucosa, shows atopic tissue.
Features that suggest a pathologic lead point for intussusception
Recurrent episodes
Atypical locations (SB into SB)
Atypical age
Persistent rectal bleedings despite reduction
MCC: Meckels –> anemia/ occult blood
