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Clin med sem 2 > GI- peds > Flashcards

GI- peds Flashcards

1
Q

Physiologic Jaundice- pathophysiology

A

Yellowing of skin/sclera from deposition of bilirubin

Inability of immature liver to metabolize and excrete bilirubin

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2
Q

Physiologic Jaundice- epidemiology

A

2-3d - peak Day 4

Gone by 1-2w

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3
Q

Physiologic Jaundice- treatment

A

Reassurance

Feed and Poop - faster it will all get out

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4
Q

Physiologic Jaundice- concerns

A

Concerns:

  • Maternal -fetal blood group incompatibility - ABO, Rh, minor traints
  • Elevated direct hyperbilirubinemia - biliary atresia, gallstones, alpha 1 anti-trypsin deficiency, CF, infection
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5
Q

Breast Milk Jaundice- pathophysiology

A

Enzymatic activity causes inc absorption of bilirubin from the intestine

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6
Q

Breast Milk Jaundice- epidemiology

A

Start - End of 1w

Last - 3-10w

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7
Q

Breast Milk Jaundice- treatment

A

Resolves spontaneously

Can still breast feed

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8
Q

Breast Milk Jaundice- risk

A 
Risk - 
J - jaundice w/in first 24 hr of life
A - a sibling who was jaundiced as a neonate
U - unrecognized hemolysis
N- non-optimal sucking/nursing
D - deficiency of G6PD
I - infection 
C - cephalohematoma/bruising 
E - east Asian/north Indian
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9
Q

Breastfeeding jaundice- pathophysiology

A

Newborn doesn’t get adequate milk intake

Delayed/insufficient milk production

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10
Q

Breastfeeding jaundice- S/S & PE

A

Dehydration
dec stooling
Dec bilirubin excretion

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11
Q

Gastroesophageal Reflux (GER)- pathophysiology

A

Passage of gastric contents into the esophagus

Nl in infants

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12
Q

Gastroesophageal Reflux (GER)- epidemiology

A

80% resolve by 6m

90% resolve by 12m

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13
Q

Gastroesophageal Reflux (GER)- S/S & PE

A

After feeding
Gaining weight

GERD?

  • fussiness, sleep disturbance, dec appetite
  • arching, chocking, gagging, pulling off the breast/bottle
  • Not gaining weight
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14
Q

Gastroesophageal Reflux (GER)- diagnosis

A

Vitals - growth

Clinical

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15
Q

Gastroesophageal Reflux (GER)- treatment

A 
Reassurance
Lifestyle mods: 
- prop up after feeds
- elevate head of bed
- carry upright
- tummy

Dec volume/inc frequency

Thicken formula

Trial - hypoallergenic milk formula or exclude mother’s intake of dairy

Empiric trial - acid suppression w/ H2- receptor antagonist or PPI x4weeks
- only when really bad

SEVERE - Peds GI referral, Nissen

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16
Q

Pyloric Stenosis- pathophysiology

A

hypertrophic musculature surrounding pylorus

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17
Q

Pyloric Stenosis- epidemiology

A

4w of life

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18
Q

Pyloric Stenosis- S/S & PE

A

Projectile emesis - nonbilious
Hungry!!!
Olive size mass

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19
Q

Pyloric Stenosis- diagnosis

A

U/S

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20
Q

Pyloric Stenosis- treatment

A

Rehydration

Surgery

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21
Q

Pyloric Stenosis- prognosis

A

If cont -> metabolic alkalosis

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22
Q

Intestinal Atresia and Stenosis- pathophysiology

A

Pylorus - atresia - 1%
Duodenum - atresia, stenosis, web - 45%
Jejunoileal - atresia, stenosis - 50%
Colon - atresia - 5-9%

Multiple sites

Do not let the sun set!!!

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23
Q

Intestinal Atresia and Stenosis - epidemiology

A

w/in 48hr of life

1/3 of all cases - neonatal gut obstruction

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24
Q

Intestinal Atresia and Stenosis - S/S & PE

A

Bile-stained vomiting

Abdominal distention

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25
Q

Intestinal Atresia and Stenosis - diagnosis

A

x-ray - dilate loops of bowel, absent gas bubble

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26
Q

Intestinal Atresia and Stenosis- treatment

A

Surgery

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27
Q

Midgut Volvulus- epidemiology

A

Presents - 3w

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28
Q

Midgut Volvulus- S/S & PE

A 
Severe diffuse abdominal pain and distention
Persistent bilious emesis
Bloody stools
Lethargy
Poor Feeding
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29
Q

Midgut Volvulus- diagnosis

A

KUB - corkscrew pattern, dilated loops of bowel overlying the liver, no gas distal to obstruction

Upper Gi - GOLD

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30
Q

Midgut Volvulus- treatment

A

SURGICAL EMERGENCY!

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31
Q

Diaphragmatic Hernia- pathophysiology

A

Found early on

- incidental or w/u of GERD

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32
Q

Omphalocele- pathophysiology

A

Midline abdominal wall defect - covered by amnion and peritoneum
Containing abdominal contents

Defect - at base of umbilical cord - cord inserting at its apex

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33
Q

Omphalomesenteric Duct- pathophysiology

A

Remnant ligament b/t ileum and abdominal wall
Meckel diverticulum
Patent duct - stool leaks out of umbilicus

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34
Q

Ileus- pathophysiology

A

Impaired intestinal motility/dec gut peristalsis

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35
Q

Ileus- cause

A

Abdominal surgery
Infections
Electrolyte disturbances
Meds - narcotics, anesthetics, chemo

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36
Q

Ileus- S/S & PE

A

Abdominal pain
Distention
V
Hypoactive bowel sounds

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37
Q

Ileus- treatment

A 
Supportive
NPO
IVF
Decompression w/ NG tube
Surgery consult
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38
Q

Meconium Ileus- pathophysiology

A

Mechanical ileal obstruction

Inc consistency of meconium - thicker than nl due to high protein

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39
Q

Meconium Ileus- cause

A

CF - needs to be ruled out if <6m

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40
Q

Meconium Ileus- prognosis

A

Lead to ileal perf and meconium peritonitis

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41
Q

Cow’s Milk Protein Allergy- pathophysiology

A

Inflammation in distal colon

NON IgE mediated

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42
Q

Cow’s Milk Protein Allergy - cause

A

one + food proteins

- Cow’s milk, soy

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43
Q

Cow’s Milk Protein Allergy - epidemiology

A

1st week

Resolves - late infancy

44
Q

Cow’s Milk Protein Allergy - S/S & PE

A

Rectal bleeding

45
Q

Cow’s Milk Protein Allergy- treatment

A

Elimination diet via mom

- then slowly introduce things back into her diet

46
Q

Intussusception- pathophysiology

A

Telescoping bowel

- proximal to ileocecal valve - 90%

47
Q

Intussusception - epidemiology

A

6-36m or <2y

Usually, viral illness in last 2 w

48
Q

Intussusception - S/S & PE

A 
Sudden onset
Severe cramping intervals
Vomiting
Sausage mass
Lethargy 
Currant Jelly stools
49
Q

Intussusception - diagnosis

A

Barium/air enemas

50
Q

Intussusception- labs & imaging

A

Rectal

US - doughnut or target appearance

51
Q

Intussusception- treatment

A

Barium/air enemas

52
Q

Pancreatitis- pathophysiology

A

infection of pancreas

53
Q

Pancreatitis - cause

A

Trauma, gallstones, idiopathic, infectious, drug associated, vasculitis, genetic, autoimmune

54
Q

Pancreatitis - S/S & PE

A 
RUQ or epigastric pain 
Radiation to back 
Vomiting
Anorexia
low-grade fever

Tenderness to palpation w/out peritoneal signs

55
Q

Pancreatitis - labs & imaging

A

Serum lipase - inc
Serum amylase - inc
Ca - inc

Abdominal US or CT

56
Q

Pancreatitis- treatment

A

Admit
Pain control
H2O
Bowel rest

57
Q

Pancreatitis- Complications

A

Complications - hypovolemic shock, hypocalcemia, hyperglycemia

58
Q

Appendicitis- S/S & PE

A

Vague periumbilical pain -> localized to RLQ
Fever
Anorexia

59
Q

Appendicitis- labs & imaging

A

WBC - high or nl - w/ left shift

CT w/ contrast
US - thickening of appendix

60
Q

Appendicitis- treatment

A

Surgical removal

61
Q

Appendicitis - prognosis

A

Complications - appendix per-> peritonitis

62
Q

Functional abdominal Pain- treatment

A

Get them function

individual management

63
Q

Viral Gastroenteritis- cause

A

Roavirus
Adenovirus
Enterovirus
Norwalk

64
Q

Viral Gastroenteritis - S/S & PE

A 
Mild fever
Non-bloody emesis 
Cramping
Discomfort
Diarrhea

Lasts - 2-10day

65
Q

Viral Gastroenteritis - labs & imaging

A

Labs, x-rays?

66
Q

Viral Gastroenteritis- treatment

A

Supportive

67
Q

Viral Gastroenteritis - complications

A

Complications - temporary lactose intolerance

68
Q

Eosinophilic Esophagitis- pathophysiology

A

Eosinophil’s infiltrate into the esophageal epithelium

69
Q

Eosinophilic Esophagitis - cause

A

Food allergies

70
Q

Eosinophilic Esophagitis - S/S & PE

A 
Vomiting
Chest pain
Epigastric pain
Dysphagia
Food impaction/stricture
Ineffective antireflux therapy
71
Q

Eosinophilic Esophagitis - diagnosis

A

Endoscopy w/ biopsy - patch testing

72
Q

Eosinophilic Esophagitis - treatment

A

Elimination diet
Steroids
Repeat endoscope

73
Q

Cyclical Vomiting Syndrome- pathophysiology

A

Idiopathic

Recurrent, stereotypical bouts of vomiting

74
Q

Cyclical Vomiting Syndrome- cause

A

Abdominal migraines
Hypothalamic-pituitary axis hyperreactivity
Rapid gastric emptying
Cannabis

75
Q

Cyclical Vomiting Syndrome- epidemiology

A

Anxiety

76
Q

Cyclical Vomiting Syndrome- S/S & PE

A

Baseline/normal b/t episodes

77
Q

Diarrhea- pathophysiology

A

Gastrointestinal infection - most common cause

78
Q

Diarrhea - cause

A

Viral - most common cause

79
Q

Diarrhea - treatment

A

Loperamide and other antidiarrheal - NOT INDICATED

Symptomatic care

80
Q

Bacterial Gastroenteritis- pathophysiology

A

HUS?

  • microanemia
  • Thrombocytopenia
  • Acute kidney injury
81
Q

Bacterial Gastroenteritis- cause

A 
Shigella
Salmonella
Campylobacter
Yersinia
Ecoli
82
Q

Bacterial Gastroenteritis- S/S & PE

A

Fever
Abdominal pain
Diarrhea - bloody/mucous

83
Q

Bacterial Gastroenteritis- treatment

A 
Hydration 
BRAT diet
Avoid fruit juice/high surage food
Priobiotics ? 
Rule out concerning causes - porlonged/severe 
Refer if necessary
84
Q

Toddler’s Diarrhea- pathophysiology

A

Chronic nonspecific diarrhea

85
Q

Toddler’s Diarrhea- cause

A 
Non-infections
Malabsorption
Protein/cars
Food allergies
ingestion
Systemic disease
86
Q

Toddler’s Diarrhea- epidemiology

A

9-24m

87
Q

Toddler’s Diarrhea- S/S & PE

A

explosive loose stools w/ flecks of food

88
Q

Toddler’s Diarrhea- treatment

A 
Limit fruit juice
Adjust fiber
Fat in diet
Keep hydrated
Find cause
Refer for chronic
89
Q

Constipation- pathophysiology

A

Infrequent and/or passage of hard stools

90
Q

Constipation - cause

A 
Poor diet
inadequate fluid intake
Medications
Anxiety/behavioral
Underlying issues
91
Q

Constipation - epidemiology

A

Common during toilet training

92
Q

Constipation - S/S & PE

A 
Overflow diarrhea
Committing
Abdominal pain
Anal fissures
Rectal bleeding
Impaction
UTI
93
Q

Constipation- diagnosis- diagnosis (scale)

A 
Bristal Stool Scale
Type 1 - pellots
Type 2 - sausage-shaped but lumpy
Type 3 - sausage but w/ cracks 
Type 4 - sausage or snake - smooth
Type 5 - soft blobs w/ clear-cut edges
Type 6 - fluffy pleces w/ ragged edges, mushy stool
Type 7 - watery, no solid pieces, entirely liquid
94
Q

Hirschsprung Disease- pathophysiology

A

Absence of ganglion cells in mucosa and muscular layers of colon -> functional obstruction

95
Q

Hirschsprung Disease - S/S & PE

A 
Failure to pass meconium w/ first 24hr of life
Distention
Overflow diarrhea
Enterocolitis
Sepsis - megacolon 
Constipation - older kids
96
Q

Hirschsprung Disease - diagnosis

A

Contrast enema - transition zone - ganglionic portion dilated
Rectal biopsy

97
Q

Hirschsprung Disease - treatment

A

Surgery

98
Q

Anorectal Anomalies- pathophysiology

A

Anterior displacement of anus
Anal stenosis
Imperforate anus

99
Q

Foreign body in Esophagus- cause

A

Coin

Small toys

100
Q

Foreign body in Esophagus- epidemiology

A

6m-3y

101
Q

Foreign body in Esophagus- S/S & PE

A 
Asymptomatic
Choking
Gagging
Coughing
salivation
Dysphagia
refusal to eat
vomiting
Stridor
Perforation
102
Q

Foreign body in Esophagus- diagnosis

A

Hx

Xray

103
Q

GI Foreign body- pathophysiology

A

Pass on own

104
Q

GI Foreign body- cause

A

Batteries and magnets - surgery

105
Q

Growth- pathophysiology

A 
24/32oz/day
BW - 10-14 days
Doubled - 4-6m
Tripled -12 m 
5-7 wet diapers per day 
3-4 dirty diapers per day

Clin med sem 2 (30 decks)

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