GI- peds Flashcards
Physiologic Jaundice- pathophysiology
Yellowing of skin/sclera from deposition of bilirubin
Inability of immature liver to metabolize and excrete bilirubin
Physiologic Jaundice- epidemiology
2-3d - peak Day 4
Gone by 1-2w
Physiologic Jaundice- treatment
Reassurance
Feed and Poop - faster it will all get out
Physiologic Jaundice- concerns
Concerns:
- Maternal -fetal blood group incompatibility - ABO, Rh, minor traints
- Elevated direct hyperbilirubinemia - biliary atresia, gallstones, alpha 1 anti-trypsin deficiency, CF, infection
Breast Milk Jaundice- pathophysiology
Enzymatic activity causes inc absorption of bilirubin from the intestine
Breast Milk Jaundice- epidemiology
Start - End of 1w
Last - 3-10w
Breast Milk Jaundice- treatment
Resolves spontaneously
Can still breast feed
Breast Milk Jaundice- risk
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
Breastfeeding jaundice- pathophysiology
Newborn doesn’t get adequate milk intake
Delayed/insufficient milk production
Breastfeeding jaundice- S/S & PE
Dehydration
dec stooling
Dec bilirubin excretion
Gastroesophageal Reflux (GER)- pathophysiology
Passage of gastric contents into the esophagus
Nl in infants
Gastroesophageal Reflux (GER)- epidemiology
80% resolve by 6m
90% resolve by 12m
Gastroesophageal Reflux (GER)- S/S & PE
After feeding
Gaining weight
GERD?
- fussiness, sleep disturbance, dec appetite
- arching, chocking, gagging, pulling off the breast/bottle
- Not gaining weight
Gastroesophageal Reflux (GER)- diagnosis
Vitals - growth
Clinical
Gastroesophageal Reflux (GER)- treatment
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
Pyloric Stenosis- pathophysiology
hypertrophic musculature surrounding pylorus
Pyloric Stenosis- epidemiology
4w of life
Pyloric Stenosis- S/S & PE
Projectile emesis - nonbilious
Hungry!!!
Olive size mass
Pyloric Stenosis- diagnosis
U/S
Pyloric Stenosis- treatment
Rehydration
Surgery
Pyloric Stenosis- prognosis
If cont -> metabolic alkalosis
Intestinal Atresia and Stenosis- pathophysiology
Pylorus - atresia - 1%
Duodenum - atresia, stenosis, web - 45%
Jejunoileal - atresia, stenosis - 50%
Colon - atresia - 5-9%
Multiple sites
Do not let the sun set!!!
Intestinal Atresia and Stenosis - epidemiology
w/in 48hr of life
1/3 of all cases - neonatal gut obstruction
Intestinal Atresia and Stenosis - S/S & PE
Bile-stained vomiting
Abdominal distention
Intestinal Atresia and Stenosis - diagnosis
x-ray - dilate loops of bowel, absent gas bubble
Intestinal Atresia and Stenosis- treatment
Surgery
Midgut Volvulus- epidemiology
Presents - 3w
Midgut Volvulus- S/S & PE
Severe diffuse abdominal pain and distention Persistent bilious emesis Bloody stools Lethargy Poor Feeding
Midgut Volvulus- diagnosis
KUB - corkscrew pattern, dilated loops of bowel overlying the liver, no gas distal to obstruction
Upper Gi - GOLD
Midgut Volvulus- treatment
SURGICAL EMERGENCY!
Diaphragmatic Hernia- pathophysiology
Found early on
- incidental or w/u of GERD
Omphalocele- pathophysiology
Midline abdominal wall defect - covered by amnion and peritoneum
Containing abdominal contents
Defect - at base of umbilical cord - cord inserting at its apex
Omphalomesenteric Duct- pathophysiology
Remnant ligament b/t ileum and abdominal wall
Meckel diverticulum
Patent duct - stool leaks out of umbilicus
Ileus- pathophysiology
Impaired intestinal motility/dec gut peristalsis
Ileus- cause
Abdominal surgery
Infections
Electrolyte disturbances
Meds - narcotics, anesthetics, chemo
Ileus- S/S & PE
Abdominal pain
Distention
V
Hypoactive bowel sounds
Ileus- treatment
Supportive NPO IVF Decompression w/ NG tube Surgery consult
Meconium Ileus- pathophysiology
Mechanical ileal obstruction
Inc consistency of meconium - thicker than nl due to high protein
Meconium Ileus- cause
CF - needs to be ruled out if <6m
Meconium Ileus- prognosis
Lead to ileal perf and meconium peritonitis
Cow’s Milk Protein Allergy- pathophysiology
Inflammation in distal colon
NON IgE mediated
Cow’s Milk Protein Allergy - cause
one + food proteins
- Cow’s milk, soy
Cow’s Milk Protein Allergy - epidemiology
1st week
Resolves - late infancy
Cow’s Milk Protein Allergy - S/S & PE
Rectal bleeding
Cow’s Milk Protein Allergy- treatment
Elimination diet via mom
- then slowly introduce things back into her diet
Intussusception- pathophysiology
Telescoping bowel
- proximal to ileocecal valve - 90%
Intussusception - epidemiology
6-36m or <2y
Usually, viral illness in last 2 w
Intussusception - S/S & PE
Sudden onset Severe cramping intervals Vomiting Sausage mass Lethargy Currant Jelly stools
Intussusception - diagnosis
Barium/air enemas
Intussusception- labs & imaging
Rectal
US - doughnut or target appearance
Intussusception- treatment
Barium/air enemas
Pancreatitis- pathophysiology
infection of pancreas
Pancreatitis - cause
Trauma, gallstones, idiopathic, infectious, drug associated, vasculitis, genetic, autoimmune
Pancreatitis - S/S & PE
RUQ or epigastric pain Radiation to back Vomiting Anorexia low-grade fever
Tenderness to palpation w/out peritoneal signs
Pancreatitis - labs & imaging
Serum lipase - inc
Serum amylase - inc
Ca - inc
Abdominal US or CT
Pancreatitis- treatment
Admit
Pain control
H2O
Bowel rest
Pancreatitis- Complications
Complications - hypovolemic shock, hypocalcemia, hyperglycemia
Appendicitis- S/S & PE
Vague periumbilical pain -> localized to RLQ
Fever
Anorexia
Appendicitis- labs & imaging
WBC - high or nl - w/ left shift
CT w/ contrast
US - thickening of appendix
Appendicitis- treatment
Surgical removal
Appendicitis - prognosis
Complications - appendix per-> peritonitis
Functional abdominal Pain- treatment
Get them function
individual management
Viral Gastroenteritis- cause
Roavirus
Adenovirus
Enterovirus
Norwalk
Viral Gastroenteritis - S/S & PE
Mild fever Non-bloody emesis Cramping Discomfort Diarrhea
Lasts - 2-10day
Viral Gastroenteritis - labs & imaging
Labs, x-rays?
Viral Gastroenteritis- treatment
Supportive
Viral Gastroenteritis - complications
Complications - temporary lactose intolerance
Eosinophilic Esophagitis- pathophysiology
Eosinophil’s infiltrate into the esophageal epithelium
Eosinophilic Esophagitis - cause
Food allergies
Eosinophilic Esophagitis - S/S & PE
Vomiting Chest pain Epigastric pain Dysphagia Food impaction/stricture Ineffective antireflux therapy
Eosinophilic Esophagitis - diagnosis
Endoscopy w/ biopsy - patch testing
Eosinophilic Esophagitis - treatment
Elimination diet
Steroids
Repeat endoscope
Cyclical Vomiting Syndrome- pathophysiology
Idiopathic
Recurrent, stereotypical bouts of vomiting
Cyclical Vomiting Syndrome- cause
Abdominal migraines
Hypothalamic-pituitary axis hyperreactivity
Rapid gastric emptying
Cannabis
Cyclical Vomiting Syndrome- epidemiology
Anxiety
Cyclical Vomiting Syndrome- S/S & PE
Baseline/normal b/t episodes
Diarrhea- pathophysiology
Gastrointestinal infection - most common cause
Diarrhea - cause
Viral - most common cause
Diarrhea - treatment
Loperamide and other antidiarrheal - NOT INDICATED
Symptomatic care
Bacterial Gastroenteritis- pathophysiology
HUS?
- microanemia
- Thrombocytopenia
- Acute kidney injury
Bacterial Gastroenteritis- cause
Shigella Salmonella Campylobacter Yersinia Ecoli
Bacterial Gastroenteritis- S/S & PE
Fever
Abdominal pain
Diarrhea - bloody/mucous
Bacterial Gastroenteritis- treatment
Hydration BRAT diet Avoid fruit juice/high surage food Priobiotics ? Rule out concerning causes - porlonged/severe Refer if necessary
Toddler’s Diarrhea- pathophysiology
Chronic nonspecific diarrhea
Toddler’s Diarrhea- cause
Non-infections Malabsorption Protein/cars Food allergies ingestion Systemic disease
Toddler’s Diarrhea- epidemiology
9-24m
Toddler’s Diarrhea- S/S & PE
explosive loose stools w/ flecks of food
Toddler’s Diarrhea- treatment
Limit fruit juice Adjust fiber Fat in diet Keep hydrated Find cause Refer for chronic
Constipation- pathophysiology
Infrequent and/or passage of hard stools
Constipation - cause
Poor diet inadequate fluid intake Medications Anxiety/behavioral Underlying issues
Constipation - epidemiology
Common during toilet training
Constipation - S/S & PE
Overflow diarrhea Committing Abdominal pain Anal fissures Rectal bleeding Impaction UTI
Constipation- diagnosis- diagnosis (scale)
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
Hirschsprung Disease- pathophysiology
Absence of ganglion cells in mucosa and muscular layers of colon -> functional obstruction
Hirschsprung Disease - S/S & PE
Failure to pass meconium w/ first 24hr of life Distention Overflow diarrhea Enterocolitis Sepsis - megacolon Constipation - older kids
Hirschsprung Disease - diagnosis
Contrast enema - transition zone - ganglionic portion dilated
Rectal biopsy
Hirschsprung Disease - treatment
Surgery
Anorectal Anomalies- pathophysiology
Anterior displacement of anus
Anal stenosis
Imperforate anus
Foreign body in Esophagus- cause
Coin
Small toys
Foreign body in Esophagus- epidemiology
6m-3y
Foreign body in Esophagus- S/S & PE
Asymptomatic Choking Gagging Coughing salivation Dysphagia refusal to eat vomiting Stridor Perforation
Foreign body in Esophagus- diagnosis
Hx
Xray
GI Foreign body- pathophysiology
Pass on own
GI Foreign body- cause
Batteries and magnets - surgery
Growth- pathophysiology
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
