GI- Peds Flashcards
whole milk should not be given under 1 bc?
can cause microscopic bleeding and allergies
when should solid foods be introduced?
at 4 months
what foods are choking hazards for infants?
raisins, nuts, hot dogs, grapes
if a peds pt vomits their med within 20 mins of taking it, what do you do?
you can re-dose and not worry about overdosing
when to be concerned about vomiting
- bile in vomit
- blood in vomit
- severe dehydration
- significant changes in mental status/activity level “lethargic”
limit dairy to___ servings per day
2
*The more dairy they have, the more fluid they need to push it out
for constipation, what do you recommend?
a strict toileting schedule; at least have them attempt to sit and have a BM at least daily when constipation is a concern
if mucus in stool more concerning for a….
food intolerance/allergy
if blood in the stool, can be…
post-viral and if large amount and constant this is concerning!
when to be concerned about diarrhea
- large amounts of blood in diarrhea
- symptoms of diarrhea
- significant weight loss
- family hx of IBD
- daily abd pain
tx of diarrhea
- increase fluids
- BRAT diet: bland, starching foods to bulk up stools–bananas, rice, applesauce, toast
constipation
- dairy is VERY constipating
- avoid Miralax
- increase fluids
- increase fiber: fruits with skin, most fibrous: peaches, pears, prunes, plumes, pineapples
giardiasis
- can be passed to person to person contact (spread through feces)
- poor sanitation and unsafe water increase the risk of catching intestinal parasites
giardiasis: s/s (typically appear 2 weeks after infection)
- watery diarrhea
- soft, greasy stools
- fatigue
- abd cramping
- bloating
- nausea
- weight loss
- does not have blood/mucus in stool
diagnosis giardiasis
stool culture
tx giardiasis
- metronidazole
- albendazole
- mebendazole
- nitazoxanide
- tinidazole
- albendazole
pinworm
- Transmitted indirectly; eggs from an infected person can stick to toys/bedding/clothing/objects. (can live off of a host on material for up to 2 weeks)
- Tiny, white, thread-like worms that live in the rectum
- At night the worm crawls out of the anus and lays eggs in the nearby skin; this causes severe itching
pinworm s/s
o Itchy in anus: worst at night (when they are active)
o Parents report at times seeing something move in and out of the rectum (in the bath, when changing a diaper)
pinworm diagnosis
o Tape test: Cellophane tape is pressed against the skin around the anus. If doing the test at home, it is best to do it in the morning before your child bathes or goes to the bathroom. When you look at the piece of tape, you will see the worms.
o Another way to test for pinworm is if you see the adult worm around your child’s anus, in underwear or diapers, or in the toilet after going to the bathroom. Remember, they are white and only about a centimeter long.
tx of pinworm
- albendazole
- mebendazole
- pyrantel pamoate
tapeworms
- Caused by contaminated food or water
- Flat, hermaphroditic worms that can live as parasites in the human gastrointestinal tract
- Eggs move from intestines to form cysts in tissue/organs. Eaten tapeworm larvae can grow into adult tapeworms, which live in the intestines.
tapeworms s/s
o Some can be asymptomatic
o Visible worms in stool
o Nausea
o Anorexia (not want to eat)
o Epigastric pain
o Urticaria
diagnosis of tapeworm
stool culture
tx of tapeworms
- 1st line Praziquantel
appendicitis
inflammation of appendix
appendicitis testing
o Psoas sign: have the pt lie on his or her left side and then you flex their right thigh backward. If they have pain when flexing that right thigh backward that’s bc the muscle of the thigh and the movement is pushing up that inflamed appendix. If positive will elicit pain
o Obturator sign: have the pt lie on their back and do a slow internal movement of their hip joint while the right knee is flexed.
o Mc’ Burneys: Rebound tenderness; pain worse when you let go of RLQ, more than with pressing in
o Rovsing’s: Pain radiates to RLQ, when you palpate LLQ
s/s appendicitis
o Sudden pain that begins on the right side of the lower abdomen
o Sudden pain that begins around your navel and often shifts to your lower right abdomen
o Pain that worsens if you cough, walk or make other jarring movements
o Nausea and vomiting
o Loss of appetite
o Low-grade fever that may worsen as the illness progresses
o Constipation or diarrhea
o Abdominal bloating
o Flatulence
o RLQ pain
concerns with appendicitis
- rupture/sepsis
- abscess
diagnostics for appendicitis
ultrasound/CT to confirm this
Hirschsprung’s Disease
- large intestine becomes swollen due to a blockage
- affects the large intestine (colon)
- causes problems passing stool
Hirschsprung’s Disease: s/s in infants
o Failure to pass meconium
o Swollen belly
o Vomiting (bile stained)
o Flatulence
Hirschsprung’s Disease: s/s in older children
o Swollen abdomen
o Chronic constipation
o Gas
o Failure to thrive
o Fatigue
o Ribbon-like (pencil) foul smelling stool
Hirschsprung’s disease diagnosis
o Biopsy of colon
o Abdominal x-ray using contrast dye (avoid in pts with kidney issues, or family hx of allergies to contrast dye)
Hirschsprung’s disease tx
Surgery: to bypass/remove portion of the colon lacking nerve cells
* Pull-through surgery: diseased portion of colon removed; normal section pulled through the inside of the colon and attached to the anus
* Ostomy: to allow time for colon to heal/rest; can be reverse
pyloric stenosis
o Blocks foods from entering the small intestine
o Normally, a muscular valve (pylorus) between the stomach and small intestine holds food in the stomach until it is ready for the next stage in the digestive process. In pyloric stenosis, the pylorus muscles thicken and become abnormally large, blocking food from reaching the small intestine. This causes an “olive pit” palpable in the pylorus.
pyloric stenosis: s/s
o Typically appear within 3-5 weeks after birth; rare in babies >3 months.
o Projectile vomiting after feeding
o Persistent hunger
o Abdominal contractions
o Dehydration
o Changes in bowel movements
o FTT
risk factors for pyloric stenosis
o More often in males
o Caucasians
o Prematurity
o Family history
o Smoking during pregnancy
o Early antibiotic use
how is pyloric stenosis diagnosed?
by ultrasound
tx of pyloric stenosis
surgical correction is needed
intussusception
Telescoping of a section of the intestines into the adjacent part of the intestines; this blocks food/fluid from passing through. It can also cut off the blood supply to the affected portion of the intestine, which can lead to a perforation in the bowel. This can result in infection/death of the bowel.
intussusception: s/s
o “Currant jelly stool”; stool mixed with blood and mucus
o Vomiting
o Lump in the abdomen
o Weakness/lack of energy
o Diarrhea
intussusception risk factors
o Age: more common in younger children; most common cause of bowel obstructions in children between the ages of 6months-3 years
o More common in males
o Increased risk when there is intestinal malrotation history
o Certain disorders predispose someone:
* CF
* Henoch-Schonlein Purpura (HSP) also known as IgA Vasculitis
* Crohn’s disease
* Celiac disease
intussusception: complications
peritonitis
* Abdominal pain
* Abdominal swelling
* Fever
* Vomiting
* Cool, clammy, pale skin
* Weak, rapid, thready pulse
* Abnormal breathing
* anxiety/agitation
* Listlessness
diagnostics of intussusception
- abd ultrasound
- x-ray
- CT scan
- any imaging will show a “bullseye”: intestine coiled within the intestine
tx of intussusception
- air enema (1st line)
- surgery (if perforation/peritonitis)
