GI Problems in Children Flashcards
WHat is an objective measure of dehydration?
percentage of weight loss
What are some exam maneuvers you can do to check dehydration?
capillary refill time (over 2 seconds is bad)
skin turgor (tenting is bad)
deep breathing
sunken eyes
dry oral mucosa
altered mental status
What are some lab evaluatoins of dehydration?
urine output
urine specific gravity
Why are serum electrolyte determinations usually not needed in mild dehydration?
most episodes of dehydration caused by diarrhea are isonatremic and won’t affect the electrolyte levels
What drug should be used for treatment of vomiting in children?
ondansetron (zofran)
NOT metoclopramide - no evidence supports it
Almomst all children who have vomiting and dehydration can be treated with what?
oral rehydration therapy
Describe oral rehydration therapy.
administer small amounts of a glucose-electrolyte solution frequently
as the vomiting lessens, larger amounts of the solution can be given at longer intervals
when rehydration is achieved, other fluids and foods may be started
If a child has diarrhea but isn’t dehydrated, what should they drink?
just normal age-appropriate diets
so infants should continue to drink milk or regular strength formula
Which is more effective at rehydrating children with mild to moderate dehydration - ORT or IV hydration?
trick question - they’re equally as effective, making ORT the preferable choice
Does early refeeding with food after rehydration prolong diarrhea?
nope
milk might, so maybe wait a day or two
What sorts of foods are good to offer after successful rehydration?
rice creal
bananas
potatoes
carb-rich foods without lactose
True or false - the clear liquids recommended in the past are not appropriate for us in oral rehydration therapy.
true
What children wlll require IV hydration?
those that are severely dehydrated and in a state of shock or near shock
or those that are moderately dehydrated but cannot retain oral liquids because pf persistent vomiting
How much normal saline should you give in this situation? WHat are the other options?
20 mL per kg of normal saline
or
20 ml per Kg of 5% dextrose
How much of a benefit will probiotics give you for diarrhea in a kid?
on average, they’ll reduce the duration of diarrhea by about one day
True or false: the AAP considers opiates, bismuth subsalicylate, and attapulgite safe for use in young children and thus use of these antidarrheal agents is advised.
false - they can have serious adverse effects in infants and young children
When should you check for white blood cells in the stool?
in any child who appears toxic with high fever and diarrhea
if there is leukocytosis in the stool, you should further investigate for invasive bacterial diseases
What are the top three viral causes of infectious idarrhea in children?
Rotavirus
Calicivirus
Norovirus
What are the top three bacterial causes of infectious diarrhea in children?
Camylobacter jejuni
Salmonella
E coli
What are the two most common parasitic causes of diarrhea in children?
cryptosporidium
Giardia
If the child has bloody diarrhea, what are the likely cuprits?
more likely to be bacterial - shigella, campylobacter and EHEC
About 1 in ___ of infants are described as having colic.
1 in 5
Describe colic.
it’s inconsolable crying often accompnied by drawing up of the legs and gaseous distension of the abdomen
When does colic usually start in a baby’s life?
usually by 3 weeks of age, with a peak occuring by 6 weeks of age
may occur around the clock but more commonly occurs at a predictable time in the evening
At what age does the severity of colic typically decline and normal patterns reestablish?
about 3 months
Before you just call a baby colicky, what should you rule out?
other causes for irritability and crying like otitis, another infectious cause like UTI, intussusception, hairs around the penis, fingers or toes
WHat drug has been found to be significantly better at reducing symptoms of colic than placebo?
Dicyclomine
What are the issues with dicyclomine though?
Severe adverse effects were mroe common in those receiving the active medications (especially if younger than 7 weeks)
manufacturer no longer believes dicyclomine is appropriate for children younger than 6 months and it’s now contraindicated
True or false: soy formula may decrease the duration of colic symptoms.
true
True or false: sucrose solution was associated with a reduction in colic-associated crying, and the effect was surprisingly long-lived.
false - short-lived at only a matter of minutes
Have herbal teas been found to reduce colic symptoms?
Yes actually
but the issue is that using tea may lead to a decreased intake of milk with consequential nutritional adverse effects
What are some potential treatments for colic that have been found to have no effect?
Simethicone Methylscopalamine Hypoallergenic diet lactase enzymes carrying infant more using car-ride stimulators decreasing infant stimulatin training parents in a behavioral approach
90-95% of childhood consipation is ____
functional
What should the physical evaluation of a child with chronic constipation include?
an abdominal AND a rectal exam (check for fecal impaction)
What percent of encopresis cases involve fecal constipation and retention? What is this called?
80-95%
this is retentive encopresis
Describe the type of encopresis that will occur with retentive encopresis?
children will often soil small quantities of loose fecal matter several times a day, but periodically pass very large bowel movements
also…they may present wiht urinary complaints and abdominal pain or distention
What is nonretentive encopresis. What percentage of encopresis cases?
inappropriate soiling without evidence of fecal constipation or retention
makes up about 20% of cases
Describe the characteristics of nonretentive encopresis?
soiling accompanied by daily bowel movements that are normal in size and consisency
Which one is likely to have an abnormal physical exam: retentive or nonretentive encopresis?
retentive - will have clinical signs of constipation
nonretentive will typically be normal
Hirschpsrung disease is frequently mentioend in the differential diagnosis of encopresis, but why doesn’t he like this?
they typically don’t pass large bowel mvoements and rarely every soil
What is the first step management for retentive encopresis?
dietary changes or short term use of supplements like flavored fiber dirnks or bran sprinkles to increase the numer of bowel movements and to maximize daily toileting opportunities
If these steps don’t work and obtaining frequent soft and well-formed bowel movements is still a problem, what could you add?
stool softeners or laxatives
What are some stool softener options for children?
polyetheylene glycol (miralax)
Milk of magnesia
Mineral oil (but not if they’re at risk for aspiration!)
Sorbitol
Why might these supplements make soiling accidents more common?
they bulk up stool so sometimes they make it difficult for children to withold bowel movements
In general, you can expect the treatment to last ____ as long as the duration of the problem.
twice
If stool witholding leads to impaction in a child, what can you try as opposed to the trauma of rectal manipulation?
polyethylene glycol - will trigger a bowel movement in about 2-3 days
How long must abdominal pain last in a kid to be called chronic?
2 weeks
Night pain or pain on awakening suggest what origin of pain?
peptic
Pain occuring in the evening or during dinner is likely from what?
constipation
Recurrent abdominal pain syndrome is a prepubertal functional pain with two distinct peaks of frequency. When?
Peak 1 is between 5 and 7 years of age (equal frequency between boys and girls0
Peak 2 is between 8 and 12 and is far more prevalent in girls
How will the pain in recurrent abdominal pain syndrome be described?
typically vague and around the umbilicus or epigastric area
not related to meals, activity or stool pattern
What autonomic features usually accompany the pain in recurrent abdominal pain syndrome?
pallor, nausea, dizziness, headache and fatigue
Family history is often positive for what in recurrent abdominal pain syndrome?
functional bowel disease like IBS
Describe management for recurrent abdominal pain syndrome
Acknowledge te pain is real!
no extensive investigation is warranted
make sure the child continues normal routine - go to school, activities, normal diet, etc.
In older children and adolescents, a component of recurrent abdominal pain syndrome is seen in cases of what disorders?
depression or panic disorder with a learned symptomatic conversion reaction
IBS is best characterized by what?
an intestinal dysmotility with intervals of nuisance diarrhea or constipation
Whatis periodic syndrome or cyclic vomiting/abdominal migraine?
kids present with nausea, abdominal pain and significant emesis beginning during the night or early hours lasting about 6-48 hours
then intervening weeks to months with no symptoms or findings at all.
True or false: headache is very common in children with cyclic vomiting syndrome.
false - headache will be rare, but it can evolve into a more classic migraine when the child enters adolescence
Describe the abdominal pain that kids will complain of in UC or CD?
lower abdominal cramping that increases after meals or activity
Why do kids with CD or UC often have growth impairment?
the pain is reduced by eating smaller meals, so they develop anorexia
WHat are some things that will make the diagnosis of childhood IBD easy?
- bloody diarrhea
- need to defecate during the night
- perianal disease
- ileal mass on abdominal exam
What are some other subtle features of IBD in kids?
- delayed puberty
- anemia not responsive to iron supplmentation
- recurrent oral aphthous ulcers
- chronic liver disease
- large joint synovitis or arthritis
