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Peds: Growth and Development > GI Tract Disorders > Flashcards

GI Tract Disorders Flashcards

1
Q

What normal physiological factors predispose infants to GE?

A
  1. Small stomach capacity
  2. Frequent large volume feedings
  3. Short esophageal length
  4. Supine position
  5. Slow swallow reflex
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2
Q

What are the sxs of gerd in infants?

A
  1. Frequent postprandial regurgitation

A. Most common sx

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3
Q

What are the sxs of gerd in OLDER CHILDREN?

A
  1. Regurgitation of stomach contents into throat
  2. Heartburn
  3. Dysphagia
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4
Q

What is the ddx for gerd?

A
  1. Important differentiating point in evaluating infants with GE
  2. Whether vomited material contains bile
    A. If bile present, suspect intestinal obstruction
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5
Q

What dx studies are used for gerd in infants?

A

None, clinical dx

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6
Q

What dx studies are indicated for older children with gerd?

A
  1. Older children w/heartburn who have persistent sx’s when treated
    A. UGI
    B. Endoscopy
    C. pH esophageal monitoring
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7
Q

How is gerd managed in infants?

A
  1. Reflux resolves spontaneously in 85% infants by 12 months of age
  2. Reduce sx’s w/ symptomatic measures
    A. Smaller more frequent feedings
    B. Thicken feedings with rice cereal
    C. H2 antagonists or PPI’s reduce pain asst w/ reflux
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8
Q

How is gerd managed in older children?

A
  1. H2 blockers or PPI’s
  2. Weight reduction
  3. Dietary measures
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9
Q

Define colic

A

An otherwise healthy infant aged 2-3 months seems to be in pain

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10
Q

what is the rule of threes in colicky children?

A
  1. Cries for > 3 hrs /day
  2. Episodes occur > 3 days/week
  3. Episodes occur for > 3 weeks
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11
Q

What is the epidemiology of colic?

A
  1. Common in infants 2-3 months
  2. Commonly in late afternoon & early evening hours
  3. Anxious parents
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12
Q

What are the sxs of colic?

A
  1. Crying
  2. Abd pain
  3. Abd distention
  4. Irritability
  5. Knees drawn up
  6. Fists clenched
  7. Symptoms mimic intestinal obstruction
    A. R/O organic Dz or obstruction
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13
Q

What is the treatment for colic?

A
  1. Eliminate cow’s milk
  2. Change to soy milk until 4 months of age
  3. Reassure parents
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14
Q

What are the strategies to manage colic?

A
  1. Change to soy-based formula
  2. Nursing other
    A. Avoid milk-based products, caffeine
  3. Frequent burping
  4. Change bottle nipple
  5. Ride in car
  6. Front carrier
  7. Pacifier
  8. Belly massage
    9.Swaddling
  9. Warm bath
  10. Simethicone (Mylicon) qtts
  11. Parental support
  12. Swing
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15
Q

What are the general considerations for a FB in the alimentary canal?

A
  1. Ingestion of non-food items accounts for 80% of documented foreign body ingestions
    A. 80-90% of these pass spontaneously
    B. 10-20% require endoscopic or surgical management
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16
Q

What are the mc fb ingested?

A
  1. Coins
  2. Batteries
  3. Buttons
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17
Q

Where do fb tend to lodge in the gi tract?

A
  1. Ingested FB tend to lodge in narrowed areas

A. GE junction, pylorus, ligament of Treitz, ileocecal junction

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18
Q

How soon should an esophageal fb be removed? What about batteries?

A
  1. Esophageal FB should be removed w/in 24 hrs to avoid ulceration
    A. Disk shaped batteries in esophagus especially concerning
    B. Should be removed immediately
    C. Can cause thermal injury w/in 2 hrs
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19
Q

What objects usually pass spontaneously?

A 
1. Smooth FB (buttons or coins)
A. Usually pass spontaneously
B. Monitor child without attempting removal
2. Objects with blunt end
A. Straight pins, screws, nails
B. Generally pass w/out incident
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20
Q

What objects need to be removed?

A
  1. Wooden toothpicks
    A. Should be removed
  2. Objects longer than 5 cm should be removed
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21
Q

What are the sxs of fb in the gi tract?

A
  1. Dysphagia
  2. Odynophagia
  3. Drooling
  4. Regurgitation
  5. Abd pain
  6. Maintain high degree of suspicion for toddler who presents with these sx’s
    A. Even w/out witnessed ingestion
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22
Q

What is the treatment for a fb in the gi tract?

A
  1. Observation & monitor
  2. Endoscopic removal
  3. Surgery
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23
Q

Describe pyloric stenosis

A

Postnatal pyloric muscular hypertrophy with gastric outlet obstruction

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24
Q

What are the epidemiological trends regarding pyloric stenosis?

A
  1. Incidence 1-8 per 1000 births
  2. Male > female (4:1)
  3. FH: 13% cases
  4. Mean age @ Dx 43.1 days
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25
Q

What are the sxs of pyloric stenosis?

A 
1. PP vomiting 
A. Usually begins @ 2-4 weeks of age
B. Non-bilious projectile vomiting
2. Infants hungry & nurse frequently
3. Constipation
4. Weight loss
5. Distended upper abd after feeding
6. Palpable “olive”
A. Oval mass with deep palpation in epigastrium
B. Noted in 13.6% pts
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26
Q

What are the dx studies for pyloric stenosis?

A 
1. UGI w/barium
A. Delayed gastric emptying
B. Long narrow pyloric channel
C. “String sign”
D. Filling defects in antrum
2. Ultrasonography
A. “Target sign”
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27
Q

What is the treatment for pyloric stenosis?

A
  1. Treat dehydration & electrolyte imbalance before surgery
  2. Pyloromyotomy
    A. Treatment of choice
  3. Prognosis
    A. Excellent
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28
Q

What are the general characteristics of intussusception?

A
  1. Most frequent cause of intestinal obstruction in first 2 yrs of life
  2. Male > females (3:1)
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29
Q

What is the etiology of intussusception?

A
  1. 85% cases: etiology unknown
  2. Some causes:
    A. Adenovirus
    -Recent studies show correlation
    B. Meckel’s diverticulum
    C. Small bowel polyp
    D. Lymphoma: Children > 6 yrs
    E. Parasites
    F. FB
    G. Hypertrophy of Peyer’s patches
    -Small masses of lymphatic tissue in ileum
    -AKA aggregated lymphoid nodules
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30
Q

What is the pathophys of of intussusception?

A
  1. Intussusception starts just proximal to ileocecal valve & extends into colon
    A. Terminal ileum telescopes into colon
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31
Q

What are the complications of intussusception?

A
  1. Swelling
  2. Hemorrhage
  3. Vascular compromise
  4. Incarceration
  5. Necrosis
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32
Q

What is the typical scenario for intussusception?

A
  1. 3-12 month thriving infant develops recurring paroxysms of abd pain, screaming & drawing up knees
  2. Vomiting & diarrhea occur soon afterward
  3. Bloody bowel movements with mucus in next 12 hours
    A. “Current jelly” stool
  4. Sausage shaped mass in upper abd
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33
Q

What is the initial screening tool for intussusception?

A

KUB or abd ultrasound

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34
Q

What is the Ba or air enema used for?

A
  1. Both diagnostic & therapeutic for intussusception

2. If signs of strangulated bowel, perforation or toxicity, Ba enema contraindicated

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35
Q

When is surgery indicated for intussusception?

A
  1. Extremely ill pts
  2. Evidence bowel perforation
  3. Persistent intussusception after Ba & air enemas
36
Q

What is the prognosis for intussusception?

A
  1. Relates directly to duration of intussusception before reduction
  2. Pt should be carefully observed after barium &/or air enema reduction
  3. Intussusception can recur w/in 24 hrs in 3-4% pts
37
Q

What is hte mc indication for emergency abd surgery in childhood?

A

appendicitis

38
Q

What is the peak age for acute appendicitis?

A
  1. 15-30 yrs
  2. Incidence perforation 40% in childhood
    A. Greatest in children
39
Q

What are the predisposing factors?

A
  1. Idiopathic -> majority of cases

2. Fecalith -> 25% cases

40
Q

What are the hx indications for appendicitis?

A
  1. Classically, initial pain is poorly localized (visceral pain) around epigastrium or umbilicus
    A. Later pain shifts to RLQ
  2. Anorexia, N/V, low grade fever may be present
41
Q

What are the pe indications for appendicitis?

A
  1. RLQ tenderness over McBurney’s point
  2. (+) psoas & obturator signs
  3. Guarding
  4. Tenderness on rectal exam
42
Q

What criteria are included in the pediatric appendicitis score?

A
  1. Anorexia
  2. Nausea/vomiting
  3. Migration of pain
  4. Fever >100.5
  5. Pain with cough, percussion, hopping
  6. RLQ tenderness
  7. WBC > 10,000
  8. Neutrophils plus bands >7500
43
Q

What does a PAS

A
  1. Low risk for appendicitis
  2. Children with a PAS score in this range may be discharged home as long as their caretakers understand that persistent pain or additional symptoms warrant repeat evaluation
44
Q

What does a PAS of 3-6 mean?

A
  1. Indeterminate for appendicitis
    2, Best approach is not clear
  2. Options include surgical consultation, diagnostic imaging, serial abdominal examinations while being observed in the hospital, or a combination of these approaches depending upon local resources
45
Q

What does a PAS of >7 mean?

A
  1. High risk for appendicitis

2. Children with a PAS score in this range warrant surgical consultation

46
Q

What labs may be done for acute appendicitis?

A
  1. WBC may be elevated w/left shift
  2. Pyuria
  3. CT Abd with contrast -> dilated appendix or perforated appendix
47
Q

How is acute appendicitis treated?

A
  1. STAT surgery consult
    A. Laproscopic appendectomy
    B. Exploratory laparotomy
  2. Analgesia: tylenol otpt, morphine/toradol inpt
  3. IV fluids
  4. Broad spectrum intra-operative IV antibiotics
    A. Cefoxitin (Mefoxin),piperacillinor piperacillin/tazobactam (Zosyn)
48
Q

What abx are indicated for acute appendicitis?

A

Cefoxitin (Mefoxin),piperacillinor piperacillin/tazobactam (Zosyn)

49
Q

Describe congenital aganglionic megacolon/hirschsprung dz

A

Results from congenital absence of ganglion cells in mucosal & muscular layers of colon

50
Q

What is the pathophys of congenital aganglionic megacolon/hirschsprung dz?

A
  1. Neural crest cells fail to migrate into mesodermal layers of gut during gestation
  2. Usually involves rectum (44%), recto-sigmoid (30%), or entire colon (8%)
51
Q

What are the sxs of congenital aganglionic megacolon/hirschsprung dz?

A
  1. Failure of newborn to pass meconium in first 24 hrs of life
    A. First sign
  2. Vomiting
  3. Abd distention
  4. Reluctance to feed
  5. DRE
    A. Anal & rectal canal devoid of stool despite evidence of fecal material on X-ray
    B. Squirt sign if fecal material is low enough
52
Q

What are the dx studies for congenital aganglionic megacolon/hirschsprung dz?

A
  1. Rectal / colon biopsy
    A. Absence of ganglion cells
  2. KUB
    A. Dilated proximal colon
53
Q

How is congenital aganglionic megacolon/hirschsprung dz treated?

A
  1. Surgical resection of affected bowel

A. Diverting colostomy is performed proximal to aganglionic segment

54
Q

What are the potential post-op complications of hirschsprung’s dz?

A
  1. Fecal retention
  2. Fecal incontinence
  3. Anastomotic breakdown
  4. Post-op obstruction
55
Q

Describe chronic constipation

A
  1. Chronic constipation in childhood is defined as 2 or more of following for 2 months:
    A. 1 episode encopresis per week
    C. Involuntary fecal leakage
    D. Rectal stool impaction
    E. Passage of stool so large that it obstructs toilet
    F. Fecal withholding
    G. Painful defecation
56
Q

What causes most constipation in children?

A

Most constipation in childhood is result of voluntary & sometimes involuntary retention

57
Q

What are the organic causes of constipation?

A 
1. Diet
A. Low fiber, ↓ fluids
2. Gastrointestinal
A. Hirschsprung’s Dz
B. Ileus
C. Rectal abscess/fissure
3. Drugs/toxins
A, Lead
B. Narcotics
C. Anticholinergics
4. Neuromuscular
A. Infant botulism
5. Metabolic
A. CF, hypothyroid, hypercalcemia, hypokalemia
58
Q

What are the sxs of constipation in infants

A

Grunt, strain, turn red

59
Q

What are the sxs of constipation in toddlers and older children?

A
  1. Painful defecation
  2. Skeletal muscle weakness
  3. Psychological issues
    A. Control & authority
  4. Distaste for public bathrooms
60
Q

What are the ddx for constipation?

A
  1. Hirschprung’s dz
61
Q

What is the treatment for older children with constipation?

A
  1. ↑ fiber
  2. ↑ water
  3. Stool softeners
    A. Docusate sodium bid
  4. Relieve fecal impaction
  5. Psych consult if persistent
  6. Treat metabolic cause
62
Q

What is the treatment for infants with constipation?

A
  1. Mineral oil
  2. Contraindicated in non-ambulatory infants & physically handicapped
    A. Aspiration of mineral oil can cause lipid pneumonia
63
Q

What is the etiology of acute diarrhea?

A

Viruses are the most common cause of acute gastroenteritis in developed countries

64
Q

What is the most common pathogen that causes acute diarrhea? What other pathogens?

A 
1. Most common pathogen
A. Rotavirus
-Most common in 3 months – 15 months
-Peak incidence in winter 
B. Other common pathogens
-Enteric adenovirus
-Calicivurus
65
Q

What is the pathophys of diarrhea?

A

Viruses typically affect small intestine -> voluminous watery diarrhea without leukocytes or blood

66
Q

What is the incubation period, sxs, and diagnostics for rotavirus?

A 
1. Incubation period
A. 1-3 days
2. Signs & Sx’s
A. Vomiting usually first sx in 80-90% pts
B. Low grade fever
C. Watery diarrhea
3. Diagnostics
A. Rotavirus antigen in stool
67
Q

What is the treatment for rotavirus diarrhea?

A
  1. Supportive
  2. Treat dehydration & electrolyte loss
    A. Pedialyte, Gatorade, WHO rehydration formula
  3. Oral rehydration
  4. Breast fed infant should continue to breast feed in addition to oral rehydration
68
Q

How is rotavirus prevented?

A

RV vaccine @ 2, 4, 6 months

69
Q

What pathogens cause bacterial enterocolitis?

A
  1. Salmonella
  2. Shigella
  3. Yersinia
  4. Campylobacter
  5. Toxigenic E coli
70
Q

What pathogen causes abx induced diarrhea?

71
Q

What extraintestinal infections can cause diarrhea?

72
Q

What gastrointestinal conditions can cause diarrhea?

A
  1. Intussception
  2. Appendicitis
  3. Hyperconcentrated formula
73
Q

What renal conditions can cause acute diarrhea?

A

Hemolytic Uremic Syndrome

74
Q

What questions need to be asked regarding acute diarrhea?

A
  1. Frequency
  2. Appearance
    A. Bloody
    B. Mucus
  3. Amount
  4. Consistency
  5. Color
  6. Dietary changes
  7. Travel history
  8. Weight changes
  9. Medications
  10. Ill contacts
75
Q

How is hydration status assessed in a pe (diarrhea)?

A
  1. Tachycardia
  2. Tachypnea
  3. Weight loss
  4. Dry mucus membranes
    5 .Sunken fontanelle
  5. Sunken eyes
76
Q

What needs to be assessed on the abdomen when a pt has diarrhea?

A 
1. Bowel sounds
A. Hypoactive
B. Hyperactive
2. Distention
3. Tenderness
4. Masses
77
Q

What dx studies need to be performed for acute diarrhea?

A
  1. Stool C&S
  2. Stool O&P
  3. Fecal leukocytes
  4. If dehydration, add
    A. CBC
    B. BMP
    C. UA
  5. If bacterial enterocolitis in infant
78
Q

What is the treatment for acute diarrhea in an infant?

A
  1. Small frequent feedings
    Ricelyte, Pedialyte, WHO rehydration formula
    A. If vomiting
79
Q

What is the treatment for acute diarrhea in children?

A 
1. Isotonic fluids
A. Soup
B. Dilute apple juice
2. NO antidiarrheal meds in viral gastroenteritis
A. Can cause toxic megacolon
80
Q

When is hospitalization indicated for pts with diarrhea?

A 
1. If >5% dehydrated
A. Dry mucus membranes
B. ↓ tears
C. ↓ urine output
D. Sunken eyes/fontanelle 
E. ↓ skin turgor
F. Tachycardia
G. Tachypnea
81
Q

What pathogen is ‘pinworms’?

A

Enterobus vermicularis

82
Q

Where do the pinworms live?

A 
1. Adult worm lives in colon
A. Approx 5-10 mm
2. Females deposit eggs in perianal area
A. Primarily at night
B. Leads to intense itching
83
Q

What are the sxs of pinworms?

A
  1. Localized pruritis

2. Worms in stool

84
Q

What are the dx studies for pinworms?

A
  1. Press piece of tape on child’s anus in morning prior to bathing
  2. Place tape on slide, add 1 drop xylene, & examine under microscope
  3. Observe for ova
85
Q

What is the hygeine treatment for pinworms?

A
  1. Good hygiene measures
  2. Nails short
  3. Bathe in AM
  4. Launder linens & bed clothes frequently
86
Q

What is the medical treatment for pinworms?

A 
1. Pyrantal pamoate (Pin-X) single dose
A. 1 mg/kg to max 1 gm
2. Mebendazole (Vermox)100 mg po x 1
3. Treat both patient as well as close family contacts
4. Repeat 2 wks prn

Peds: Growth and Development (13 decks)

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