Initial GI peds Flashcards
features of GERD in infants
emesis (may be absent, or may cause FTT). Sandifer syndrome (toticollis with back arching caused by painful esophagitis), feeding refusal or constant hunger (both indicate esophagitis).
sequelae of GERD in kids
upper and lower airway disease, bronchopulmonary constriction (can cause aspiration, laryngitis, wheezing, vocal cord nodules), FTT, esophageal strictures, (barrett’s)
predictors of outcome in GERD in kids
-infants who have GERD after 1 year of age, or older kids, usually don’t have spontaneous resolution of symptomsa and need medical management or surgery
GERD management in kids
- upright positioning, thickened foods, acid inhibition (antacidis, histamine H2 blockers, PPI)
- motility agents to incr.gastric empyting (metoclopromide). often limited by side effects (drowsiness, dystonia)
- Surgery- nissen fundoplication, with gastrostomy tube to help stretch the stomach and give tube feeds in infants
features of congenital pyloric stenosis
- nonbilious projectile vomiting
- hungry, irritable infants
- jaundice in 5% (low levels of glucuronyl transferase)
- dehydration
diagnosis of congenital pyloric stenosis
ultrasound is first choice
UGI may show a long, narrow pyloric channel (string sign)
What is malroatation/midgut volvulus?
anatomic abnormality of intestinal rotation that allows the midgut to twist around the superior mesentaeric vessels (volvulus). may cause obstruction and bowel infarction.
features of midgut volvulus
- bilious vomiting and sudden onset abd pain in an otherwise healthy infant. older kids may have crampy pain and vomiting.
- anorexia, distention, bloody stools
- physical exam usually normal at first, but may progress to peritoneal signs, shock, cardiovascular collapse
evaluation for midgut volvulus
abdominal xrays (gastric andproximal intestinal distention and obstruction) upper intestinal contrast imaging is study of choice. show abnormal position of the ligament of treitz, obstruction, jejunum right of midline
intussusception: what age kids, most common location,
- most common cause of bowel obstruction between 1 month and 2 years; usually between 5-9 months of age
- most commonly occurs at ileocolic location
etiology of intussusception
usually unknown, but consider lead points (meckel’s diverticulum, polyp, intestinal duplication, peyer’s patch, lymphoma). lead points are actually rarely identified, and more commonly found in older kids
why is intussusception dangerous?
causes bowel wall edema/hemorrhage, and can lead to bowel ischemia and infarction
clinical features of intussusception
- previously healthy kid with sudden onset crampy/colicky abd pain. pain occurs in intervals followed by periods of calm
- vomiting
- lethargy
- normal stool or currant jelly stool
- sausage shaped mass
intussusception evaluation
- fluid resuscitation
- radiographs are of limited utility
- possible abdominal ultrasound
- air or contrast enema is the gold standard. contrast enema shows coil spring sign
management of intussuscpeiton
- contast enemas
- surgery if contrast enema fails to reduce the intussusception or if kid has peritoneal signs or pneumoperitoneum
- risk of recurrance 5% after contrast enema and 1% after surgery
