Knott - Peds GI Flashcards
1
Q
main difference between adult GI tract and newborn GI tract
A
tummy size
- other:*
- gut flora evolving*
- immature liver*
2
Q
jaundice peaks on day __ of life
A
4
3
Q
unconjugated bilirubin is bilirubin before it
A
makes it to liver
4
Q
conjugated bilirubin has been
A
taken up by the liver
5
Q
jaundice usually self resolves in
A
2-3 weeks
6
Q
red flags w. newborn jaundice
A
no poop
neuro symptoms
jaundice w.in first 24 hr of life
non optimal sucking/nursing
cephalohematoma/bruising
7
Q
breast milk jaundice appears __
and can last __
A
at the end of the first week of life
3-10 weeks
8
Q
breastmilk jaundice is caused by increased absorption of bilirubin from the __
and increased __ from mom’s breast milk
A
intestine
beta glucoronidase
9
Q
breast milk jaundice resolves __
A
spontaneously
10
Q
can babies w. breastmilk jaundice still breastfeed?
A
yes!
11
Q
breast feeding jaundice is caused by
A
baby not getting enough milk dt delayed/insufficient production → dehydration → decreased stooling → increased bilirubin
12
Q
what type of jaundice is a sign of liver dysfxn, and is a medical emergency
A
elevated direct (conjugated) bilirubin
13
Q
elevated conjugated (direct) bilirubin can cause
A
BIND: bilirubin induced neurologic dysfxn
14
Q
how do bili lights fxn
A
make bilirubin more soluble to get it out of system
15
Q
when is GER normal
A
during/after feeds
if baby still gaining wt/happy
16
Q
what is GER
A
gastroesophageal reflux → passage of gastric contents into esophagus
17
Q
what is GERD
A
pathologic GER → heart burn/discomfort
18
Q
symptoms of GERD in infant
A
fussy
sleep disturbance
decreased appetite
arching, choking, gagging, pulling of breast/bottle
not gaining wt
19
Q
symptoms of GERD in older kids
A
coughing
dental erosions
epigastric pain
20
Q
how do you dx infant GERD
A
vitals
growth
21
Q
__% of GERD resolves by 12 months
A
90
22
Q
tx for infant GERD
A
reassurance
lifestyle mods: carry upright, tummy time, decrease volume/increase frequency of feeds
thicken formula
+/- PPI
23
Q
how do you tx severe infant GERD
A
GI referral
Nissen
24
Q
what is pyloric stenosis
A
hypertrophy of musculature around pylorus
25
what do you think when you see **projectile** non-bilious emesis, **hungry,** fussy, metabolic alkalosis, and **olive sized mass** in 4th week of life
pyloric stenosis
26
dx for pyloric stenosis
US
27
tx for pyloric stenosis
rehydration
surgery
28
what do you think when you see **bile stained vomit, abd distension in 1st 48 hr** of life or **first few days/weeks of life**
intestinal atresia and stenosis
29
intestinal artresia is
complete blockage of intestines
30
intestinal stenosis is
narrowing of the intestines
31
where can intestinal artresia/stenosis occur
anywhere along intestines (beyond the stomach)
32
differentiation btw intestinal artresia/stenosis and GERD/other benign infant GI conditions
bilious vomiting
33
what do you think when you see, dilated loops of bowel w. absence of colonic gas
xray findings of intestinal artresia/stenosis
34
never let the sun set on \_\_;
it is always \_\_\_
and an __ condition
bilious emesis
pathologic
all-stop
35
2 other obstructions besides intestinal artresia/stenosis
malrotation
volvulus
36
what is a midgut volvulus
rotation of intestines ***with pinching off***
37
midgut volvulus occurs in the first _ weeks of life,
and sx include
3
severe diffuse abd pain/distension
persistent bilious emesis
bloody stools
lethargy
poor feeding
38
what is KUB imaging
kidney, ureter, bladder xray
39
dx for midgut volvulus
upper GI w. contrast
40
what do you think when you see, corkscrew pattern, dilated loops of bowel overlying liver shadow w. no distal gas to obstruction
KUB findings of midgut volvulus
41
tx for midgut volvulus
surgical emergency
42
what is a diaphragmatic hernia
herniation of bowel thru diaphragm
43
what is this showing
diaphragmatic hernia
44
1st thing to consider in child w. abd pain
age! → helps narrow dx
45
acute reasons for abd pain
gastroenteritis
**constipation**
pancreatitis
intussusception
obstruction
malrotation
volvulus
appendicitis
ovarian/testicular torsion
trauma
46
chronic reasons for abd pain
**constipation**
functional abd pain
anxiety/behavioral
47
other reasons for abd pain
acid-related d.o
meds
48
what are the two types of abd pain
visceral
peritoneal
49
with peritoneal pain, the child can
localize pain w. one finger
50
with visceral pain, the child may __ when asked to localize pain
circle the whole tummy
51
exam to perform for abd pain
DRE
52
appendicitis pe will show
peritoneal signs
53
what are 5 peritoneal signs
abd pain/tenderness
bloating
fever
n/v
loa
54
what special test is used to look for appendicitis
jump test
55
labs for appendicitis will show
high, normal, or elevated WBC w. left shift
elevated CRP
56
2 imaging options for appendicitis
CT w. contrast
US → thickened appendix
57
tx for appendicitis
appendectomy
58
what is intussusception
telescoping bowel just proximal to ileocecal valve
59
test to perform if you suspect intussusception
DRE
60
intusussception usually presents in __ yo;
with __ clinical presentation
6-36 mo
odd
61
sx of intussusception
**sudden onset of severe cramping/pain intervals**
vomiting
sausage mass
lethargy
**currant jelly stools**
62
what diagnostic and therapeutic for intussusception
barium or air enema
63
what do you think when you see, donut or target appearnce
US findings for intussusception
64
what is this showing
donut/target appearance
US findings of intussusception
***very accurate***
65
what do you think when you see, sudden onset of severe cramping/pain, currant jelly stools, and donut/target appearance
intussusception
66
causes of peds pancreatitis
trauma
gallstones
idiopathic infxn
drug associated
vasculitis
genetic
AI
67
what drug can cause pancreatitis in peds
valproic acid
68
pe findings of pancreatitis
ttp
peritoneal signs
69
sx of pancreatitis
RUQ/epigastric pain, +/- radiation to the back
vomiting
anorexia
low grade fever
70
labs for pancreatitis will show
elevated lipase and amylase
hypercalcemia
71
imaging for pancreatitis
US
CT
72
tx for pancreatitis
admit!
pain control
hydration
bowel rest
73
what do you think when you see, visceral hyperalgesia, reduced threshold for pain, and impaired gastric relaxation
functional abdominal pain
74
dx for functional abdominal pain is a
dx of rule out
75
what can help you narrow ddx for vomiting
anatomy
age
characteristics → ***bilious or not***
76
types of vomit from newborn-teen
dribble
projectile
bloody or bilious
77
tx for vomiting
hydration
+/- anti emetics
+/- antihistamines and anticholinergics
78
common pathogens associated w. viral gastroenteritis (4)
rotavirus
adenovirus
enterovirus
norwalk
79
viral gastroenteritis can last __ days
and sx include
2-10
mild fever
non-bloody emesis
cramping
discomfort
diarrhea
80
tx for uncomplicated viral gastroenteritis
supportive
hydration
temporary lactose intolerance → avoid dairy
81
what do you think when you see, eosinophilic infiltrate into esophageal epithelium
eosinophilic esophagitis (EOE)
82
what is a major consideration in eosinophilic esophagitis
food allergies!
83
sx of EOE
vomiting
cp
epigastric pain
dysphagia
food impaction (stricture)
ineffective reflux therapy
84
dx for EOE
endoscopy w. bx and patch testing
85
tx for EOE
elimination diet
steroids
repeat endoscopies
86
what do you think when you see, recurrent stereotypical bouts of vomiting w. baseline/normal health in between episodes
cyclical vomiting syndrome
87
what is a major comorbidity for cyclical vomiting syndrome
anxiety
88
cyclical vomiting syndrome dx: at least __ attacks at any interval,
or a minimum of __ attacks
during a __ mo perior
5
3
6
89
in a teenager w. cyclical vomiting syndrome, you should think about
cannabinoid hyperemesis
90
tx for cyclical vomiting syndrome
time
effort
support
91
ddx if a newborn/neonate is pooping blood
swallowed maternal blood
bacterial GE
CMPA (cow's milk protein allergy)
colitis
92
#1 cause for bloody diarrhea in peds
CMPA
93
sx of CMPA
bright red rectal bleeding in otherwise healthy infant
94
CMPA occurs in __ weeks of life,
and resolves by \_\_
1st
late infancy
95
t/f cow's milk protein is IgE mediated
F!! → it is NOT IgE mediated
96
in dx of CMPA, you have to make sure the blood is real by (2)
have mom bring in diaper
OR
DRE
97
definition of CMPA
inflammation in distal colon caused by one or more food proteins (cow milk, soy, etc)
98
tx for CMPA
elimination diet → reintroduce
99
mom can breastfeed thru CMPA unless (2)
HIV (+)
any contraindicating meds
100
mc cause of diarrhea in peds
viral GI infxn
101
with diarrhea, first consider __ to narrow down ddx
age
102
to be chronic, diarrhea must last \>
1 mo
103
mc viruses in viral GI infxn
norovirus
rotavirus
adenovirus
104
what is NOT recommended to treat infectious diarrhea in peds
loperamide and other antidiarrheals
105
mc cause of HUS in peds
shiga toxin-producing e.coli
106
what do you think when you see shiga toxin-producing e.coli, microangiopathic anemia, thrombocytopenia, AKI
HUS
107
what type of diarrhea is characteristic of bacterial gastroenteritis
bloody
mucus
108
dx for bacterial gastroenteritis
stool study
labs
urine
109
what do you think when you see, chronic nonspecific diarrhea, or toddler's diarrhea
functional diarrhea
110
causes for functional diarrhea
noninfectious:
malabsorption syndromes
food allergies
ingestions
systemic dz
111
functional diarrhea occurs in __ yo
and involves loose stools w. \_\_
9-24 mo
flecks of blood
112
tx for functional diarrhea
limit fruit, adjust fiber/fat
BRAT diet
hydration
find cause
refer if chronic
113
most important consideration w. lack of pooping, or infrequent/no stool
age
114
there is a major connection btw __ and constipation in potty trained kids
UTI
115
constipation is common when kids are
potty training
116
what do you think when you see, overflow diarrhea, rectal bleeding, impaction, and UTI
constipation
117
t/f you can prevent constipation w. water, but you can't treat it w. water
T!
118
mc med used in peds for constipation
miralax
119
what tx is NOT recommended for constipation in peds
oral stimulant laxatives
ex. Bisacodyl
120
what do you think when you see, impaired intestinal motility, decreased gut peristalsis, and obstruction
ileus
121
sx of ileus
severe abd pain w. distension
vomiting
hypoactive bs
122
why is ileus a serious concern in kids
kids can get septic quickly
123
what is this xray showing
dx of ileus → **multiple gas fluid levels**
124
tx for ileus
supportive
NPO
IVF
**decompression w. NGT**
surgical consult
125
mc cause of meconium ileus
cystic fibrosis → *almost always*
126
complex meconium ileus means that it is
complicated by other GI pathology
127
simple meconium ileus means there is
no other GI pathology
128
what is this showing
meconium ileus → obstruction of SI at terminal ileum dt thicker than normal meconium
129
what do you think when you see, **patent anal opening** and failure to pass meconium w.in 1st 24 hr
hirschprung dz
130
sx of hirschprung dz
distension
overflow diarrhea
enterocolitis
sepsis
131
you should consider hirschprung dz if
refractory meconium ileus → tx is not effective
132
dx for hirschprung dz
rectal bx -\> **absence of ganglion cells**
133
tx for hirschprung dz
surgery
134
what are the 3 pediatric anorectal abnormalities
anterior displacement of anus
anal stenosis
imperforate anus
135
70% of foreign bodies are
upper esophageal
136
sx of esophageal/GI foreign bodies
choking/gagging
coughing
increased salivation
dysphagia
refusal to eat
vomiting
stridor
perforation
137
gastric/esophageal foreign bodies usually resolve on their own; but what are the 2 all stop medical emergencies
magnets
batteries
138
do foreign bodies always require imaging
no
139
what are the pediatric abdominal wall defects (3)
omphalocele
gastroschisis
umbilical hernia
140
midwall defect; abd contents outside belly covered by 3-layer membranous sac
omphacele
141
omphacele is associated w.
other structural abnormalities/genetic syndromes
142
dx for omphacele
prenatal US
143
what abdominal wall defect is associated w. young moms and alpha feto protein levels
gastroschisis
144
difference btw gastroschisis and omphacele
gastroschisis is not covered by 3-layer membranous sac
145
w. gastroschisis, at delivery you need to
cover to protect from heat, fluid loss
caution w. blood supply
tx w. abx
fluid resuscitation
146
what is this showing
umbilical hernia
147
why are we concerned about umbilical hernia
increased risk for infxn
148
almost all umbilical hernias self resolve by
3 mo
149
you should tx umbilical hernia w. \_\_
only if it is \_\_
silver nitrate
pedunculated
*no tx otherwise*
150
if belly button is draining in neonate, you should consider
omphalomesenteric duct abnormalities
151
neonates require __ calories/day for adequate growth
10g/kg/day
~100-120 kcal/kg/day
152
formula and breast milk both have ~ __ kcal/oz
20
153
neonates need ~ __ oz
q __ hr
2
3
154
weight gain goal for neonates
24-32 oz/day
155
birth weight should have doubled by \_\_
and tripled by \_\_
4-6 mo
12 mo
156
babies should produce __ diapers/day;
and at least __ dirty diapers/day by 1 week old
5-7
3-4
157
drop offs on growth charts are almost always related to
calorie deficit
