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Clin Med II - Exam 3 > Knott - Peds GI > Flashcards

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*
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2
Q

jaundice peaks on day __ of life

A

4

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3
Q

unconjugated bilirubin is bilirubin before it

A

makes it to liver

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4
Q

conjugated bilirubin has been

A

taken up by the liver

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5
Q

jaundice usually self resolves in

A

2-3 weeks

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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

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7
Q

breast milk jaundice appears __

and can last __

A

at the end of the first week of life

3-10 weeks

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8
Q

breastmilk jaundice is caused by increased absorption of bilirubin from the __

and increased __ from mom’s breast milk

A

intestine

beta glucoronidase

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9
Q

breast milk jaundice resolves __

A

spontaneously

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10
Q

can babies w. breastmilk jaundice still breastfeed?

A

yes!

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11
Q

breast feeding jaundice is caused by

A

baby not getting enough milk dt delayed/insufficient production → dehydration → decreased stooling → increased bilirubin

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12
Q

what type of jaundice is a sign of liver dysfxn, and is a medical emergency

A

elevated direct (conjugated) bilirubin

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13
Q

elevated conjugated (direct) bilirubin can cause

A

BIND: bilirubin induced neurologic dysfxn

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14
Q

how do bili lights fxn

A

make bilirubin more soluble to get it out of system

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15
Q

when is GER normal

A

during/after feeds

if baby still gaining wt/happy

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16
Q

what is GER

A

gastroesophageal reflux → passage of gastric contents into esophagus

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17
Q

what is GERD

A

pathologic GER → heart burn/discomfort

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18
Q

symptoms of GERD in infant

A

fussy

sleep disturbance

decreased appetite

arching, choking, gagging, pulling of breast/bottle

not gaining wt

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19
Q

symptoms of GERD in older kids

A

coughing

dental erosions

epigastric pain

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20
Q

how do you dx infant GERD

A

vitals

growth

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21
Q

__% of GERD resolves by 12 months

A

90

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22
Q

tx for infant GERD

A

reassurance

lifestyle mods: carry upright, tummy time, decrease volume/increase frequency of feeds

thicken formula

+/- PPI

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23
Q

how do you tx severe infant GERD

A

GI referral

Nissen

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24
Q

what is pyloric stenosis

A

hypertrophy of musculature around pylorus

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25
Q

what do you think when you see projectile non-bilious emesis, hungry, fussy, metabolic alkalosis, and olive sized mass in 4th week of life

A

pyloric stenosis

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26
Q

dx for pyloric stenosis

A

US

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27
Q

tx for pyloric stenosis

A

rehydration

surgery

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28
Q

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

A

intestinal atresia and stenosis

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29
Q

intestinal artresia is

A

complete blockage of intestines

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30
Q

intestinal stenosis is

A

narrowing of the intestines

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31
Q

where can intestinal artresia/stenosis occur

A

anywhere along intestines (beyond the stomach)

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32
Q

differentiation btw intestinal artresia/stenosis and GERD/other benign infant GI conditions

A

bilious vomiting

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33
Q

what do you think when you see, dilated loops of bowel w. absence of colonic gas

A

xray findings of intestinal artresia/stenosis

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34
Q

never let the sun set on __;

it is always ___

and an __ condition

A

bilious emesis

pathologic

all-stop

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35
Q

2 other obstructions besides intestinal artresia/stenosis

A

malrotation

volvulus

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36
Q

what is a midgut volvulus

A

rotation of intestines with pinching off

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37
Q

midgut volvulus occurs in the first _ weeks of life,

and sx include

A

3

severe diffuse abd pain/distension

persistent bilious emesis

bloody stools

lethargy

poor feeding

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38
Q

what is KUB imaging

A

kidney, ureter, bladder xray

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39
Q

dx for midgut volvulus

A

upper GI w. contrast

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40
Q

what do you think when you see, corkscrew pattern, dilated loops of bowel overlying liver shadow w. no distal gas to obstruction

A

KUB findings of midgut volvulus

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41
Q

tx for midgut volvulus

A

surgical emergency

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42
Q

what is a diaphragmatic hernia

A

herniation of bowel thru diaphragm

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43
Q

what is this showing

A

diaphragmatic hernia

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44
Q

1st thing to consider in child w. abd pain

A

age! → helps narrow dx

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45
Q

acute reasons for abd pain

A

gastroenteritis

constipation

pancreatitis

intussusception

obstruction

malrotation

volvulus

appendicitis

ovarian/testicular torsion

trauma

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46
Q

chronic reasons for abd pain

A

constipation

functional abd pain

anxiety/behavioral

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47
Q

other reasons for abd pain

A

acid-related d.o

meds

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48
Q

what are the two types of abd pain

A

visceral

peritoneal

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49
Q

with peritoneal pain, the child can

A

localize pain w. one finger

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50
Q

with visceral pain, the child may __ when asked to localize pain

A

circle the whole tummy

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51
Q

exam to perform for abd pain

A

DRE

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52
Q

appendicitis pe will show

A

peritoneal signs

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53
Q

what are 5 peritoneal signs

A

abd pain/tenderness

bloating

fever

n/v

loa

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54
Q

what special test is used to look for appendicitis

A

jump test

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55
Q

labs for appendicitis will show

A

high, normal, or elevated WBC w. left shift

elevated CRP

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56
Q

2 imaging options for appendicitis

A

CT w. contrast

US → thickened appendix

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57
Q

tx for appendicitis

A

appendectomy

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58
Q

what is intussusception

A

telescoping bowel just proximal to ileocecal valve

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59
Q

test to perform if you suspect intussusception

A

DRE

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60
Q

intusussception usually presents in __ yo;

with __ clinical presentation

A

6-36 mo

odd

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61
Q

sx of intussusception

A

sudden onset of severe cramping/pain intervals

vomiting

sausage mass

lethargy

currant jelly stools

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62
Q

what diagnostic and therapeutic for intussusception

A

barium or air enema

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63
Q

what do you think when you see, donut or target appearnce

A

US findings for intussusception

64
Q

what is this showing

A

donut/target appearance

US findings of intussusception

very accurate

65
Q

what do you think when you see, sudden onset of severe cramping/pain, currant jelly stools, and donut/target appearance

A

intussusception

66
Q

causes of peds pancreatitis

A

trauma

gallstones

idiopathic infxn

drug associated

vasculitis

genetic

AI

67
Q

what drug can cause pancreatitis in peds

A

valproic acid

68
Q

pe findings of pancreatitis

A

ttp

peritoneal signs

69
Q

sx of pancreatitis

A

RUQ/epigastric pain, +/- radiation to the back

vomiting

anorexia

low grade fever

70
Q

labs for pancreatitis will show

A

elevated lipase and amylase

hypercalcemia

71
Q

imaging for pancreatitis

A

US

CT

72
Q

tx for pancreatitis

A

admit!

pain control

hydration

bowel rest

73
Q

what do you think when you see, visceral hyperalgesia, reduced threshold for pain, and impaired gastric relaxation

A

functional abdominal pain

74
Q

dx for functional abdominal pain is a

A

dx of rule out

75
Q

what can help you narrow ddx for vomiting

A

anatomy

age

characteristics → bilious or not

76
Q

types of vomit from newborn-teen

A

dribble

projectile

bloody or bilious

77
Q

tx for vomiting

A

hydration

+/- anti emetics

+/- antihistamines and anticholinergics

78
Q

common pathogens associated w. viral gastroenteritis (4)

A

rotavirus

adenovirus

enterovirus

norwalk

79
Q

viral gastroenteritis can last __ days

and sx include

A

2-10

mild fever

non-bloody emesis

cramping

discomfort

diarrhea

80
Q

tx for uncomplicated viral gastroenteritis

A

supportive

hydration

temporary lactose intolerance → avoid dairy

81
Q

what do you think when you see, eosinophilic infiltrate into esophageal epithelium

A

eosinophilic esophagitis (EOE)

82
Q

what is a major consideration in eosinophilic esophagitis

A

food allergies!

83
Q

sx of EOE

A

vomiting

cp

epigastric pain

dysphagia

food impaction (stricture)

ineffective reflux therapy

84
Q

dx for EOE

A

endoscopy w. bx and patch testing

85
Q

tx for EOE

A

elimination diet

steroids

repeat endoscopies

86
Q

what do you think when you see, recurrent stereotypical bouts of vomiting w. baseline/normal health in between episodes

A

cyclical vomiting syndrome

87
Q

what is a major comorbidity for cyclical vomiting syndrome

A

anxiety

88
Q

cyclical vomiting syndrome dx: at least __ attacks at any interval,

or a minimum of __ attacks

during a __ mo perior

A

5

3

6

89
Q

in a teenager w. cyclical vomiting syndrome, you should think about

A

cannabinoid hyperemesis

90
Q

tx for cyclical vomiting syndrome

A

time

effort

support

91
Q

ddx if a newborn/neonate is pooping blood

A

swallowed maternal blood

bacterial GE

CMPA (cow’s milk protein allergy)

colitis

92
Q

1 cause for bloody diarrhea in peds

A

CMPA

93
Q

sx of CMPA

A

bright red rectal bleeding in otherwise healthy infant

94
Q

CMPA occurs in __ weeks of life,

and resolves by __

A

1st

late infancy

95
Q

t/f cow’s milk protein is IgE mediated

A

F!! → it is NOT IgE mediated

96
Q

in dx of CMPA, you have to make sure the blood is real by (2)

A

have mom bring in diaper

OR

DRE

97
Q

definition of CMPA

A

inflammation in distal colon caused by one or more food proteins (cow milk, soy, etc)

98
Q

tx for CMPA

A

elimination diet → reintroduce

99
Q

mom can breastfeed thru CMPA unless (2)

A

HIV (+)

any contraindicating meds

100
Q

mc cause of diarrhea in peds

A

viral GI infxn

101
Q

with diarrhea, first consider __ to narrow down ddx

A

age

102
Q

to be chronic, diarrhea must last >

A

1 mo

103
Q

mc viruses in viral GI infxn

A

norovirus

rotavirus

adenovirus

104
Q

what is NOT recommended to treat infectious diarrhea in peds

A

loperamide and other antidiarrheals

105
Q

mc cause of HUS in peds

A

shiga toxin-producing e.coli

106
Q

what do you think when you see shiga toxin-producing e.coli, microangiopathic anemia, thrombocytopenia, AKI

A

HUS

107
Q

what type of diarrhea is characteristic of bacterial gastroenteritis

A

bloody

mucus

108
Q

dx for bacterial gastroenteritis

A

stool study

labs

urine

109
Q

what do you think when you see, chronic nonspecific diarrhea, or toddler’s diarrhea

A

functional diarrhea

110
Q

causes for functional diarrhea

A

noninfectious:

malabsorption syndromes

food allergies

ingestions

systemic dz

111
Q

functional diarrhea occurs in __ yo

and involves loose stools w. __

A

9-24 mo

flecks of blood

112
Q

tx for functional diarrhea

A

limit fruit, adjust fiber/fat

BRAT diet

hydration

find cause

refer if chronic

113
Q

most important consideration w. lack of pooping, or infrequent/no stool

A

age

114
Q

there is a major connection btw __ and constipation in potty trained kids

A

UTI

115
Q

constipation is common when kids are

A

potty training

116
Q

what do you think when you see, overflow diarrhea, rectal bleeding, impaction, and UTI

A

constipation

117
Q

t/f you can prevent constipation w. water, but you can’t treat it w. water

A

T!

118
Q

mc med used in peds for constipation

A

miralax

119
Q

what tx is NOT recommended for constipation in peds

A

oral stimulant laxatives

ex. Bisacodyl

120
Q

what do you think when you see, impaired intestinal motility, decreased gut peristalsis, and obstruction

A

ileus

121
Q

sx of ileus

A

severe abd pain w. distension

vomiting

hypoactive bs

122
Q

why is ileus a serious concern in kids

A

kids can get septic quickly

123
Q

what is this xray showing

A

dx of ileus → multiple gas fluid levels

124
Q

tx for ileus

A

supportive

NPO

IVF

decompression w. NGT

surgical consult

125
Q

mc cause of meconium ileus

A

cystic fibrosis → almost always

126
Q

complex meconium ileus means that it is

A

complicated by other GI pathology

127
Q

simple meconium ileus means there is

A

no other GI pathology

128
Q

what is this showing

A

meconium ileus → obstruction of SI at terminal ileum dt thicker than normal meconium

129
Q

what do you think when you see, patent anal opening and failure to pass meconium w.in 1st 24 hr

A

hirschprung dz

130
Q

sx of hirschprung dz

A

distension

overflow diarrhea

enterocolitis

sepsis

131
Q

you should consider hirschprung dz if

A

refractory meconium ileus → tx is not effective

132
Q

dx for hirschprung dz

A

rectal bx -> absence of ganglion cells

133
Q

tx for hirschprung dz

A

surgery

134
Q

what are the 3 pediatric anorectal abnormalities

A

anterior displacement of anus

anal stenosis

imperforate anus

135
Q

70% of foreign bodies are

A

upper esophageal

136
Q

sx of esophageal/GI foreign bodies

A

choking/gagging

coughing

increased salivation

dysphagia

refusal to eat

vomiting

stridor

perforation

137
Q

gastric/esophageal foreign bodies usually resolve on their own; but what are the 2 all stop medical emergencies

A

magnets

batteries

138
Q

do foreign bodies always require imaging

A

no

139
Q

what are the pediatric abdominal wall defects (3)

A

omphalocele

gastroschisis

umbilical hernia

140
Q

midwall defect; abd contents outside belly covered by 3-layer membranous sac

A

omphacele

141
Q

omphacele is associated w.

A

other structural abnormalities/genetic syndromes

142
Q

dx for omphacele

A

prenatal US

143
Q

what abdominal wall defect is associated w. young moms and alpha feto protein levels

A

gastroschisis

144
Q

difference btw gastroschisis and omphacele

A

gastroschisis is not covered by 3-layer membranous sac

145
Q

w. gastroschisis, at delivery you need to

A

cover to protect from heat, fluid loss

caution w. blood supply

tx w. abx

fluid resuscitation

146
Q

what is this showing

A

umbilical hernia

147
Q

why are we concerned about umbilical hernia

A

increased risk for infxn

148
Q

almost all umbilical hernias self resolve by

A

3 mo

149
Q

you should tx umbilical hernia w. __

only if it is __

A

silver nitrate

pedunculated

no tx otherwise

150
Q

if belly button is draining in neonate, you should consider

A

omphalomesenteric duct abnormalities

151
Q

neonates require __ calories/day for adequate growth

A

10g/kg/day

~100-120 kcal/kg/day

152
Q

formula and breast milk both have ~ __ kcal/oz

A

20

153
Q

neonates need ~ __ oz

q __ hr

A

2

3

154
Q

weight gain goal for neonates

A

24-32 oz/day

155
Q

birth weight should have doubled by __

and tripled by __

A

4-6 mo

12 mo

156
Q

babies should produce __ diapers/day;

and at least __ dirty diapers/day by 1 week old

A

5-7

3-4

157
Q

drop offs on growth charts are almost always related to

A

calorie deficit

Clin Med II - Exam 3 (14 decks)

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