L2 Peds Gastroenterology Flashcards
1
Q
causes of bilious vomit
A
OBSTRUCTION- URGENT
malrotation +/- volvulus
congenital intestinal atresia
2
Q
causes of bloody vomit
A
maternal ingestion
esophageal varices
foreign body
3
Q
unhappy spitters/GERD may present
A
failure to thrive, esophagitis, respiratory complications, fussy, dystonic neck posturing, feeding refusal
4
Q
GER treatment
A
patient education, reassurance, normal for <6 month olds
5
Q
GERD treatment
A
upright eating
hypoallergenic diet or thickened feeds
avoid overfeeding, tobacco smoke
6
Q
meds for refractory/complicated GERD tx
A
proton pump inhibitor
H2 blocker
7
Q
omeprazole
A
proton pump inhibitor
8
Q
ranitidine
A
H2 blocker
9
Q
can cause infantile hypertrophic pyloric stenosis
A
macrolide antibiotic use during first few weeks of life
10
Q
classic presentaiton of hypertrophic pyloric stenosis
A
first born male
M>F
11
Q
happy spitter
A
GER
12
Q
unhappy spitter
A
GERD
13
Q
hungry vomiter
A
pyloric stenosis
14
Q
projectile vomiting immediately after feeding in an infant 3-6 weeks
A
pyloric stenosis
15
Q
olive-like mass in RUQ
A
pyloric stenosis
16
Q
string sign
A
narrowed lumen seen on barium contrast study of pyloric stenosis
17
Q
test of choice for pyloric stenosis
results
A
ultrasound
elongation and thickening of pylorus
18
Q
when to order a upper GI barium contrast study
A
suspected pyloric stenosis with non-diagnostic utlrasound
19
Q
treatment of pyloric stenosis
A
pyloromyotomy
20
Q
most common site of congenital intestinal atresia (absent/obstruction)
A
duodenum
21
Q
intestinal atresia is more common in patients with
A
down syndrome
cystic fibrosis
22
Q
Vomiting +/- bile in first 48 hour
Abdominal distention
Failure to pass meconium
A
congenital intestinal atresia
23
Q
dilated loops of bowel with air fluid levels on xray
A
jejunoileal/colonic atresias
24
Q
double bubble sign due to gas dilation in both stomach and duodenum on xray
A
duodenal atresia
25
uses of upper GI and contrast enema in congenital atresia
confirm diagnosis
| further identify obstruction
26
volvulus
small bowel twists around the superior mesenteric artery --> risk of small bowel ischemia
27
```
bilious green/yellow vomiting
abdominal pain
hemodynamic instability
+/- hematochezia
abdominal distention and tenderness
```
midgut malrotation
28
what needs to be ruled out in midgut malrotation and how
bowel perforation
| xray
29
gold standard test to detect malrotation +/- volvulus
upper GI contrast imaging
30
corkscrew appearance of duodenum on upper GI contrast imaging
midgut malrotation
31
surgery for midgut malrotation
ladd procedure
32
most common cause of abdominal emergency in kids under 2
intussusception
33
sudden, intermittent, severe, crampy abdominal pain
Inconsolable crying, legs drawn to chest
Vomiting
intussusception
34
intussusception triad
abdominal pain
abdominal mass
currant jelly stools (blood and mucous)
35
Palpable sausage shaped mass
intussusception
36
lead point
a lesion/variation in the intestine which is dragged by peristalsis into a distal segment
37
causes of lead point
```
Meckel's diverticulum (most common)
polyp/tumor/cyst
Crohn's/Celiac/Cystic fibrosis
gastroenteritis
Rotashield
```
38
Target sign, coiled spring on ultrasound
intussusception
39
test of choice intussusception
ultrasound
40
perforated intussusception, or refractory to enema
immediate surgery
41
treatment of intussusception
hydrostatic/pneumatic enema guided by ultrasound or fluorscope
90% succes rate
42
appendicitis age group
2nd decade of life, rare before 5 years old
43
Anorexia, migration abdominal pain (RUQ), vomiting, fever, peritoneal irritation
appendicitis
44
Signs of peritoneal irritation in appendicitis
Positive rovsing, obturator, iliopsoas signs
45
2/3 of the way between umbilicus and ASIS
McBurney's point
| location of appendix
46
imaging for appendicitis
**Classic presentation may proceed to surgical consult prior to imaging**
Ultrasound
CT scan
47
appendicitis labs
WBC >100,000
48
diarrhea definition
>3 loose watery stools/day
49
most common cause of acute diarrhea
***Viral: rotavirus, adenovirus, calcivirus***
50
diarrhea red flags
fever, severe pain, blood in stool, recent abx, persistent sx, dehydration, leukocytosis, growth and development affected
51
celiac labs
IgA antibodies to tissue transglutaminase, small bowel biopsy
52
Failure to thrive, anemia, +/- foul smelling stools
celiac disease
53
6mos-5 years, self limited
toddler's diarrhea
54
stool testing indications
NOT recommended for most diarrheas
| when red flags are present
55
biggest tx for acute diarrhea
hydration
56
antidiarrheal (antimotility) agents and acute diarrhea
not recommended
57
why not give abx if a pathogen is unknown in acute diarrhea
risk of hemolytic uremic syndrome
58
2 subtypes of inflammatory bowel disease
Crohn
| Ulcerative colitis
59
ages of inflammatory bowel disease
15-30 years
60
smoking and IBD
2x increased risk of crohn's
| 50% decreased risk of ulcerative colitis
61
diarrhea, abdominal pain, +/- hematochezia, growth failure/delayed puberty, anemia, malabsorption
IBD
62
Extraintestinal manifestations of IBD
mouth, skin, joints, liver, eye, can occur before GI sxs
63
diagnosis of IBD
colonoscopy
64
Skip lesions, cobblestone appearance, perianal fissures, fistulas,
crohn's disease
65
involvement of IBD
crohn's: mouth to anus
| ucerative colitis: rectum and large colon
66
inflammation of IBD
crohn's: transmural inflammation
| ulcerative colitis: mucosal layer only
67
diffuse/continuous edema, erythema, friability, ulcerataion of colon
ulcerative colitis
68
has an increased risk of colon cancer
ulcerative colitis
69
5 ASA
aminosalicylate
70
sulfasalazine
aminosalicylate
71
mesalamine
aminosalicylate
72
mercaptopurine
Immunomodulating agent
73
methotrexate
Immunomodulating agent
74
azathioprine
Immunomodulating agent
75
tx of IBD
Immunomodulating agent
aminosalicylate
Biologics
steroids (acute flair)
76
infliximad
Biologics
77
remicade
Biologics
78
concerns with steroids
bone density, growth, development
| use for IBD acute flair
79
Rule of 2’s:
2% of the population
2:1 M:F ratio
2% develop a complication (usually before age 2)
2 feet from the ileocecal valve
80
```
Vitelline duct (embryonic remnant) leads to formation of diverticulum (outpouching) of intestinal and gastric epithelium
Gastric acid production → damage→ mucosal ulceration → bleeding
```
Meckel's diverticulum
81
Meckel's diverticulum symptoms
painless rectal bleeding
obstruction (volvulus or intussusception)
diverticulitis (can mimic appendicitis)
82
Technetium-99 scan aka
Meckel’s scan
83
functional constipation
psychological/psychosomatic
| diet
84
organic constipation
```
anal stenosis
hypothyroidism
celiac disease
Hirschsprung’s
hypercalcemia
cystic fibrosis
```
85
encopresis
leakage of retained stool, can be seen with impacted constipation
86
periods when kids are most likely to develop constipation
intro to solid food/cow's milk
toilet training
start of school
87
recommended fiber intake
<2 years old: 5 g/day
| >2 years old: age + 5-10 g /day
88
Findings suggestive of organic cause of constipation
```
failure to pass meconium
failure to thrive
abdominal distention/obstructive symptoms
anterior placed anus
occult blood in stool
```
89
presentation of constipation
abdominal discomfort (general/LLQ)
impacted→ hypoactive bowel sounds
anal fissures
90
constipation red flags
```
weight loss
poor growth
anorexia
fever
vomiting
hematochezia
history of delayed passing of meconium (CF)
acute onset
failure to respond to conservative measures
```
91
constipation management
```
fluids
gradually increase fiber
decrease dairy
juice
relieve impaction
```
92
meds for constipation
Miralax
Lactulose
enemas
suppositories
93
first line to relieve impacted constipation
*****
Polyethylene glycol (miralax)
*****
94
hirchsprung disease aka
congenital aganglionic megacolon
95
Absence of ganglion cells in mucosa/mucosal layers of colon → spasm and abnormal motility→ possible obstruction
hirchsprung disease
96
higher risk for hirchsprung disease
down syndrome
97
hirchsprung disease presentation
failure to pass meconium in first 48 hours of life (classic)
| Bilious vomiting, abdominal distention (clinical)
98
gold standard for hirchsrpung disease diagnosis
Rectal biopsy: confirms absence of ganglion cells
99
squirt sign
hirchsrpung disease
| tight anal sphincter, explosive release of gas/stool when finger removed
100
test unprepped to localize transition zone from narrowed aganglionic segment to dilated proximal colon
contrast enema of hirchsrpung disease
