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Pediatrics > Lecture 18: Pediatric GI Disorders > Flashcards

Lecture 18: Pediatric GI Disorders Flashcards

1
Q

Generally, yellow emesis suggests (), while a greenish discoloration suggests ()

A
  • Yellow = mostly just stomach
  • Greenish = more bile

Bile in emesis could suggest SBO

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2
Q

The MCC of vomiting in children is…

A

Viral Gastroenteritis

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3
Q

() describes an infant/newborn with postprandial spitting/and or vomiting that resolves spontaneously by 12 months in 85% of cases. Only lifestyle changes are needed.

A

GER

no D!

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4
Q

GERD in an infant is treated with…

A

Medications! Intractable symptoms can be life-threatening.

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5
Q

GER and GERD can be diagnosed ()

A

clinically

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6
Q

The 5 infant risk fators for GER/GERD are:

  • () stomach capacity
  • () volume feeds
  • () esophagus
  • () positioning
  • () swallowing response
A
  • Small stomach
  • Large feeding
  • Short esophagus
  • Supine positioning
  • Slow swallowing
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7
Q

Your infant keeps spitting up their formula and arching their back when feeding. Sometimes they choke and turn blue. You suspect they have…

A

GERD

Chest pain/burning would be more in children and older

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8
Q

The 4 underlying conditions that are risk factors for GERD are…

A
  • Asthma
  • CF
  • Developmental delays
  • TEF
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9
Q

Apenic spells in newborns are typically caused by (), especially if it occurs with position change

A

Reflux

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10
Q

GERD is confirmed via () after clinical presentation and can cause ()

A
  • UGI
  • BRUE
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11
Q

In an infant, you can trial (med) daily for GERD

A

Famotidine/Pepcid or Prilosec or Nexium

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12
Q

Basic behavior modifications to help with infant GERD include:

  • () feedings
  • () 45 minutes after feeds
  • () feeds or pre-() formula
  • Breasfeeding to eliminate (2 allergens) for 2-4 weeks
A
  • Smaller feedings
  • Sit them upright 45 minutes
  • Thicken their foods
  • BFeed to eliminate eggs and milk
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13
Q

The surgery for persistent or life-threatening GERD is…

A

Nissen fundoplication

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14
Q

The MC virus to cause viral gastroenteritis is…

A

Norovirus

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15
Q

Viral gastroenteritis most commonly peaks in the (season) and 95% of admissions are children under the age of () years

A
  • Winter
  • age of 5
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16
Q

You should be concerned for a child with viral gastroenteritis if they start experiencing…

A
  • Dehydration S/S (sunken fontanelles, BP drops)
  • Wt loss
  • Blood/mucus
  • Weird breathing
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17
Q

If you suspect gastroenteritis and want to order stool studies, you should order… (3)

A
  • SSYC (salmonella, shigella, Yersinia, and campylobacter)
  • O&P (ova and parasites)
  • Viruses (GE panel)
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18
Q

The treatment for Gastroenteritis is () relief, IVF, and treating the causative agent

A

Symptom relief

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19
Q

The MC indication for emergency surgery in Peds is…

A

Acute appendicitis

MCC: Fecalith

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20
Q

Acute appendicitis differs from gastroenteritis because vomiting usually is (before/after) pain onset

A

Vomiting comes AFTER pain

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21
Q

The two items that are worth more than 1 point on the pediatric appendicitis score are…

A
  • Pain with cough/percussion/hopping
  • RLQ tenderness
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22
Q

Generally, appendicitis presents with WBCs no greater than () and an elevated ANC of greater than ()

A
  • WBCs no greater than 15k
  • ANC > 7500

CRP + leukocytosis is a 92% indicator of appendicitis apparently

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23
Q

Generally, first line imaging for acute appendicitis in a pediatric patient is…

A

U/S

Followed by CT abdomen

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24
Q

Prior to appendectomy in a kid, you should give 1 dose of…

A

Cefoxitin or cefotetan

TinTan

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25
Q

Buzzwords for Pyloric stenosis

A
  • Projectile vomiting
  • Hypertrophy of pylorus
  • Non-bilious emesis
  • Dehydration
  • Olive sign in RUQ
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26
Q

Usage of (drug class) is a risk for pyloric stenosis in children under 2 weeks of age.

A

Macrolides (Erythromycin & Azithromycin)

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27
Q

The two studies you can do for pyloric stenosis are…

A

U/S vs UGI

I think US is #1 though

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28
Q

The characteristic sign of pyloric stenosis on an Upper GI w/ barium is…

A

String sign

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29
Q

Tx for pyloric stenosis is…

A

Pyloromyotomy

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30
Q

Acute, non-inflammatory encephalopathy + hepatic dysfunction with () use in a child that had a viral URI a few weeks ago describes () syndrome

A
  • Salicylate (ASA) use in a child
  • Reye syndrome
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31
Q

The MC ethnicity for Reye’s syndrome is…

A

Caucasian

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32
Q

T/F: You must report Reye’s syndrome to the local health department

A

Yup

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33
Q

Buzzwords for Reye’s syndrome

A
  • Aspirin use in a kid with recent viral URI
  • Encephalopathy + hepatic dysfunction
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34
Q

Reye’s syndrome is managed via IVF, () and ()

A
  • Diuretics
  • Coagulants (Vit K, plasma, plts)

Reducing ICP and increasing fluid loss

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35
Q

() describes inflammation of the entire esophagus, most specifically in children with food allergens. Esophageal mucosa gets infiltrated with T-cells, B-cells, eosinophils, and IgE mast cells.

A

Eosinophilic Esophagitis

Asthma of the esophagus?

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36
Q

Generally, you should suspect () in infants who have GER symptoms that are unresponsive to PPIs

A

Eosinophilic esophagitis

They have very similar S/S

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37
Q

Diagnosis of Eosinophilic Esophagitis is via histologic confirmation showing…

A

15+ eosinophils per hpf

Need multiple esophageal bx

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38
Q

Besides avoiding food allergies, you can also treat eosinophilic esophagitis using (medication) or (procedure) to treat strictures

A
  • Inhaled steroids
  • Esophageal dilation
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39
Q

The 3 organ systems affected most commonly with peanut allergies is…

A
  • Skin
  • Respiratory
  • GI
40
Q

Peanut allergies usually are ()

A

Lifelong

41
Q

() is both diagnostic and prognostic for peanut allergies

A

ImmunoCAP (peanut specific IgE levels)

42
Q

The main stay of peanut allergy management is…

A

Prevention!!!!!!!

43
Q

The most effective future management option for peanut allergies is…

A

Food oral immunotherapy

44
Q

Generally, babies with severe eczema/egg allergies should be introduced to peanuts between () and () months of age, while mild-mod eczema should get it at () months

A
  • 4-6 months for severe
  • 6 months for mild-mod

Earlier if more severe allergy!

45
Q

The MCC of gastric/duodenal ulcers is…

A

H pylori

46
Q

Tx of Gastric/duodenal ulcers is via…

A
  • Amoxicillin
  • Clarithomycin
  • Omeprazole

2 weeks

I guess not metronidazole for amoxicillin in kids?

47
Q

Passage of () loose/watery stools is diarrhea

A

3+

48
Q

The FIRST question to ask about a child presenting with acute diarrhea is…

A

Are they immunocompromised?

49
Q

Acute diarrhea must fall within the timeframe of …

A

5-14 days

50
Q

Chronic diarrhea is usually associated more with… (4)

A
  • ABX use
  • Fruit juices/starch
  • MPA
  • Toddler’s diarrhea (?)
51
Q

The MC virus that causes diarrhea is…

A

Norovirus

2-3 days i think? its short

52
Q

The MC age range to get viral diarrhea is… () to () months

A

3-15 months of age

53
Q

The MC symptom in virus associated diarrhea is…

A

Vomiting

Followed by low grade fever and watery diarrhea.

54
Q

A stool culture for a viral diarrhea should have () blood or WBCs

A

No blood or WBCs in stool

55
Q

The treatment for diarrhea due to a virus is usually…

A

Supportive care

and treat any bicarb loss/metabolic acidosis with pedialyte probs

56
Q

In a child younger than 2, () is the MCC of intestinal obstruction

A

Intussusception

Esp between 6-12 months

57
Q

Buzzwords for Intussusception

A
  • Colicky pain
  • Drawing up legs
  • Currant, jelly stool
  • Sausage shaped abdominal mass in mid-right abd
58
Q

Gold standard to diagnose intussusception is…

A

Barium enema

59
Q

Pseudomembranous enterocolitis, or C. Diff, is MC due to…

A

ABX use

60
Q

The first line tx for C Diff is…

A

Discontinuing abx use :)

61
Q

The first line pharm tx for C Diff is either ORAL () or ()

A

Oral vanco or metronidazole

MUST BE ORAL

62
Q

Your healthy 15 month old has watery diarrhea during their waking hours only. They are growing normally and have all negative tests. They love apple juice! You suspect that they have…

A

Toddler’s diarrhea

Excessive fruit juice worsens it.

Self-resolving by age 3-4

63
Q

T/F: Milk protein allergies are IgE mediated.

A

False. It is a NON-allergic food sensitivity

64
Q

Generally, you would suspect MPA in a healthy infant showing () in their stool.

A

Flecks of bright red blood in stool (heme positive)

65
Q

The treatment for MPA is…

A

Avoiding milk protein via formula.

Disappears by 8-12 months usually.

66
Q

The lab test for Celiac disease is…

A

tTG (tissue transglutaminase)

99% specificity

67
Q

() is diagnostic for celiac disease

A

Endoscopy with small intestine biopsy

68
Q

IBD induced diarrhea is (bloody/watery)

A

Bloody

69
Q

The definition of constipation timing-wise in an infant/toddler is that it must be present for at least () month, and () month in older children.

A
  • 1 month in infants/toddlers
  • 2 months if older
70
Q

Constipation occurs during 3 main transitions in a child’s life, which are…

A
  • Introduction to solid foods/cow’s milk
  • Toilet training
  • School entry
71
Q

A child less than 2 years old who is constipated should try to eat at least () grams of fiber daily.

A

5g of fiber daily

Also drink less milk since it slows intestinal motility.

72
Q

Once a child becomes school-aged, they should aim for () grams of fiber daily.

A

11-24 grams daily

And drink more water. No poop shy pls

73
Q

T/F: Pain with pooping counts as constipation

A

True

74
Q

In a toddler/child, the pharm tx for constipation is () or ()

A
  • PEG/miralax 1-1.5g/kg/day
  • Lactulose 1-2 g/kg/day
75
Q

Encopresis is..

A

Fecal incontinence/soiling

Accidentaly pooping your pants

Builds up hard, painful stools until your sphincters give up

76
Q

Diagnosis of encopresis is via () or ()

A
  • Rectal exam
  • KUB XR
77
Q

Acute treatment of encopresis is via…(5)

A
  • PEG/Miralax for kids 6 months or older
  • Fleets enema for kids 2 years or older
  • Dulcolax suppository
  • Glycerin suppository for infants
  • Rectal stimulation PRN
78
Q

What is toilet sitting?

A
  • Pooping at the same time 5-10 minutes after meals.
  • Timing them via stopwatch
  • Reward for effort not success

Habit training!

79
Q

Avoiding what common food/drink is important for constipation?

A

Cow’s milk

80
Q

Absence of ganglion cells in the mucosal and muscular layers of the colon describes…

A

Hirschsprung’s Disease

Congenital Aganglion megacolon

81
Q

The first sign of Hirschsprung’s disease once a neonate is born would probably be failure to …

A

Failure to pass meconium in the first 24-48 hrs

82
Q

The definitive dx of hirschsprung disease is via…

A

Rectal biopsy showing no ganglion cells.

Can do KUB XR first tho!

83
Q

Abdominal distension is (more/less) common in Hirschsprung’s over functional megacolon.

A

More common in hirschsprung’s

84
Q

The treatment for Hirschsprung’s disease is…

A

Diverting colostomy or ileostomy

85
Q

Anal fissures are characterized by () with defecation and () on toilet paper

A
  • Pain with defecation
  • Bright red blood on toilet tissue
86
Q

75% of all rectal anomalies in children is a…

A

Imperforate anus

87
Q

Ribbon-like stools probably suggest

A

Imperforate anus or anal stenosis

or Hirchsprung’s

88
Q

Severe dehydration is greater than () volume loss

A

10%

89
Q

Sunken () and () are suggestive of volume depletion in a child

A
  • Fontanelles
  • Eyes
90
Q

If a child loses 2 kg of wt, they prob lost () liters of fluid

A

2 liters of fluid

91
Q

The most useful lab to assess the degree of dehydration in a child is

A

Serum Bicarb

< 17 mEq/L

also BUN goes up

92
Q

Oral rehydration is best achieved using a (tool), and by administering (fluid choice)

A

Syringe, adminstering pedialyte

93
Q

Besides rehydrating a child, you can also trial (med) in children older than 2

A

Zofran 4mg ODT

94
Q

IV rehydration of a child uses (fluid)

A

NS

95
Q

Pedialyte must be used for oral rehydration over something like gatorade or ginger ale in a child because…

A

It contains 30 mEq/L of bicarb

Pediatrics (23 decks)

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