Part 13. The Digestive System Flashcards
Nutritive sucking in neonates first develops at about _ wk of gestation.
34
Regurgitation gradually resolves in 80% of infants by _ mo of age and in 90% by _ mo.
6
12
What is toddler’s diarrhea? What is its cause? How do you manage it?
A pattern of intermittent loose stools, known as toddler’s diarrhea, occurs commonly between 1 and 3 yr of age. These otherwise healthy growing children often drink excessive carbohydrate-containing beverages. The stools typically occur during the day and not overnight. The volume of fluid intake is often excessive; limiting sugar and unabsorbable carbohydrate-containing beverages and increasing fat in the diet often lead to resolution of the pattern of loose stools.
In neonates, The direct bilirubin fraction should account for no more than ____ of the total serum bilirubin.
15–20%
____ hyperbilirubinemia, which occurs commonly in normal newborns, tends to tint the sclerae and skin golden yellow, whereas ____ hyperbilirubinemia produces a greenish yellow hue.
Indirect; direct
This occurs when the transfer of the food bolus from the mouth to the esophagus is impaired.
Oropharyngeal dysphagia (also termed transfer dysphagia)
Acute diarrhea is defined as sudden onset of excessively loose stools of >____ in infants and > ____ in older children which lasts < 14 days.
10 mL/kg/day
200 g/24 hr
Describe secretory diarrhea (Presentation / characteristics, pathophysiology)
Secretory diarrhea occurs when the intestinal epithelial cell solute transport system is in an active state of secretion. It is often caused by a secretagogue, such as cholera toxin, binding to a receptor on the surface epithelium of the bowel and thereby stimulating intracellular accumulation of cyclic adenosine monophosphate or cyclic guanosine monophosphate.
It is usually of large volume and persists even with fasting. The stool ion gap is 100 mOsm/kg or less.
How to you compute for stool ion gap?
Ion gap = Stool osmalality −[(Stool Na + stool K) × 2]
Describe osmotic diarrhea (Presentation / characteristics, pathophysiology)
Osmotic diarrhea occurs after ingestion of a poorly absorbed solute. The solute may be one that is normally not well absorbed (magnesium, phosphate, lactulose, or sorbitol) or one that is not well absorbed because of a disorder of the small bowel (lactose with lactase deficiency or glucose with rotavirus diarrhea).
This form of diarrhea is usually of lesser volume than a secretory diarrhea and stops with fasting. The osmolality of the stool will not be explained by the electrolyte content, because another osmotic component is present and so the anion gap is >100 mOsm.
Visceral pain tends to be dull and aching and is experienced in the dermatome from which the affected organ receives innervations.
Painful stimuli originating in the liver, pancreas, biliary tree, stomach, or upper bowel are felt in the ____ ; pain from the distal small bowel, cecum, appendix, or proximal colon is felt at the ____ ; and pain from the distal large bowel, urinary tract, or pelvic organs is usually ____ .
epigastrium
umbilicus
suprapubic
When does all 20 primary teeth erupt by?
3 years old
When do the permanent teeth start erupting? When is it usually completed?
6 yrs old
13 yrs old
Excessive consumption of this during enamel formation affects ameloblastic function, resulting in inconspicuous white, lacy patches on the enamel to severe brownish discoloration and hypoplasia.
Fluoride (Fluorosis - can result from systemic fluoride consumption >0.05 mg/kg/day during enamel formation
When is surgical closure of a cleft lip is usually performed?
By 3 mo of age, when the infant has shown satisfactory weight gain and is free of any oral, respiratory, or systemic infection.
The initial repair may be revised at 4 or 5 yr of age. Corrective surgery on the nose may be delayed until adolescence. Nasal surgery can also be performed at the time of the lip repair.
In an otherwise healthy child with cleft palate, when is closure of the palate is usually done?
Before 1 yr of age to enhance normal speech development
Frequent sequelae of cleft palate
2
Recurrent otitis media
hearing loss
Dental defect associated with osteogenesis imperfecta.
Dentinogenesis imperfecta or
hereditary opalescent dentin, is a condition analogous to amelogenesis imperfecta in which the odontoblasts fail to differentiate normally, resulting in poorly calcified dentin
This an autosomal dominant condition that includes other findings such as prominent joints, arthritis, hypotonia, hypermobile joints, mitral valve prolapse, hearing loss, spine problems (scoliosis, kyphosis, platyspondyly), and ocular problems (high myopia, glaucoma, cataracts, retinal detachment).
Stickler syndrome (30-50% of pts with Pierre-Robin syndrome also has this)
This an autosomal dominant syndrome that primarily affects the face. The facial appearance varies but is characterized by downward-sloping palpebral fissures, colobomas of the lower eyelids, sunken cheekbones, blind fistulas opening between the angles of the mouth and the ears, deformed pinnae, atypical hair growth extend- ing toward the cheeks, receding chin, and large mouth
Mandibulofacial dysostosis (Treacher Collins syndrome or France- schetti syndrome)
This group of microorganisms is associated with the development of dental caries. These bacteria have the ability to adhere to enamel, produce abundant acid, and survive at low pH.
Mutans streptococci
What is the most cariogenic sugar?
Sucrose.
Dietary behaviors, such as consuming sweetened beverages in a nursing bottle or frequently consuming sticky candies, increase the cariogenic potential of foods because of the long retention of sugar in the mouth
Red Flags Suggestive of a Spreading Dental Infection
- Pyrexia
- Tachycardia or tachypnea
- Trismus; may be relative due to pain or absolute due to a collection within the muscle causing muscle spasm in cases of masticator space involvement
- Raised tongue and floor of mouth, drooling
- Periorbital cellulitis
- Difficulty with speaking, swallowing, and breathing
- Hypotension
- Increased white blood cell count
- Lymphadenopathy
- Dehydration
What is the antibiotic of choice for dental infections associated with fever, cellulitis, and facial swelling or if it is difficult to anesthetize the tooth in the presence of inflammation?
Penicillin is the antibiotic of choice, except in patients with a history of allergy to this agent. Clindamycin and erythromycin are suitable alternatives. Oral analgesics, such as ibuprofen, are usually adequate for pain control.
The most effective preventive measure against dental caries is?
communal water supplies with optimal fluoride content.
Topical fluoride recommended for prevention of dental caries
Amount of fluoridated toothpaste for 3-6 y/o
pea-sized (~0.25g) amount on toothbrush
Topical fluoride recommended for prevention of dental caries
Amount of fluoridated toothpaste for less than 3 y/o
less than a smear or grain-sized amount of fluo- ridated toothpaste.
What comprise the periodontium?
4
- gingiva,
- alveolar bone,
- cementum, and
- periodontal ligament
Name 2 drugs that can induce gingival hyperplasia
Cyclosporine
Phenytoin
These are yellow-white granules in clusters or plaque-like areas on the oral mucosa, most commonly on the buccal mucosa or lips.
Fordyce granules.
They are aberrant sebaceous glands. The glands are present at birth, but they can undergo hypertrophy and first appear as discrete yellowish papules during the preadolescent period in approximately 50% of children. No treatment is necessary.
This is a large, soft, mucus-containing swelling in the floor of the mouth. What is its management?
Ranula. The cyst should be excised, and the severed duct should be exteriorized
This is a salivary gland lesion caused by a blockage of a salivary gland duct.
Mucocele.
It is most common on the lower lip and has the appearance of a fluid-filled vesicle, or a fluctuant nodule with the overlying mucosa being normal in color. Treatment is surgical excision, with removal of the involved accessory salivary gland.
What is a hallmark of lack of normal swallowing or of esophageal or upper gastrointestinal tract obstructionin the fetus?
Polyhydramnios
This is a reflex wherein facial stimulation by a puff of air can induce swallowing and esophageal peristalsis in healthy young infants.
Santmyer swallow
A neonate presenting with frothing and bubbling at the mouth and nose after birth as well as episodes of coughing, cyanosis, and respiratory distress most likely have?
Esophageal atresia.
Feeding exacerbates these symptoms, causes regurgitation, and can precipitate aspiration. Aspiration of gastric contents via a distal fistula causes more damaging pneumonitis than aspiration of pharyngeal secretions from the blind upper pouch.
What is the most common type of esophageal atresia? Describe it.
Type C. The upper esophagus ends in a blind pouch and the TEF is connected to the distal esophagus
How to differentiate between obstructing from motility disorders of the esophagus?
in terms of symptoms
Obstructing lesions classically produce dysphagia to solids earlier and more noticeably than to liquids and can manifest when the infant liquid diet begins to incorporate solids; this contrasts to dysphagia from dysmotility, in which swallowing of liquids is affected as early as, or earlier than, solids.
What are the most common external masses that compress the esophagus and produce obstructive symptoms?
Enlarged mediastinal or subcarinal lymph nodes, caused by infection (tuberculosis, histoplasmosis) or neoplasm (lymphoma)
This is characterized by loss of LES relaxation and loss of esophageal peristalsis, both contributing to a functional obstruction of the distal esophagus.
Achalasia.
Degenerative, autoimmune (antibodies to Auerbach plexus), and infec- tious (Chagas disease caused by Trypanosoma cruzi) factors are possible causes.
