Pearson: Pediatric Gastrointestinal Problems

Question 1

What is important to keep in mind when evaluating a child for dehydration?

Answer 1

Percentage of weight lost is an objective measure

Question 2

When evaluating dehydration, is it necessary to look at serum electrolytes?

Answer 2

No–serum electrolytes are NOT needed in mild dehydration. They are usually normal since most episodes of dehydration caused by diarrhea are isonatremic

Question 3

When you have a child present w/ vomiting, what drug should you consider?

Answer 3

Ondansetron (zofran)

Almost all children who have been vomiting or are dehydrated can be treated w/ ORT (oral rehydration therapy)

Question 4

ORT for a child who had DIARHHEA but is NOT dehydrated.

Answer 4

Continue to give age-appropriate diet

Children who are NOT dehydrated are least likely to take ORT b/c of the salty taste of the solution.

Question 5

ORT for infant w/ diarrhea.

Answer 5

Continue to drink human milk or regular strength formula.

Question 6

ORT for older child w/ diarrhea.

Answer 6

May continue to drink milk

Question 7

How does ORT compare to IV therapy for rehydration children w/ mild-mod dehydration?

Answer 7

As effective

*less expensive and can be administered in many settings, including at home by family members

Question 8

In a pt w/ diarrhea, does early refeeding w/ food after rehydration prolong diarrhea?

Answer 8

no

Milk may increase diarrhea but is NOT contraindicated (you can delay reintroduction a day or two)

Question 9

Children who are severely dehydrated and in a state of shock need IV fluids. What should you give a child during a 1 hour period?

Answer 9

20 mL per kg of Normal Saline (NS)

OR

Normal Saline with %5 dextrose (D5NS)

Question 10

How can probiotics help children w/ acute diarrhea d/t viral gastroenteritis?

Answer 10

probiotics reduce the duration of diarrhea by about one day. Not yogurt

Question 11

Is the routine use of antidiarrheal agents like opiates, bismuth subsalicylate, attapulgite recommended in infants and young children?

Answer 11

NO

may have adverse SE

Question 12

What is colic?

Answer 12

inconsolable crying (usually at a predictable time of day) accompanied by drawing up of legs and gaseous distension of the abdomen?

Question 13

When does colic usually start and peak?

Answer 13

Colic starts by 3 weeks of age, and the peak occurs by 6 weeks of age

May include about 3 hours of crying a day.

The severity declines and by 3 months of age “normal” patterns are reestablished.

Question 14

What should you do w/ a crying infant?

Answer 14

Rule out other causes for irritability and crying (especially otitis, another infections cause, intussusception, hairs around the penis, fingers, or toes)

Question 15

What treatments for colic show NO BENEFITS?

Answer 15

Simethicone
Methylscopolamine
hypoallergenic diet 
no milk, egg, wheat or nut products
lactase enzymes 
Carrying the infant more often
using car-ride simulators
decreasing infant stimulation
training the parents intensively in a behavioral approach

Question 16

What percent of constipation in children is function?

Answer 16

90-95%

Question 17

What is retentive encopresis?

Answer 17

Inappropriate soiling w/ evidence of constipation and retention.

Children often soil small quantities of loose fecal matter several times a day put periodically pass very LARGE BMs.

May present w/ urinary complaints, abdominal pain or distention but PE is usually suggestive of constipation.

Question 18

What is nonretentive encopresis?

Answer 18

inappropriate soiling w/out evidence of fecal constipation and retention

Question 19

How should you treat retentive encopresis?

Answer 19

In 1-2 doses/day:

• *Polyethylene glycol (PEG) (Miralax) 0.5-1 g/kg/day
• Milk of Magnesia, in a dosage of 1 to 3 mL per kg per day
• Mineral oil, in a dosage of 1 to 5 mL per kg per day
• Sorbitol, in a dosage of 1 to 3 mL per kg per day

*expect the tx to last TWICE as long as the duration of hte problem

Question 20

What should you try if stool withholding leads to impaction?

Answer 20

Polyethylene glycol > child will have a bowel movement in 2-3 days.

Avoids the “trauma” of rectal manipulation.

Question 21

What is recurrent abdominal pain syndrome?

Answer 21

prepubertal functional pain with two distinct peaks of frequency

Pain is:
vauge
unrelated to meals/acitivty/stool
not awakened by pain
HA, N, dizziness, fatigue

*Family Hx if often + for IBS, PE is often normal

Question 22

When do the peaks associated w/ RAPS occur?

Answer 22

FIRST PEAK: occurs between five and seven years of age, with equal frequency in boys and girls and in 5 to 8 percent of children.

It is often attributed to the adjustment to parental separation when starting school.

SECOND PEAK: occurs between eight and 12 years of age and is far more prevalent in girls.

Question 23

How do you tx RAPS?

Answer 23

Pain is real

emphasize that child must remain in school/normal activities

Question 24

When does IBS rarely occur and what best characterizes it?

Answer 24

rarely before late adolescence

Intestinal dysmotility w/ intervals of diarrhea/constipation

Stress> flare-up sxs

Question 25

What is most important for diagnosing a peptic disorder in a child?

Answer 25

positive family hx of PUD

Question 26

A child presents w/ episodic nausea, abdominal pain and significant emesis, beginning during the night/early morning hours and lasting from six to 48 hours. The child has NO HEADACHE. The child has intervals of weeks to months with no symptoms or findings at all.

Answer 26

periodic syndrome or Abdominal migraine

Question 27

What are common features/hx of children w/ abdominal migraines?

Answer 27

Family Hx of migraine

Autonomic Fx:
pallor
explosive diarrhea
letheragy 
tachycardia

Question 28

A four-year-old boy presented with a three-day history of bloody diarrhea with no vomiting and a temperature up to 40｡C (104｡F). Over the previous 24 hours the child had had watery, bloody bowel movements every 20 minutes. His fluid intake consisted of soft drinks, and urination was infrequent. One other family member had non-bloody diarrhea. Na and Bicarb were both abnormal.

What is the most likely cause of this child’s problem?

Answer 28

Bacterial infection cause by Shigella

Question 29

A four-week-old female, breast fed twin born at 37 weeks of gestation had large, watery diarrheal stools five to six times per day for three to four days, with some vomiting. She was taking formula and no clear liquids. Her twin sister had a similar but less severe illness. The infant’s neonatal course was normal. At two weeks of age she weighed 2.36 kg (5 lb, 3 oz). The patient was lethargic and weakly responsive, with cool extremities. Her skin turgor was decreased, and capillary-refilling time was about 3.0 seconds.

What is the most appropriate treatment in this case?

Answer 29

Bolus 20 cc/kg of NS

Continue breast feeding

Question 30

A three-year-old boy presented with abdominal pain, fever and bloody diarrhea. No other family members were ill. The child had four to five bloody diarrheal stools per day, with no vomiting and decreased urination. Rare petechiae present.

What is the most likely pathogen?
jejuni
E. Coli
Shigella
Yersinia Enterocolitica
Samonella

Answer 30

E. Coli

Petechiae!

Question 31

An 18-month-old girl presented with a three-day history of fever and frequent, bright red, bloody diarrheal stools. She was taking fluids, including some broth. There was no vomiting, and no other family members were ill. The child had recently traveled to Mexico. 104 temp.

Answer 31

Parasite

Mexico, bloody diarrhea, stool culture negative

Question 32

A five-year-old child presents with diarrhea. Just using prevalence as a tool, which of the following is the most likely pathogen?

Answer 32

Rotavirus

Norwalk–epidemics (named after a town)

Question 33

A 12-year-old child presents with diarrhea and is found to have white cells in his stool increasing the likelihood that he has a bacterial cause for his infection. Which of the following would be most likely using prevalence as a tool?

Answer 33

Campylobacter is most likley

White cells in the stool increase the likelihood that a bacterial infection is hte cause rather than a viral infection.

Campylobacter is the MC of the bacterial infections in children.

Question 34

A three-week-old infant presents with increased crying for two days; inconsolable for “hours at a time”. Otherwise there has been no fever or vomiting. Intake has been slightly down – more fussy when breast feeding q2-3 hours (on demand). Her weight is appropriate.

What is the best intervention at this time?

Answer 34

Always check the extermities and penis in an irritable infant to look for a hair

Question 35

A mother brings in her 3-yr-old child for diarrhea and incontinence of stool. Duration has been one week. He has had some mild problems with constipation but his mother states he reports large firm stools every 3-4 days. His most likely problem is:

Answer 35

Retentive encopresis

Retaining and “leaking around the log”

Question 36

A mother brings in her 2-year-old child who has had diarrhea for three days. She has been able to get him to take fluids only. When he has had milk or solids, he has vomited. She has been giving him primarily chicken broth. Clinically he has a warm, “doughy” texture to his skin with little skin fold TENTING. He is also very droopy (your nurse thought him lethargic) but irritable when touched. His pulse is 160 and resp. is 35

These findings and hx are most compatible w/?

Answer 36

Hypernatremia–soft dough, won’t tent as you would expect w/ dehydration

Question 37

In an 11 month old child without dehydration who is not vomiting and has diarrhea, which of the following is LEAST useful to maintain intake?

Answer 37

Pedialyte

Question 38

All of the following would be interventions to be considered in a child with dehydration EXCEPT:

Breast milk
Oral rehydration fluid
IV normal saline
Antidiarrheal agents

Answer 38

Antidiarrheal agents

Question 39

Which of the following have been shown to decrease colic?

Simethicone
Methylscopolamine
hypoallergenic diet
using car-ride simulators
herbal teas

Answer 39

Herbal teas

Question 40

All of the following interventions can be used in a child with non-organic encopresis and a history of aspiration pneumonia EXCEPT:

Milk of Magnesia
Mineral oil
Sorbitol
Flavored fiber drinks
Bran sprinkles

Answer 40

Mineral oil

Question 41

A 16-year-old child has intermittent episodes of non-bloody diarrhea and constipation over a period of 6 month. He also complains of intermittent 5/10 dull, crampy, periumbilical pain that will last from 20 to 120 min. once to twice a week. He is otherwise healthy with no travel history. The most likely cause is:

Inflammatory bowel disease
Hirschsprung's disease
Retentive encopresis
Recurrent Abdominal Pain Syndrome
Irritable bowel syndrome

Answer 41

IBS