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Pediatrics > Ped GI Disorders - Exam 3 > Flashcards

Ped GI Disorders - Exam 3 Flashcards

1
Q

What does true emesis look like? What if severe? What does it indicate?

A

true emesis: slightly yellow tinge due small amounts of bile

severe: greenish to lighter yellow if severe

small bowel obstruction

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2
Q

What is GER? How common is it? What is the tx?

A

infant or newborn with postprandial spitting and/or vomiting that resolves spontaneously by 12 months of age in over 85% cases.

Lifestyle changes help, no meds needed

no tx needed

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3
Q

What are infant risk factors for GER/GERD?

A

Small stomach capacity

Large volume feeds

Short esophageal length

Supine positioning

Slow swallowing response to refluxed material

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4
Q

Spitting up formula after feeds which worsens over time
Excessive belching or gas
Cyanosis or choking
Persistent congestion, cough or wheezing
Arching of the back while feeding

What am I?
What will it present like in children/adolescent?
What is important to note?

A

GERD

abdominal pain/chest pain/burning

EFFORTLESS spitting up is fine! but when they have to try for it, thats a problem

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5
Q

What are the risk factors for GERD?

A

asthma

CF

developmental delays

Tracheoesophageal Fistula

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6
Q

Apneic spells in newborns are typically caused by _____ especially if occurs with ______

A

reflux

positional change

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7
Q

What are the behavioral tx options for GERD/GER in infants? What are the medications options?

A

Smaller, more frequent feeds
Upright 45 min after feeds
Thickened feeds if needed or pre thickened formula
Breastfed - eliminate milk and eggs for 2 - 4 weeks

trial of famotidine or omeprazole

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8
Q

_____ is the sx procedure for GERD and is especially used in cerebral palsy

A

NISSEN fundoplication

for life threatening (think apneic spells)

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9
Q

Vomiting, fever, anorexia, headache, cramps and myalgia with an exposure to ____, ____ or _____. What is the peak timing?

A

gastroenteritits

viral
parasitic
bacterial

peak in the winter

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10
Q

What is the #1 cause of viral gastroenteritis? What are some parasitic causes? What are some bacterial causes?

A

Norovirus (#1)

Cryptosporidium, Giardia

Campylobacter, Clostridium, Salmonella, E. Coli

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11
Q

How is viral gastroenteritis transmitted? What is the incubation period? What age range is the MC?

A

fecal-oral route

12 hours – 4 days lasting 4 -7 days

More than 95% admissions under age 5 yo

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12
Q

What are concerning features of gastroenteritis?

A

Presence of blood or mucous

Weight loss

Prolonged cap refill, loss of turgor

Diminished BP, sunken fontanelle, dry mucous membranes

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13
Q

What lab studies would you want to order in gastroenteritis?

A

CBC
CMP
stool studies
UA- check for dehydration

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14
Q

What is the tx for gastroenteritis?

A

tx the symptoms

IV fluids!!

treat the underlying cause

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15
Q

______ is the MC indications for emergency surgery in peds. What is the MC underlying cause?

A

Acute Appendicitis

Obstruction by fecalith

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16
Q

What is the order of vomiting and pain in acute appendicitis? What is the order for gastroenteritis?

A

pain THEN vomiting

P then V= surgery

vomiting then pain is the order for gastro

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17
Q

What score on the pediatric appendicitis scale is likely for appendicitis?

A

7+ appendicitis is HIGHLY likely

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18
Q

What are the lab values in AA? What imaging studies should you order?

A

WBC >15,000
Elevated ANC >7500

US then CT abdomen

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19
Q

What is the abx of choice for AA?

A

1 dose of cefoxitin (Mefoxin) OR cefotetan (Cefotan) to prevent infection at least 30 - 60 min prior to incision for appendectomy

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20
Q

_____ is projectile vomiting associated with hypertrophy of the pylorus with elongation and thickening leading to near complete obstruction. What will the vomit look like?

A

pyloric stenosis

Non-bilious vomiting, dehydration, alkalosis in infants < 12 weeks old

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21
Q

What gender is MC for pyloric stenosis? What are 3 additional risk factors?

A

male

First born child
twins
Family history in 13%

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22
Q

In pyloric stenosis, when does the postprandial vomiting begin? How would the parents describe their eating pattern?

A

usually around 2-4 weeks old

Hungry and avid nurser “hungry vomiter”

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23
Q

What medication increases risk of pyloric stenosis?

A

Using erythromycin / azithromycin use is risk in children , specifically under age of 2 weeks of age

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24
Q

**What is the PE finding associated with pyloric stenosis?

A

**“Olive sign” – palpable oval mass RUQ at lateral edge of rectus abdominis muscle

pt will also be very dehydrated!

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25
What acid/base disorder can be seen in pyloric stenosis? What diagnostic study should you order?
Hypochloremic hypokalemic metabolic alkalosis US
26
What is the "string sign?" What is the dx?
a radiographic finding where a thin, string-like appearance of barium passes through a narrowed pyloric canal on an upper GI series pyloric stenosis
27
What is the tx for pyloric stenosis?
Pyloromyotomy laparoscopically
28
_____ is an acute, non inflammatory encephalopathy with a fatty, degenerative liver. When does it occur after? What medication is it associated with?
reye's syndrome Occurs during or after a VIRAL illness (3-5 days after onset) - typically influenza, varicella, or GE taken aspirin (salicylate) within 3 weeks of illness
29
What is the MC age range of Reye's syndrome?
Affects children up to 18 years of age with peak 5 - 14 years of age; rare in newborns MC in white
30
What is the pathopsy behind Reye's syndrome?
ASA which injures the mitochondria of the cell. This injured mitochondria inhibits the oxidative phosphorylation and fatty-acid beta-oxidation in the host
31
What will the cells infected with Reye's syndrome look like? Why is it super bad?
All cells have swollen, reduced number of mitochondria, along with glycogen depletion and minimal tissue inflammation. Hepatic mitochondrial dysfunction results in hyperammonemia, resulting in cerebral edema and ICP aka liver is damaged which leads to high ammonia which leads to encephalopathy. Can also harm the kidneys
32
Persistent and continuous vomiting and diarrhea after a viral illness . Lethargy Tachypnea Confusion, disorientation, hallucinations Seizures Weakness or paralysis in arms and legs Decreased LOC What am I? How do you dx? What should you do next?
Reye's syndrome aka lots of puking will be present dx of exclusion order tests for inborn errors of metabolism
33
Any child with _____ and _____ ddx of _____ should be considered
vomiting and AMS Reye's syndrome
34
What is the tx for Reye's Syndrome?
tx the symptoms!! IV fluids and diuretics meds to prevent bleeding: Vit K, plasma and platelets
35
Why do you give diuretics in Reye's syndrome? Why do you give Vit K, plasma and platelets?
Decrease ICP and increase fluid loss through urination need to prevent bleeding because the liver is NOT working well
36
What is the prognosis for Reye's Syndrome? Why?
Death usually due to cerebral edema or ICP, but may be due to CV collapse, resp failure, renal failure, GI bleeding, status epilepticus, or sepsis
37
What factors increase the risk of mortality in Reye's Syndrome?
Age younger than 5 Rapid progression of illness CVP < 6 mm H2O Ammonia level > 45 Glucose < 60 hypoproteinemia unresponsive to Vit K and plasma Muscle involvement
38
What is the underlying cause of eosinophilic esophagitis?
ATOPIC inflammatory disease of both proximal and distal esophagus eosinophil-rich inflammation inhabits the esophagus
39
In children, what is eosinophilic esophagitis associated with? What should you do next?
driven by food allergen exposure in which skin prick testing is positive for food allergies
40
What is the imaging of choice eosiniophilic esophagitis?
EGD and will see abnormal esophageal mucosa: Active inflammation, diminished vascular pattern, mucosal abnormalities, transient rings, fixed rings, and strictures aka the esophagus does NOT look smooth
41
What is the MC pt with eosinophilic esophagitis?
developed countries, male, all ethnic groups equal
42
**What is one hx finding that would make you think potential eosinophilic esophagitis?
**GER symptoms unresponsive to PPIs
43
Vomiting Dysphagia - infants refusing to feed; adults with solid foods Abdominal pain Feeding disorder / Food intolerance Heartburn Food impaction Vague chest pain - retrosternal Diarrhea What am I? What would be in the pts hx?
eosinophilic esophagitis food allergy, asthma, eczema or chronic rhinitis
44
What will a pts lab show in EE? **What is the histologic confirmation needed to dx EE?
May show peripheral eosinophilia Elevated total IgE levels in about 70% **Histologic confirmation via multiple esophageal bx revealing 15 or more eosinophils per hpf is diagnostic
45
What is the tx for EE? What if strictures are present?
avoid food allergies! Inhaled steroids are puffed, then swallowed from a MDI fluticasone (Flovent) or budesonide (Pulmicort) Esophageal dilation may be needed to treat strictures
46
What is the pt education for fluticasone (Flovent) or budesonide (Pulmicort) when treating EE?
Inhaled steroids are puffed, then swallowed from a MDI Do not rinse mouth or eat for 30 min to max effectiveness
47
_____ is a food allergy that kiddos do NOT tend to outgrow. What age range?
peanut alllergy around 24 months old
48
What is the difference between a peanut and treenut?
peanuts are beans that grow in the ground treenuts: are fruit that grow on trees
49
When do s/s of a peanut allergy tend to show up? What 3 organs systems do they involve the most?
Usually develop within minutes of exposure but may be delayed up to 2 hours Skin Respiratory GI
50
What lab test can you order for a peanut allergy? What can you do if either are positive?
Skin prick vs serological testing ImmunoCAP - peanut specific IgE level either are positive NO need to for oral food challenge
51
What is the tx for mild/moderate peanut allergy reaction? severe?
mild/moderate: Benadryl or cetirizine (Zyrtec) severe: epinephrine via EpiPen at home then immediately go to ED
52
What is the recommendation for a baby with severe eczema and/or egg allergy to be introduced to peanuts?
Introduce peanut products between 4-6 months of age
53
What is the recommendation for a baby with mild/moderate eczema to be introduced to peanuts? babies without eczema?
Introduce peanut products at 6 months of age Not important to introduce early, but ok if parents do so
54
____ is the MC pathogen associated with gastric ulcers. How do you test for it?
H. pylori stool for H pylori
55
What is the dx test for gastric ulcers? What is the tx?
UGI, endoscopy and biopsy amoxicillin, clarithromycin and omeprazole
56
What is considered diarrhea?
passage of 3 or more loose/watery stools
57
What is considered acute diarrhea? chronic?
acute: 5-14 days chronic: longer than 1 month
58
How long does the diarrhea caused by viruses last? What is the MC virus? What age range?
Diarrhea can last 2-3 weeks norovirus is the MC 3-15 months is most common age range
59
Vomiting (80-90%), followed 24 hours by low grade fever, watery diarrhea Diarrhea 4-8 days or longer What am I? What dx are needed? What is the tx?
viral diarrhea stool culture: to identify the virus, no blood or WBC will be seen tx: supportive care with fluids, may need to replace bicarb
60
_____ is the MC cause of intestinal obstruction for the first 2 years of life. What specific age range is MC?
intussusception 6-12 months old
61
Sudden onset of severe, crampy, colicky pain Inconsolable crying and drawing up legs Vomiting (90%), Bloody diarrhea (50%) What am I? What is the PE stool finding? What is the PE finding?
intusseusception “Currant, jelly stool” Sausage-shaped abdominal mass mid-right abdomen
62
What is the gold standard dx for intusseusception? If that does not work, move on to _____
barium enema: usually dx and tx then sx if barium enema does not work
63
What is a volvulus? What are some precipitating causes?
when the intestine twists on itself severe constipation hirschsprung's dz adhesions from a former sx
64
Abdominal pain Bloating Vomiting Constipation BLoody stools complication: loss of blood supply and bowel ischemia What am I? How do you dx? What is the tx?
volvulus abdominal xray tx: surgery to untwist bowel
65
_______ is abx associated diarrhea and usually starts 1-14 days after abx therapy and up to 30 days after abx use. How do you dx?
Pseudomembranous Enterocolitis stool culture: Neutrophils and gross blood in stool
66
What is the tx for pseudomembranous enterocolitis?
d/c abx use metro or vanc
67
____ is the MC cause of loose stools in otherwise healthy kids 6-20 months old. What are the defining characteristics?
toddler's diarrhea 3-6 loose stools/day waking hours only!!! no blood
68
When does toddler's diarrhea tend to resolve? What will the dx tests show?
Resolved by 3-4 years old normal growing toddlers and all tests are negative!!
69
_______ is a NON-allergic food sensitivity. Is it mediated by IgE? What gender?
milk protein allergy non-IgE mediated MC in males with a family hx
70
A milk protein allergy will present in a healthy infant with ________. What is the tx? When will it go away?
flecks of bright red blood in stool (heme positive) Treatment is to eliminate source of protein (cow’s milk - 60% of cases or soy-based milk) and maternal avoidance of milk protein in nursing mothers need to give hydrolyzed formula to the baby Disappears by 8-12 months of age
71
Diarrhea, abdominal distention, fatty stools, FTT, irritability, constipation What am I? When will s/s start to appear?
celiac dz Occurs at 6-24 months of age after gluten introduced
72
**What is the lab you should order for celiac dz? What is diagnostic?
tTG (tissue transglutaminase Endoscopy with small intestinal biopsy is diagnostic
73
_____ is the MC problem throughout childhood and must be present ____ month in infants/toddlers and _____ in older children
constipation Must be present 1 month in infants and toddlers, 2 months in older children
74
What is defined as constipation?
Less than 3 bowel movements per week impacted rectum with stool, large bulk stools or painful hard stools
75
When are the major 3 transitions in a child's life that constipation is common?
Introduction to solid foods or cow’s milk Toilet Training School entry
76
What are ways to make sure your kiddo does not get constipation?
ensure adequate fiber intake increase fluids pureed veggies, fruits and fiber infant cereal decrease cow's milk to less than 24oz per day (16 oz is ideal)
77
What is the goal fiber intake for a kiddo less than 2 years old?
<2 years old – 5 grams fiber/day
78
What are common reasons that kiddos get constipated?
intentionally withholding stool because it is painful using adult toilets, not wanting to go at school inadequate fiber intake cows milk
79
What is the tx for constipation in children?
miralax or lactulose increase fiber, decrease milk and increase fluids
80
What is encopresis?
when soft poop comes out around the impacted hard stool fecal incontinence or soiling can lead to rectal enlargement and loss of sensation
81
Why does encopresis occur?
Internal and external sphincters relax – semi-solid stool leaks onto perianal skin and clothing child holds in stool of pain and stretched out nerves and muscle does not work well
82
What are the underlying causes of encopresis?
functional due to chronic constipation emotional: school, divorce etc etc
83
What are s/s of encopresis? How do you dx?
Abdominal pain, fecal mass, dilated rectum packed with stool May cause enuresis or urinary frequency rectal exam and KUB
84
What is the tx for encopresis?
Daily, soft stools without pain every 1-2 days without incontinence Rebuild rectal muscles that control bowels Stability on laxatives for 6 months to years Having a rescue plan in place GI referral if needed
85
What is the acute treatment for encopresis?
PEG/Miralax/fleets enema/dulcolax rectal stimulation
86
What is the chronic treatment for encopresis?
Maintenance laxatives for at least 6 months – 1 year eliminate cow's milk 1-2 week trial High fiber diet Increased fluid intake scheduled toilet time parental monitoring and having a rescue plan in place in case the kiddo goes 3 days without a BM
87
How often does a kiddo need to follow up for encopresis? Why do most treatments fail?
Monthly, then every 3-4 months Most treatment failures are caused by inadequate meds and/or discontinuing meds too soon
88
What do you need to r/o in a newborn with severe constipation?
r/o Hirschsprung's or CF
89
What is Hirschsprung's Dz? What is the key feature?
Absence of ganglion cells in mucosal and muscular layers of colon Failure to pass meconium in first 24-48 hours
90
Vomiting - bilious emesis Abdominal distention Reluctance to feed fever, diarrhea, foul-smelling or ribbon-like stools Tight anal sphincter and anal canal What am I? What gender is more common?
Hirschsprung's dz males are 4 times more common than females
91
What am I? What should you do next?
Hirschsprung's Disease KUB and rectal bx!!
92
What will a KUB show in a pt with Hirschsprung's Disease?
Dilated proximal colon and absence of gas in pelvic colon Rectum void of stool despite impaction on KUB
93
What is the gold standard diagnostic test for Hirschsprung's dz? What is the tx?
Rectal biopsy – ganglion cells absent in both submucosal and muscular layers of involved bowel Surgical – diverting colostomy or ileostomy
94
_____ is 75% of all rectal anomalies. What is the key finding?
Imperforate anus failure to pass meconium at all
95
Slit-like tear in squamous epithelium of anus Cries with defecation and holds stool Bright red blood on toilet tissue What am I?
anal fissure
96
Very small anus with a dot of meconium Ribbon-like stools Blood or mucus in rectum Fecal impaction or abdominal distention Tight ring in anal canal Could be ____ or _____ How do you tell the difference?
anal stenosis or imperforate anus imperforate anus will not have any meconium pass at all
97
What is considered mild, moderate and severe dehydration?
Mild – 3-5% volume loss Moderate – 6-9% volume loss Severe - >10% volume loss
98
What is considered volume depletion? What are some s/s?
Volume depletion = 2 kg weight loss = 2 Liters of fluid loss Increased pulse rate, decreased skin turgor, decreased blood pressure, increased thirst, lethargy, decreased UOP, sunken eyes
99
**______ is the most useful lab to assess degree of dehydration in children. ____ will be increased
serum bicarb BUN will be increased
100
What is the tx for dehydration if choosing to go oral rehydration?
101
What is the tx for dehydration if choosing the IV rehydration route?
102
What are the 2 MC oral fluids given for rehydration?
pedialyte or gatorade
103

Pediatrics (24 decks)

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