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Ped's GI > Ped's GI #2 > Flashcards

Ped's GI #2 Flashcards

1
Q

Pyloric stenosis is most common in what child?

A

first born male

5:1 male

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2
Q

Pyloric stenosis will have what electrolyte abnormalities

A

low Chloride and low potassium

due to decreased acid contents

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3
Q

What is Midgut malrotation or volvulus

A

abnormal roration of the small intestinges in utero
*while in MOM
causes malpostion of abdominal contents

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4
Q

When does Midgut malrotation or volvulus occur?

A

while in utero

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5
Q

What will a child present with Midgut malrotation or volvulus

A

May or may not be symptomatic

abdominal pain, Nausea, vomiting, fever, peritoneal sings you touch them they are fine but in extreme pain, shock

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6
Q

If you have a child with Midgut malrotation what do you suspect has already happened?

A

Volvulus has occured

twisting around the mesenteric base

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7
Q

what is a volvulus ?

what can it cause?

A

common in midgut malrotation
is twisting around the mesenteric base that will compromise vascular supply leading to bowel ischemia and necrosis
AKA - CUTS OFF THE BLOOD FLOW BOWEL DIES

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8
Q

Treatment for Midgut malrotation

A

Surgery!!

Emergency

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9
Q

What condition is a congential intestinal motility disorder

A

Hirschsprung disease

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10
Q

Hirschspring disease is also know as what?

A

Congenital agaglionic megacolon

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11
Q

What is the patho behind Hirschspring disease

A

failure of ganglion cells to migrate to the distal bowel early in fetal development
causing abnormal agaglionic segment
leading to motlity and funciton obstuctions due to spasms

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12
Q

What is the most common affected area in Hirschspring disease
most common in whom?

A

most common in males

most involve the rectosigmoid colon

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13
Q

What are the s/s of Hirschspring disease

A

will NOT have a bowel movement within the first 24 hours of life
if only a short segment is affected could be delayed and not know about until childhood
if time goes on could lead to an obstruction = poor feeding, bilious vomiting, abdomen is distended
*failure to thrive with constipation

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14
Q

What is the definitive diagnosis for Hirschspring disease

what is other testing that can be performed?

A

*Biopsy = no ganglion cells

barium enema will show distal segment with proximal dilated bowel

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15
Q

Treatment for Hirschspring disease

A

Surgery

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16
Q

What is Meckel diverticulum

A

An outpouching of the distal ileum

from fetal development of the omphalomesenteric duct

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17
Q

What are s/s for Meckel diverticulum

A

often asymptomatic
painless GI bleeding (from gastric tissue with acid secretion)
can minic appendicitis if it has diverticulitits

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18
Q

Meckel diverticulum can lead to what complications in the GI tract?

A
  1. Ulceration of the adjacent ileal mucosa due to the acid secretion
  2. *can act as a lead point for intussuception
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19
Q

Technetium- 99 scan is used to diagnosis what?

A

Meckel diverticulum
its called a meckels scan that uses Technetium- 99
which labels acid- producing mucosa
so the stomach and little diverticula off the distal ileum will light up

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20
Q

Treatment for Meckel diverticulum

A

Surgery

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21
Q

What is the most common abdominal emergency in young kids

A

Intussusception

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22
Q

What is the most common cause of bowel obstruction in kids <2

A

Intussusception

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23
Q

Where is the most common location for Intussusception

A

ileocolic

24
Q

What puts boys at in increase risk of UTI in infancy

A

uncircumcised

25
Q

What are the most common organisms to cause a UTI

A 
E. coli most common
Kelbsiella
proteus
enteroccus
pseduomonas 
Staph saprophyticus
26
Q

What are symtoms of UTI in
Neonates
Infants
>2 years old

A

Neonates - fevers, feeding problems, not gaining weight
Infants- fevers, vomiting, diarrhea, feeding problems
>2 years old- urgency, frequency, dysuria, abdominal pain

27
Q

Pyuria is defined as what?

A

> 10,000 WBC
+ leukocyte esterase and OR Nitrates
infant : Culture >50,000
child: Culture >100,00

28
Q

Treatment of UTI

A 
Treat before culture returns
Augmentin
Bactrim
Cefixime
Cefdinir
29
Q

When do you admit a child for UTI

A 
less than 2 * 
toxic- appearing 
dehydrated 
unable to tolerate oral intake 
failed outpatient treatment
30
Q

Treatment for a child <2 with a UTI

A

admit
start IV ceftriaxone
genatmicin

31
Q

When do you need to obtain a renal and bladder ultra-sound

A
  1. antibitoics did not work
  2. <2 years old with first fever and UTI
  3. recurrent fevers and UTI
  4. UTI and Family history of kidney disease, poor growth or hypertension
32
Q

25-30% of kids with their first UTI will also have what ?

A

Vesicoureteral reflux - VUR

33
Q

what is Vesicoureteral reflux

why does it occur?

A
  1. retrograde flow of urine form bladder up the ureter and even can enter the kidney
  2. from incompetent ureterovesical junction
    usually matures and resolves in early childhood
34
Q

What are complications of Vesicoureteral reflux

A

renal scarring

UTI’s

35
Q

What is the best imaging for Vesicoureteral reflux

A

voiding cystourethrogram - VCUG

they inject dye into the bladder and watch it go up

36
Q

When do you suspect a child has a Vesicoureteral reflux

A
  1. 2 or more UTI’s with fevers
  2. first UTI and fever with abnormal ultrasound
  3. temp >39 and positive for other organism not E. coli
  4. poor growth
  5. hypertension
37
Q

What is Cryptochidism

A

undescended testicles
stopped short on their normal path to descent into the scrotum
* no testes palpated on exam = empty scrotum

38
Q

If tests on not palpated on physcial exam

what are all the conditions that could be the cause?

A
  1. Cryptochidism- havent decend
  2. did not develop
  3. atrophied
  4. retractile tests- exaggerated cremasteric reflex- you palpated and they go into the inguinal canal. no risks
39
Q

Cryptochidism is most common in what infants?

A

30 % of premature infants

2-4% full term infants

40
Q

Cryptochidism most commonly effects both or one?

A

most are unilateral

41
Q

When do testicles descend normally ?

if it hasn’t occurred by ____ then they are unlikey to descend

A

first 6 months

if they havent droped by 12months then it is unlikely that they will descend on own

42
Q

Treatment for Cryptochidism

A

refer to urology
can try HCG first to release testosterone which may result in descent
* orchidopexy

43
Q

In a child with Cryptochidism infertility can be avoided if surgery is done when ?

A

surgery done before 2 years old

44
Q

What are complications of Cryptochidism

A

inguinal hernia
infertility (surgery before 2 )
Testicular cancer 5X more likely
testicular torsion

45
Q

What condition can increase a child risk of testicular cancer by 5 times!?

A

Cryptochidism

cancer typically in early 20-30 years of age

46
Q

What is the most common renal malignancy in children

A

Wilms tumor

500 new cases a year

47
Q

Wilms tumor is usually diagnosed by what age?

affecting what?

A 
Age 3-3.5 years old 
60% are less than 5 years 
95% are less than 10 years
**most are unilateral 
5% bilateral
48
Q

What is a wilms tumor made of?

A

primitive cells
metanephric blastema - cells for a normal kidney
mutations occur on several genes

49
Q

what is WAGR syndrome

A

Wilms tumor
Aniridia- no iris
Gentiourinary problems
Retardation mental, disabilities

50
Q

What are s/s of Wilms tumor

A

usually asymptomatic found on exam by palpating a renal mass

if symtoms: abdominal pain, hypertension, hematuria, fever

51
Q

what are the best imaging studies for wilms tumor?

A

first- ultrasound
CT or MRI for more details of the mass
CXR or CT to look for lung mets

52
Q

what is the definitive diagnostic test for wilms tumor ?

A

biopsy by histology

53
Q

Treatment for Wilms Tumor

A
  1. refer to pediatric cancer center
  2. surgery, chemo, radiation often done
    There are 2 major research groups
    National wilms tumor study - NWTS and Children’s oncology group - COG
    inernational society of pediatric oncology- SIOP
54
Q

If Wilms bx is favorable what is the reoccurance rate?

what if unfavorable?

A

unfavorable- anaplasia ?? fix this slide

55
Q

Wilms tumor is most often to occur where?

A

most often with in the first two years will occur in the lungs
1% reoccurs in the opposite kidney

56
Q

what is the survival rate when kid is diagnosed with Wilms tumor

A

5 year survival rate is 88 %

57
Q

Phenylketouria is a condition that affects what chromosome

and is a deficiency of what?

A

Autosomal recessive
chromosome 12
Phenylalanine hydroxylase in the liver

Ped's GI (2 decks)

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