Ped's GI #2 Flashcards by Kelsey Johnson

Pyloric stenosis is most common in what child?

first born male

5:1 male

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Pyloric stenosis will have what electrolyte abnormalities

low Chloride and low potassium

due to decreased acid contents

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What is Midgut malrotation or volvulus

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

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When does Midgut malrotation or volvulus occur?

while in utero

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What will a child present with Midgut malrotation or volvulus

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

Volvulus has occured

twisting around the mesenteric base

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what is a volvulus ?

what can it cause?

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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Treatment for Midgut malrotation

Surgery!!

Emergency

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What condition is a congential intestinal motility disorder

Hirschsprung disease

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Hirschspring disease is also know as what?

Congenital agaglionic megacolon

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What is the patho behind Hirschspring disease

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

most common in males

most involve the rectosigmoid colon

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What are the s/s of Hirschspring disease

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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What is the definitive diagnosis for Hirschspring disease

what is other testing that can be performed?

*Biopsy = no ganglion cells

barium enema will show distal segment with proximal dilated bowel

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Treatment for Hirschspring disease

Surgery

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What is Meckel diverticulum

An outpouching of the distal ileum

from fetal development of the omphalomesenteric duct

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What are s/s for Meckel diverticulum

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

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

Ulceration of the adjacent ileal mucosa due to the acid secretion
*can act as a lead point for intussuception

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Technetium- 99 scan is used to diagnosis what?

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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Treatment for Meckel diverticulum

Surgery

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What is the most common abdominal emergency in young kids

Intussusception

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

Intussusception

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Where is the most common location for Intussusception

ileocolic

What puts boys at in increase risk of UTI in infancy

uncircumcised

What are the most common organisms to cause a UTI

``` E. coli most common Kelbsiella proteus enteroccus pseduomonas Staph saprophyticus ```

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

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

Pyuria is defined as what?

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

Treatment of UTI

``` Treat before culture returns Augmentin Bactrim Cefixime Cefdinir ```

When do you admit a child for UTI

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

Treatment for a child <2 with a UTI

admit start IV ceftriaxone genatmicin

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

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

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

Vesicoureteral reflux - VUR

what is Vesicoureteral reflux | why does it occur?

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

What are complications of Vesicoureteral reflux

renal scarring | UTI's

What is the best imaging for Vesicoureteral reflux

voiding cystourethrogram - VCUG | they inject dye into the bladder and watch it go up

When do you suspect a child has a Vesicoureteral reflux

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

What is Cryptochidism

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

If tests on not palpated on physcial exam | what are all the conditions that could be the cause?

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

Cryptochidism is most common in what infants?

30 % of premature infants | 2-4% full term infants

Cryptochidism most commonly effects both or one?

most are unilateral

When do testicles descend normally ? | if it hasn't occurred by ____ then they are unlikey to descend

first 6 months | if they havent droped by 12months then it is unlikely that they will descend on own

Treatment for Cryptochidism

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

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

surgery done before 2 years old

What are complications of Cryptochidism

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

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

Cryptochidism | cancer typically in early 20-30 years of age

What is the most common renal malignancy in children

Wilms tumor | 500 new cases a year

Wilms tumor is usually diagnosed by what age? | affecting what?

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

What is a wilms tumor made of?

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

what is WAGR syndrome

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

What are s/s of Wilms tumor

usually asymptomatic found on exam by palpating a renal mass | if symtoms: abdominal pain, hypertension, hematuria, fever

what are the best imaging studies for wilms tumor?

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

what is the definitive diagnostic test for wilms tumor ?

biopsy by histology

Treatment for Wilms Tumor

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

If Wilms bx is favorable what is the reoccurance rate? | what if unfavorable?

unfavorable- anaplasia ?? fix this slide

Wilms tumor is most often to occur where?

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

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

5 year survival rate is 88 %

Phenylketouria is a condition that affects what chromosome | and is a deficiency of what?

Autosomal recessive chromosome 12 Phenylalanine hydroxylase in the liver