Pedi GI Flashcards
When is pyloric stenosis typically noticed in infants
withing the first 3-5 weeks of life, rare after 12
Clinical presentation of pyloric stenosis
- 3 to 6 week old with post prandial non bilious projectile vomiting
- weight loss
- hungry after vomiting
PE for a baby with pyloric stenosis
- appears think
- palpable olive at lateral edge of rectus
- peristaltic waves may be visualized pre emesis
- may be jaundice
Diagnostics of pyloric stenosis
-ultrasound
-
Treatment of pyloric stenosis
- correct hydration status first
- pyloromyotomy
When is intussesception most commonly seen
3 months to 5 years old
Where is the typical site of intussusception
near the iliocecal junction
Etiology of intussusception
proximal bowel telescopes into distal segment–> associated mesentary dragged along–> venous and lymphatic congestion–> intestinal edema–> possible ischemia
What causes intusscusception
most cases idiopathic
- virus
- post infectious bacterial enteritis
- lead point from underlying pathology
Clinical manifestations of intusscusception
- sudden, severe, crampy, progressive pain
- child will be incosolable with legs drawn up
- non bilious vomiting post pain
Presentation of intusscusception between episodes
- normal and pain free
- stool main contain gross or occult blood
- currant jelly stool
- may feel sausage shaped mass of right side of abdomen
Test to look for intusscusception
ultrasound!
“bull’s eye” or “coiled spring”
Intusscusception on xray
shows crescent sign
Non operative treatment for intusseception
- enema with hydrostatic or pneumatic pressure
* treatment of choice in stable pt w/o signs of perforation
When is surgical treatment indicated
if non operative approach failed
What always gets referred to surgery whether acute or intermittent and presently asymptomatic
intusseception
What is phenylketonuria
deficiency of pkenylalanine hydroxylase
What does a deficiency of PAH cause
increase in serum and urine phennylalanine—> intellectual disability
Increased phenylalanine interfers with what
- brain growth
- mylenination
- neurotransmitter sunthesis
Clinical findings in untreated PKU patients
- mental disability and impaired IQ-epilepsy
- abnormal gait
- pigmentation issues
- eczema
- blood and urine may smell mousy
When should treatment of PKU be started
by one weeks of life
When do levels of phenylalanine need to be monitored
- weekly for the first year
- twice a month years 1 to 12
- monthly after 12 for life
How does a child less than 5 present with appendicitis
listless, feverish kid with diffuse pain, womitting, rebound, gaurding–> perforated
Treatment of non perforated appendicitis in kids
- fluids
- pain control, anti pyretics, anti emetics
- NPO
- pre op abx (cefoxitin)
Treatment for perforated appendicitis in kids
- fluids
- pain control, anti pyretics, anti emetics
- NPO
- amp/gent/flagyl
When is surgery typically done in a kid with non perforated appendicitis
within 6-8 hours
may be 24-48 of IV abx first
Normal stooling pattern in newborn. 0-3 months. Less than 2 years. By 4 year
Newborn: NL stool withing 36 hours
0-3 months: 3 to 4 stools a day
Less than 2: 1 to 2 per day
By 4 years old: once a day
Organic causes of constipation
- anatomic
- metabolic
- neuropathic
- interstinal nerve or muscle disorders
- abdominal musculature disorder
- food intolerance
Functional causes of constipation
- painful defecation
- toilet training issues
- dietary issues
Treatment of constipation
- treat the cause
- ensure enough fluids, dietary fiber
- no cows milk until 1
- dont force toilet training
interventional treatment for infants with constipation
- glycerine suppository
- ubricated thermometer
Interventional treatment for older children with constipation
- glycerine suppository
- miralax
- ? enema
- laxative?
What is encopresis
involuntary leakage of stool unto the underpants
with or without constipation
What is the most common cause of encopresis
constipation
When does encopresis
-most often around tiems of toilet training, teasing about stooling and school onset
Diagnosis of encopresis
psychiatric diagnosis, must have
- voluntary /involuntary passage fo stool outside of bathroom or diaper
- one event a month for at 3 months
- age older than 4 years
- stooling not a result of laxatives or illness involving colon such at colitis
Treatment of encopresis
- clean out–> miralax
- stool softeners
- scheduled stooling
- parental and patient educations
What is hirschprung’s disease
incomplete migration of neural cells in the mysenteric and submucosal plexus–> part of the colon lack ganglion cells–> results in the affected segment constricting and the proximal segment becoming distended with feces
What part of the colon does hirchprung’s disease often affect
rectosigmoid
Signs and symptoms of hirschprung’s disease in newborns? children?
newborn: failure to have complete stooling or stool
Child: swollen belly, vomiting, constipation, diarrhea
-failure to thrive, fatigue
Gold standard of diagnosis of hirschprung’s disease
biopsy
Other diagnostic tools for hirschprung’s disease
- manometry of anorectum
- barium enema
- xray
Treatment of hirschprung’s disease
surgical excision of the affected area with anastomosis of the healthy ends
Meckel’s diverticulum?
congential diverticulum of the small intestine
Who gets Meckel’s? Where is it
2% of population 2:1 male to female 2 years old 2 feet from iliocecal valve 2 inches in length
How is Meckel’s diagnosed
typically an incidental finding because it is asx
If Meckel’s shows symptoms, what are they?
- GI bleeding
- intestinal obstruction
- peritonitis
- diverticulitis
- appendicitis
- fistulae
How is Meckel;s treated
excision then treat accompanied pathology
What is malrotation
congenital anomaly of the mid gut leading to
- small intestine found on R side
- cecum displaced into epigastric region
- ligament of Treitz displaced
- fibrous band form leading to obstruction
- narrow base of small intestine–>volvulus
How does malrotation present
infant with
- bilious vomiting
- abd pain
- abd distention
- melena and or mucousy stool
What things can you used to support your clinical suspicion of malrotation
- abd xray
- UGI series
- contrast enema
How do you treat malrotation
surgery
