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Clin Med IV Exam III > Pedi GI > Flashcards

Pedi GI Flashcards

1
Q

When is pyloric stenosis typically noticed in infants

A

withing the first 3-5 weeks of life, rare after 12

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2
Q

Clinical presentation of pyloric stenosis

A
  • 3 to 6 week old with post prandial non bilious projectile vomiting
  • weight loss
  • hungry after vomiting
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3
Q

PE for a baby with pyloric stenosis

A
  • appears think
  • palpable olive at lateral edge of rectus
  • peristaltic waves may be visualized pre emesis
  • may be jaundice
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4
Q

Diagnostics of pyloric stenosis

A

-ultrasound

-

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5
Q

Treatment of pyloric stenosis

A
  • correct hydration status first

- pyloromyotomy

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6
Q

When is intussesception most commonly seen

A

3 months to 5 years old

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7
Q

Where is the typical site of intussusception

A

near the iliocecal junction

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8
Q

Etiology of intussusception

A

proximal bowel telescopes into distal segment–> associated mesentary dragged along–> venous and lymphatic congestion–> intestinal edema–> possible ischemia

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9
Q

What causes intusscusception

A

most cases idiopathic

  • virus
  • post infectious bacterial enteritis
  • lead point from underlying pathology
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10
Q

Clinical manifestations of intusscusception

A
  • sudden, severe, crampy, progressive pain
  • child will be incosolable with legs drawn up
  • non bilious vomiting post pain
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11
Q

Presentation of intusscusception between episodes

A
  • normal and pain free
  • stool main contain gross or occult blood
  • currant jelly stool
  • may feel sausage shaped mass of right side of abdomen
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12
Q

Test to look for intusscusception

A

ultrasound!

“bull’s eye” or “coiled spring”

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13
Q

Intusscusception on xray

A

shows crescent sign

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14
Q

Non operative treatment for intusseception

A
  • enema with hydrostatic or pneumatic pressure

* treatment of choice in stable pt w/o signs of perforation

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15
Q

When is surgical treatment indicated

A

if non operative approach failed

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16
Q

What always gets referred to surgery whether acute or intermittent and presently asymptomatic

A

intusseception

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17
Q

What is phenylketonuria

A

deficiency of pkenylalanine hydroxylase

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18
Q

What does a deficiency of PAH cause

A

increase in serum and urine phennylalanine—> intellectual disability

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19
Q

Increased phenylalanine interfers with what

A
  • brain growth
  • mylenination
  • neurotransmitter sunthesis
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20
Q

Clinical findings in untreated PKU patients

A
  • mental disability and impaired IQ-epilepsy
  • abnormal gait
  • pigmentation issues
  • eczema
  • blood and urine may smell mousy
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21
Q

When should treatment of PKU be started

A

by one weeks of life

22
Q

When do levels of phenylalanine need to be monitored

A
  • weekly for the first year
  • twice a month years 1 to 12
  • monthly after 12 for life
23
Q

How does a child less than 5 present with appendicitis

A

listless, feverish kid with diffuse pain, womitting, rebound, gaurding–> perforated

24
Q

Treatment of non perforated appendicitis in kids

A
  • fluids
  • pain control, anti pyretics, anti emetics
  • NPO
  • pre op abx (cefoxitin)
25
Q

Treatment for perforated appendicitis in kids

A
  • fluids
  • pain control, anti pyretics, anti emetics
  • NPO
  • amp/gent/flagyl
26
Q

When is surgery typically done in a kid with non perforated appendicitis

A

within 6-8 hours

may be 24-48 of IV abx first

27
Q

Normal stooling pattern in newborn. 0-3 months. Less than 2 years. By 4 year

A

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

28
Q

Organic causes of constipation

A
  • anatomic
  • metabolic
  • neuropathic
  • interstinal nerve or muscle disorders
  • abdominal musculature disorder
  • food intolerance
29
Q

Functional causes of constipation

A
  • painful defecation
  • toilet training issues
  • dietary issues
30
Q

Treatment of constipation

A
  • treat the cause
  • ensure enough fluids, dietary fiber
  • no cows milk until 1
  • dont force toilet training
31
Q

interventional treatment for infants with constipation

A
  • glycerine suppository

- ubricated thermometer

32
Q

Interventional treatment for older children with constipation

A
  • glycerine suppository
  • miralax
  • ? enema
  • laxative?
33
Q

What is encopresis

A

involuntary leakage of stool unto the underpants

with or without constipation

34
Q

What is the most common cause of encopresis

A

constipation

35
Q

When does encopresis

A

-most often around tiems of toilet training, teasing about stooling and school onset

36
Q

Diagnosis of encopresis

A

psychiatric diagnosis, must have

  1. voluntary /involuntary passage fo stool outside of bathroom or diaper
  2. one event a month for at 3 months
  3. age older than 4 years
  4. stooling not a result of laxatives or illness involving colon such at colitis
37
Q

Treatment of encopresis

A
  • clean out–> miralax
  • stool softeners
  • scheduled stooling
  • parental and patient educations
38
Q

What is hirschprung’s disease

A

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

39
Q

What part of the colon does hirchprung’s disease often affect

A

rectosigmoid

40
Q

Signs and symptoms of hirschprung’s disease in newborns? children?

A

newborn: failure to have complete stooling or stool

Child: swollen belly, vomiting, constipation, diarrhea
-failure to thrive, fatigue

41
Q

Gold standard of diagnosis of hirschprung’s disease

A

biopsy

42
Q

Other diagnostic tools for hirschprung’s disease

A
  • manometry of anorectum
  • barium enema
  • xray
43
Q

Treatment of hirschprung’s disease

A

surgical excision of the affected area with anastomosis of the healthy ends

44
Q

Meckel’s diverticulum?

A

congential diverticulum of the small intestine

45
Q

Who gets Meckel’s? Where is it

A 
2% of population
2:1 male to female
2 years old
2 feet from iliocecal valve
2 inches in length
46
Q

How is Meckel’s diagnosed

A

typically an incidental finding because it is asx

47
Q

If Meckel’s shows symptoms, what are they?

A
  • GI bleeding
  • intestinal obstruction
  • peritonitis
  • diverticulitis
  • appendicitis
  • fistulae
48
Q

How is Meckel;s treated

A

excision then treat accompanied pathology

49
Q

What is malrotation

A

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
50
Q

How does malrotation present

A

infant with

  • bilious vomiting
  • abd pain
  • abd distention
  • melena and or mucousy stool
51
Q

What things can you used to support your clinical suspicion of malrotation

A
  • abd xray
  • UGI series
  • contrast enema
52
Q

How do you treat malrotation

A

surgery

Clin Med IV Exam III (8 decks)

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