Pedia Gastro Flashcards
Contents of WHO ORS
75 meqs of Na
64 meqs of Cl
20 meqs of K
75 mmol of Glucose
245 mOsm/L
Preferred mode of rehydration and replacement of ongoing losses for diarrhea
Oral rehydration
Types of food to be avoided during rehydration
Fatty food
Food high in simple sugars - juices, carbonated sodas
how many mg of Zinc and how long it should be given as supplementation for children with diarrhea
20 mg/day for 10-14 days
First line of treatment for Shigella as cause of diarrhea
Ciprofloxacin (15 mkday) BID x 3 days
first line of treatment for ETEC (Enterotoxigenic) as cause of diarrhea
Azithromycin 12 mkday on D1, 6 mkday on D2-D3
treatment for campylobacter diarrhea
Erythromycin for 5 days or Azithromycin for 3 days
Pediatric Appendicitis SCORE that is highly sensitive and specific for APPENDICITIS
8
Classic and consistent finding in acute appendicitis
Anorexia
2 features of PAS equivalent to a score of 2
RLQ tenderness and Cough/percussion/hopping tenderness
Gold standard imaging study for evaluating children with suspected appendicitis
Computed Tomography (CT) scan
gold standard for diagnosis of Biliary atresia
Intraoperative cholangiogram
final common pathway of Biliary atresia
Obliterative cholangiopathy
typical abdominal UTZ findings in Biliary Atresia
Nonvisualization of the gallbladder / small contracted gallbladder / nonvisualization of the common bile duct
characteristic features of biliary atresia on liver biopsy
bile duct proliferation, bile duct plugs, portal stromal edema
classic criteria on five body systems in diagnosing Alagille Syndrome
- Liver/cholestasis
- Dysmorphic facies: broad forehead, deep-set eyes, straight nose with bullous tip, pointed chin
- CHD - pulmonary artery stenosis
- Axial skeleton/vertebral anomalies
- Eye/posterior embryotoxon
most common types of choledochal malformations
Cylindrical (fusiform) and Spherical (saccular) types
features of acute cholangitis
Fever, RUQ tenderness, jaundice, leukocytosis
treatment of choice for Choledochal malformation
Excision of abnormal biliary segment
Roux-en-Y choledochojejunostomy
Most common cause of extrahepatic portal hypertension
Portal Vein Thrombosis
Criteria for cyclic vomiting syndrome
All of the ff must be met:
- at least 5 attacks in any interval or a minimum of 3 episodes during a 6 month period
- recurrent episodes of intense vomiting and nausea lasting 1 hour to 10 days and occuring at least 1 week apart
- stereotypical pattern and symptoms in the individual patient
- vomiting during episodes occurs more than 4x/hr for more than 1 hour
- return to baseline health between episodes
- not attributed to another disorder
This type of mechanism that cause diarrhea stops with fasting
Osmotic diarrhea
This type of mechanism that cause diarrhea persists even with fasting
Secretory diarrhea
All 20 primary teeth erupt by what age
3 years old
transition to full permanent dentition is completed by what age?
13 years old
Permanent teeth starts to erupt around this age
6 years old
most common congenital anomaly of the GI tract
Meckel Diverticulum
Rule of 2s in Meckel Diverticulum
- 2% of general population
- located 2 feet proximal to the ileocecal valve
- 2 inches in length
- contains 2 types of ectopic tissues (Pancreatic/Gastric)
- present before 2 yr old
- found 2x as commonly in females
Rome IV Diagnostic criteria for defecatory disorders/functional constipation in Neonates and Toddlers (up to 4 months)
Must include 1 month of >2 of the ff:
- 2 or fewer defections weekly
- history of excessive stool retention
- history of large-diameter stools
- presence of a large fecal mass in the rectum
- at least 1 weekly episode of incontinence after being toilet trained
- History of large-diameter stools that may clog the toilet
Rome IV Diagnostic criteria for defecatory disorders/functional constipation in children
must include >2 of the ff >1/week for > 1 month:
- <2 defecations in the toilet per week
- >1 episode of fecal incontinence per week
- history of retentive posturing or excessive volitional stool retention
- history of painful or hard bowel movements
- history of large diameter stools that can obstruct the toilet
- after appropriate evaluation, symptoms cannot be fully explained by another medical condition
Name possible causes of cleft lip and palate
Maternal drug exposure
Syndrome-malformation complex
Genetic factors
Classic triad of intussusception
- Pain
- palpable sausage shaped abdominal mass
- bloody or currant jelly stool
predictive value of >90: combination of paroxysmal pain, vomiting, palpable abdominal mass
most common cause of intestinal obstruction between 5 months and 3 years old and the most common abdominal emergency in children <2 yo
Intussusception
most recurrences in intussusception occur within how many hours?
72
hallmark of duodenal obstruction
bilious vomiting without abdominal distention
the diagnosis is suggested by the presence of double-bubble sign on a plain abdominal radiograph
Duodenal obstruction/atresia
GER resolves in 88% of children at what age, and almost all resolve by what age
12 months, 2 years old
treatment of helicobacter pylori-related PUD
Triple therapy — PPI (1 month) + combination of clarithromycin/metronidazole and amoxicillin x 14 days
“double-bubble” sign seen in x-ray film
Duodenal atresia
“double tract” sign seen in contrast studies
Pyloric stenosis
clinical manifestations of Hepatitis A virus infection
Acute febrile illness + abrupt onset of anorexia, nausea, malaise, vomiting, and jaundice
— typical duration of illness is 7-14 days
Patients infected with HAV are contagious during this time period
2 weeks before and approximately 7 days after the onset of jaundice
— needs isolation!!!!
excluded from school, childcare and work
Immunoglobulin prophylaxis for Hep A indications
children younger than 12 months old
immunocompromised hosts
those with Chronic Liver Disease
Hep A vaccine is contraindicated
hallmark of Duodenal obstruction/atresia
bilious vomiting without abdominal distention which appears on the first day of life
definition of acute diarrhea
sudden onset of excessively loose stools >10 cc/kg/day in infants, >200 g/24 hr in older children which last <14 days
Chronic diarrhea
> 14 days in duration
greatest volume of intestinal water is absorbed in which part of the GI tract
small bowel
what class of malocclusion: receding chin/retrognathia or protruding front teeth
Class II malocclusion
what class of maloclussion: underbite/protruding chin
Class III
Surgical closure of cleft lip and palate is done at what age
Cleft lip: 3 months
Cleft palate: before 1 yr of age — to enhance normal speech development
frequent sequelae of cleft palate
recurrent otitis media and subsequent hearing loss
associated risk factors in Esophageal atresia
Advanced maternal age
European ethnicity
Obesity
Low socioeconomic status
Tobacco smoking
criteria in diagnosing nonretentive fecal incontinence
> 1 month history of the ff:
- defecation into places inappropriate to the sociocultural context
- no evidence of fecal retention
- symptoms cannot be fully explained by another medical condition after appropriate evaluation
must have a developmental age >4 yr
most common cause of lower intestinal obstruction in neonates
Hirschsprung disease/Congenital Aganglionic megacolon
this is suspected in any full term infant with delayed passage of stool
Hirschsprung Disease
Classic findings in contrast enema done for diagnosing Hirschsprung disease
Presence of an abrupt narrow transition zone between the normal dilated proximal colon and a smaller-caliber obstructed distal aganglionic segment
gold standard for diagnosing hirschsprung disease
Rectal suction biopsy
— demonstrate hypertrophied nerve bundles that stain positively for acetylcholinesterase with an absence of ganglion cells
the success rate of this procedure done in ileocolic intussusception is 80-95%
Radiologic hydrostatic reduction
method of choice to establish the diagnosis of Peptic Ulcer Disease
Esophagogastroduodenoscopy
most common etiologies of Acute pancreatitis in children
blunt abdominal injuries
Multisystem disease such as HUS, IBD
Biliary stones/Microlithiasis (sludging)
Drug Toxicity
Drug induced pancreatitis: Valproic Acid, L-asparaginase, 6-mercaptopurine, Azathioprine
Diagnosis of pancreatitis in children
2 OUT OF 3:
1. Abdominal pain
2. Serum Amylase and/or Lipase activity at 3x UL
3. Imaging finding characteristic of/compatible with AP: pancreatic necrosis
other finding: pancreatic enlargement, hypoechoic sonolucent edematous pancreas, pancreatic masses, fluid collections and abscesses
Definition of Acute Hepatic Failure
- biochemical evidence of acute liver injury (<8 weeks duration)
- no evidence of Chronic Liver Disease
- Hepatic-based coagualopathy: PT >15 s or INR >1.5 not corrected by Vitamin K + Hepatic Encephalopathy or PT>20s or INR >2 regardless +/- hepatic encephalopathy
initial approach to symptomatic patients with Celiac Disease
Test for anti-TG2 IgA antibodies and total IgA (to rule out IgA deficiency)
only treatment for Celiac Disease
Lifelong strict adherence to a gluten-free diet
Peak incidence of Acute appendicitis happen in what age
between 10 and 18 years old
classic and consistent finding in acute appendicitis
anorexia
ultrasound findings suggestive of appendicitis
Wall thickness >6 mm
Luminal distention
Lack of compressibility
Complex mass in the RLQ
Appendicolith
Treatment of choledochal cysts
Primary excision of cyst and Roux-en-Y choledochojejunostomy
