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A Pediatrics Compendium > Pediatric First Aid: Gastrointestinal Disease > Flashcards

Pediatric First Aid: Gastrointestinal Disease Flashcards

1
Q

VACTERL pneumonic

A

Vertebral
Anorectal
Cardiac
Tracheal
Esophageal
Renal
Limb Anomalies

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2
Q

What should you expect in a neonate with excessive oral secretions and drooling?

What is diagnostic for this condition?

A

Esophageal Atresia

Dx: inability to pass nasogastric tube from mouth to stomach

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3
Q

What is the most common presentation of an atretic esophagus?

A

Proximal: ends in blind pouch (12-12 cm from nares)
Distally: connects to trachea (tracheoesophageal fistula)

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4
Q

Hx of maternal polyhydramnios, inc. oral secretions in newborn, choking/coughing/cyanosis during feeding, recurrent coughing w/aspiration pneumonia, airless abdomen on x-ray, and aspiration of gastric contents are common S&S of what condition?

A

Esophageal Atresia

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5
Q

How is esophageal atresia diagnosed?

A
  • typically at birth with inability to pass NG tube into stomach (coiled NGT on x-ray)
  • CXR reveals air in upper esophagus
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6
Q

How is esophageal atresia treated?

A

Surgery

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7
Q

What are the most common sites of foreign body impaction in the esophagus?

A

70% - thoracic inlet (between clavicles)
15% - midesophagus
15% - lower esophageal sphincter

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8
Q

Most common location for esophageal foreign body impaction?

A

Thoracic Inlet - 70%

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9
Q

How are esophageal foreign bodies diagnosed?

A

AP/Lateral CXR

  • history can help; sometimes witnessed event
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10
Q

How are esophageal foreign bodies treated?

A
  • endoscopic treatment if symptomatic or fail to pass to stomach (below diaphragm) within a few hours
  • impacted, pointed objects, batteries = IMMEDIATE REMOVAL

ASSESS TIME OF INGESTION –> 24+ hours = erosion/necrosis

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11
Q

What issues do button batteries lead to if swallowed?

A

rapid local necrosis of esophageal walls

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12
Q

What is GERD and what is the most common form?

A
  • passive reflux of gastric contents due to incompetent lower esophageal sphincter (1/300 children)
  • FUNCTIONAL gastroesophageal reflux most common
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13
Q

What are 3 common medications that can increase a patients risk for GERD?

A

theophylline, CCBs, BBs

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14
Q

Excessive spitting up in the first week of life that turns symptomatic by 6 weeks, occasional forceful vomiting, aspiration pneumonia, and chronic cough/wheezing/recurrent pneumonia in later childhood are all S&S of what condition?

A

GERD

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15
Q

How is GERD diagnosed?

A

mild: clinical assessment
severe: esophageal pH probe and barium esophagography

biopsy used for diagnosis of esophagitis

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16
Q

What medications are commonly used to help manage GERD? (3)

What motility agents are available to patients? (2)

A
  • antacids, H2 blockers (ranitidine), and PPIs (omeprazole)

motility agents: metoclopramide or erythromycin (stimulate gastric emptying)

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17
Q

What surgery can be performed for patients with continued or worsening GERD, despite medical and lifestyle treatments?

A

Nissen Fundoplication

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18
Q

What lifestyle modifications should be recommended for children experiencing GERD?

A
  • keep infant upright up to an hour after feeds
  • mealtime 2+ hours before sleep
  • sleep with head elevated
  • thicken formula with rice cereal
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19
Q

What is the most common cause of abdominal pain in children?

A

Constipation

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20
Q

3 common causes of constipation in the neonatal period

A
  • Hirschsprung
  • intestinal pseudo-obstruction
  • hypothyroidism
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21
Q

How is constipation typically treated?

A
  • inc. oral fluid and fiber intake
  • stool softeners (mineral oil)
  • glycerin suppositories
  • cathartics (senna/docusate)
  • nonabsorbable osmotic agents (polyethylene glycol) and milk of magnesia; can cause lyte imbalances
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22
Q

What are cathartics and what are two common ones used for diarrhea?

A
  • substances that accelerate defecation –> evacuation of entire colon (watery, uniform stool)

Ex: senna, docusate

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23
Q

What is Functional Constipation?

A
  • constipation with no underlying organic cause (95% of children)
  • difficult or infrequent bowel movements/ deviation from normal frequency, painful defecation, the passage of hard stools, and/or sensation of incomplete evacuation of stool
24
Q

What is gastroenteritis?

A
  • inflammation of the entire (upper and lower) GI tract, typically involving both vomiting and diarrhea
25
What is the most common cause of gastroenteritis in children and what 3 organisms are most prevelant?
MCC = VIRAL 1) rotavirus, 2) enteric adenovirus, 3) Norwalk virus
26
4 most common causes of bacterial gasteroenteritis
1) Campylobacter 2) Salmonella and Shigella 3) enterohemorrhagic E. coli
27
What is tenesmus?
feeling that you need to pass stool, even though your bowels are already empty
28
How is Acute Gastroenteritis diagnosed?
- examine stool (mucus, blood, leukocytes) - fecal leukocytes (invasive cytotoxin organisms) - early stool cultures - C. difficile toxins - proctosigmoidoscopy (Dx of inflammatory enteritis)
29
What is the BRAT diet for patients with diarrhea?
B - bananas R - rice A - applesauce T - toast
30
Are antidiarrheal compounds indicated for use in children with diarrhea?
NO!
31
Are empiric antibiotics indicated for children with diarrhea caused by enteropathogens?
generally NOT indicated!
32
Why is E.coli O157:H7 diarrhea not treated with antibiotics?
- higher incidence of hemolytic uremic syndrome with treatment
33
What is the antibiotic treatment of choice for these enteropathogenic bacteria? 1. Aeromonas 2. Campylobacter 3. C. difficle (2) 4. Salmonella (3) 5. Shigella (2) 6. Vibrio cholerae (2) 7. All E. coli strains
1. TMP-SMX 2. Erythromycin 3. Metronidazole or Vancomycin 4. Ampicillin or chloramphenicol or TMP-SMX 5. TMP-SMX, Ceftriaxone 6. Tetracycline or Doxycycline 7. TMP-SMX
34
How is the diagnosis of IBS made? (Rome IV Criteria)
- at least 3 days a month in the last 3 months associated with 2 or more of the following: 1. improvement in pain/discomfort with defecation 2. onset associated with change in stool frequency 3. onset associated with change in appearance of stool
35
How many times per day should these age ranges stool? 1. Newborns 2. First 3 months (breast-fed) 3. First 3 months (formula-fed) 4. 6 months-1 year 5. 1-3 years 6. 4 years and older
1. 4 soft movements 2. 3 soft movements 3. 2-3 soft movements 4. 2 bowel movements 5. 1-2 movements 6. 1 movement
36
Crohn's Disease Depth of Involvement Ileal Involvement Ulcers Cancer risk Pyoderma Gangrenosum Skip Lesions Fistulas Rectal Bleeding
1. transmural 2. common 3. common 4. decreased 5. slightly increased 6. common 7. common 8. sometimes
37
Ulcerative Colitis Depth of Involvement Ileal Involvement Ulcers Cancer risk Pyoderma Gangrenosum Skip Lesions Fistulas Rectal Bleeding
1. mucosal 2. unusual 3. unusual 4. increased 5. greatly increased 6. unusual 7. unusual 8. common
38
When is the typical onset of Inflammatory Bowel Disease and what age range does it usually affect?
Onset: adolescence and young adulthood BIMODAL = patients 15-25 AND 50-80 yo
39
Which does this describe: Crohn's or UC? Perianal fistula, sclerosing cholangitis, chronic active hepatitis, pyoderma gangrenosum, ankylosing spondylitis, erythema nodosum?
Crohn's Disease
40
Which does this describe: Crohn's or UC? Bloody diarrhea, anorexia, weight loss, pyoderma gangrenosum, sclerosing cholangitis, marked by flare-ups?
Ulcerative Colitis
41
What 3 things are common used to treat UC?
aminosalicylates oral corticosteroids colectomy
42
Corticosteroids, aminosalicylates, methotrexate, azathioprine, cyclosporine, metronidazole, sitz baths, anti-TNFalpha, and surgery are common treatments for what GI disease?
Crohn's Disease
43
What is Irritable Bowel Syndrome, what are its common symptoms, and how is it diagnosed?
- abdominal pain associated with intermittent diarrhea and constipation without organic basis Sxs: abdominal pain, diarrhea alternating with constipation Dx: at least 3 days a month in the last 3 months associated with 2 or more of the following: improvement in abdominal pain or discomfort with defecation, onset associated with a change in frequency of stool, and/or an onset accompanied by a change in form or appearance of stool
44
How is Irritable Bowel Syndrome managed?
- no specific treatment - supportive measures with reinforcement and reassurance - address underlying psychosocial stressors
45
What age range is Celiac's Disease most commonly seen in?
5 months to 2 years old
46
Diarrhea, failure to thrive, vomiting, pallor, abdominal distension, and large bulky stools are common presenting symptoms of what GI disease?
Celiac's Disease
47
How is the diagnosis of Celiac's Disease made?
Anti-endomysial and anti-tissue transglutaminase IgA Abs Biopsy! --> most reliable test
48
How is Celiac's Disease treated?
dietary restriction of gluten (completely remove barley, oats, ryes, wheats) corticosteroids if very ill and profound malnutrition, diarrhea, edema, hypokalemia
49
What are the common signs and symptoms of lactase deficiency?
- explosive watery diarrhea with abdominal distension, borborygmi, flatulence - recurrent, vague abdominal pain - episodic midabdominal pain (may or may not be related to milk intake) **seen in response to ingestion of lactose**
50
How is Lactase Deficiency treated?
- eliminate milk and dairy products from diet - oral lactase supplement (LACTAID) or lactose-free milk - yogurt (with lactase enzyme-producing bacteria tolerable in such patients)
51
Well-nourished 3 month old is brought to ED with constipation, blood-streaked stools, and excessive crying on defecation. What should you be thinking about?
Anal Fissure - painful linear tears in anal mucosa below the dentate line induced by constipation or excessive diarrhea
52
What age range are Anal Fissures common in?
6-24 months of age
53
What are the common symptoms of Anal Fissures?
- pain w/defecation/crying during bowel movement - inc. sphincter tone - visible tear upon gentle lateral retraction of anal tissue
54
How are Anal Fissures diagnosed?
Anal inspection
55
How are Anal Fissures treated?
sitz baths, fiber supplements, inc. fluid intake
56
What is borborgymi?
rumbling or gurgling sound made by movement of fluid and gas in intestines

A Pediatrics Compendium (47 decks)

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