Pediatric First Aid: Gastrointestinal Disease Flashcards
VACTERL pneumonic
Vertebral
Anorectal
Cardiac
Tracheal
Esophageal
Renal
Limb Anomalies
What should you expect in a neonate with excessive oral secretions and drooling?
What is diagnostic for this condition?
Esophageal Atresia
Dx: inability to pass nasogastric tube from mouth to stomach
What is the most common presentation of an atretic esophagus?
Proximal: ends in blind pouch (12-12 cm from nares)
Distally: connects to trachea (tracheoesophageal fistula)
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?
Esophageal Atresia
How is esophageal atresia diagnosed?
- typically at birth with inability to pass NG tube into stomach (coiled NGT on x-ray)
- CXR reveals air in upper esophagus
How is esophageal atresia treated?
Surgery
What are the most common sites of foreign body impaction in the esophagus?
70% - thoracic inlet (between clavicles)
15% - midesophagus
15% - lower esophageal sphincter
Most common location for esophageal foreign body impaction?
Thoracic Inlet - 70%
How are esophageal foreign bodies diagnosed?
AP/Lateral CXR
- history can help; sometimes witnessed event
How are esophageal foreign bodies treated?
- 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
What issues do button batteries lead to if swallowed?
rapid local necrosis of esophageal walls
What is GERD and what is the most common form?
- passive reflux of gastric contents due to incompetent lower esophageal sphincter (1/300 children)
- FUNCTIONAL gastroesophageal reflux most common
What are 3 common medications that can increase a patients risk for GERD?
theophylline, CCBs, BBs
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?
GERD
How is GERD diagnosed?
mild: clinical assessment
severe: esophageal pH probe and barium esophagography
biopsy used for diagnosis of esophagitis
What medications are commonly used to help manage GERD? (3)
What motility agents are available to patients? (2)
- antacids, H2 blockers (ranitidine), and PPIs (omeprazole)
motility agents: metoclopramide or erythromycin (stimulate gastric emptying)
What surgery can be performed for patients with continued or worsening GERD, despite medical and lifestyle treatments?
Nissen Fundoplication
What lifestyle modifications should be recommended for children experiencing GERD?
- keep infant upright up to an hour after feeds
- mealtime 2+ hours before sleep
- sleep with head elevated
- thicken formula with rice cereal
What is the most common cause of abdominal pain in children?
Constipation
3 common causes of constipation in the neonatal period
- Hirschsprung
- intestinal pseudo-obstruction
- hypothyroidism
How is constipation typically treated?
- 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
What are cathartics and what are two common ones used for diarrhea?
- substances that accelerate defecation –> evacuation of entire colon (watery, uniform stool)
Ex: senna, docusate