Pediatric Gastroenterology

Question 1

Treatment of choice for children > 6 months with functional constipation and impaction

Answer 1

Osmotic agent of some sort, usually polyethylene glycol

Effective both in disimpaction and in reducing complications, such as fissures and recurrent constipation

Question 2

Adults get anal fissures because ___.

Kids get anal fissures because ___.

Answer 2

Adults get anal fissures because they are constipated and have high anal tone.

Kids get anal fissures because something external made a hole there – iatrogenic or abuse. (often from rectal exam)

Question 3

Anal fissure diagnosis + treatment in kids

Answer 3

Diagnosis is clinical, treatment is reassurance – no need for sutures, baby stool is soft

Question 4

Classic presentation of intussusception

Answer 4

• Typically 3 months - 3 years of age
• Abrupt onset of colicky abdominal pain
• Knee-chest position brings relief
• If you wait long enough, bowel will die, slough off, and become “currant jelly diarrhea”
• “Sausage-shaped” abdominal mass

Question 5

Currant jelly stool

Answer 5

Result of dead bowel sloughing off – any etiology

Question 6

Diagnosing intussusception

Answer 6

• Best definitive diagnostic test is air enema, and is also the treatment of choice – propelled air pushes telescope back out
• Important accessory tests:
  
  • Kidney-ureter-bladder plain film - rule out perforation and obstruction
  • Ultrasound may be used to track progress, highly sensitive (“Target sign”)

Question 7

When does a child with intussusception need to go to surgery?

Answer 7

Frank peritonitis

Perforation

Failure of air enema

Question 8

Meckel’s diverticulum

Answer 8

• Remnant of the vitelline duct, made of gastric contents that can secrete acid
  
  • May bleed itself or may cause a “peptic ulcer” in the terminal ileum or colon
• Painless, intermittent hematochezia (BRBPR)
• Rule of 2’s: Presents in toddlers <2 years old, 2x as likely in males, found 2 feet from ileocecal valve, about 2 inches
• May be associated with iron deficiency in a male or FOBT +
• Diagnosis: Tc99 scan for kids, CT for teens.
• Treatment: Resection.

Question 9

Common mimics of GI bleed in kids

Answer 9

• Baby swallows mom’s blood during delivery and then has melena
  
  • Apt test can tell you if it is baby’s blood or mom’s blood
• Epistaxis-induced melena
• Iron supplementation
• Beats
• Medications
• Milk protein allergy (change to hydrolzed formula)
• Milk/soy protein-induced colitis

Question 10

Crohn’s presents as ____ while UC presents as ____.

Answer 10

Crohn’s presents as watery diarrhea with weight loss while UC presents as dysentery.

Question 11

Rule for IBD colon cancer screening

Answer 11

For pancolitis: Begin 8 years after diagnosis, screen every 1-2 years

For L sided colitis: Begin 15 years after diagnois, screen every 1-2 years

Question 12

What is the ONLY medical indication for soy formula?

Answer 12

Galactosemia