Pediatric gastroenterology, dehydration and rehydration

Question 1

intussusception

Answer 1

telescoping of distal ileum into cecum, for reasons unknown (lymphoid hyperplasia?) produces pain eventually necrosis

• mc presentation is intermittent pain in toddler, bloody diarrhea is late.
• most cases under 2 yo; presentation in infants is less specific; may present as lethargy, altered mental status, sepsis-like picture

Question 2

ger

Answer 2

commn in infants. dx with h and P 50%
most children grow of out of it by 12 mos
treat with reassurance; sometimes thickened feeds, smaller feeds, positioning.
distinguised from GERD because greater more forceful emesis, complications.
-may treat with proton pump inhibitors

Question 3

celiac disease

Answer 3

intestinal reaction to gluten (a protein) that causes malabsorption. sxs are diarrhea, abdominal bloating, irritability, decreased appetite, failure to thrive. dx by small bowel bx. treat by removing gluten from diet .

Question 4

IBD clinical presentation ulcerative colitis

Answer 4

abdominal pain, bloody stools, diarrhea, most children dont present with fever and weight loss.

Question 5

IBD clin presentation chrons disease

Answer 5

abd pain, diarrhea, weight loss. may have perianal disease, apthous ulcers, decrease in height velocity. arthralgias and arthritis extraintestinal manifestations

Question 6

diagnosis IBD

Answer 6

h and p and endoscopy with bx

Question 7

treatment IBD s

Answer 7

stepwise accorcing to severity of disease, and inversely toxicity of meds

first: budesonide in CD, 5 asa agaents in UC
second: immunomodulators in both uc and cd, methotrexate with cd.
third: biologic therapy

Question 8

what is darrhea?

Answer 8

passage of 3 or more loose or liquid stools per day, or more freqnatly than is normal for individual

Question 9

what in history predicts dehydration?

Answer 9

not much-of course, look for decreased urination, frequency and volume of stool/vomitus, whether child is drinking

Question 10

hemolytic uremic syndrome triad

Answer 10

anemia, renal failure, thrombocytopenia

Question 11

life threatening causes of vomiting

Answer 11

newborn: anatomic problems, central nervous system infection, inborn errors of metabolism
older infant: obstructtion, gastroenteritis with dehydration, occult head trauma
older child: GI, neurologica, uremia, infectiuosm metabolic, toxins/drugs

Question 12

TBW

Answer 12

2/3 INTRAcellular

1/3 extracellular

Question 13

fluid needs over 24 hours

Answer 13

maintenance 100 ml/kg for 1st 10 kg body weight
50 ml/kg for next 10 kg
20 ml/kg for anything above
rehydration–depends on weight lost, either measured or calculated
replacement of ongoing losses.

Question 14

electrolyte needs

Answer 14

maintenance: sodium 2-3 mEq/kg for 24 hours, potassium 1-2 mEq/kg
rehydration: see ORT composition, normal saline for IVfluids
typical maintenance for older child: d51/2 NS with 20 mEq/L KCL

Question 15

severe dehydration

Answer 15

treat initially with IVfluid bolus 20 ml/kg NS or LR to restore intravascular volume. (CV status)
look for signs of better hydration: better mental status, lower heart rate, higher bp

Question 16

severe dehydration next 24 hours

Answer 16

give 1/2 of deficit over 8 hours, 1/2 over next 16 hours.

Question 17

hypernatremic (type of dehydration)

Answer 17

Na over 145

causes: diarrhea (more water loss than na sometimes coupled with hyponatremic fluid intake, vomiting.
appearance: pr doesnt look as bad because of relative protection of ICF early on.
treatment: same as Iso initially, after rehydrate slowly (no more than 12 meq/L per 24 hours or risk cerebral edema