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Peds - Spring 2016 > Pediatric Gastrointestinal Disorders (Part 2) - Unit 2 > Flashcards

Pediatric Gastrointestinal Disorders (Part 2) - Unit 2 Flashcards

1
Q

What is hirschsprung’s disease? What does it result in?

A

Congenital aganglionic megacolon - essentially an absence of autonomic parasympathetic ganglion cells in the mucosal and muscular layers of the colon. IN LAYMAN’S TERMS, it means that they have no nerve cells down there so they can’t pass the stool.

It results in obstruction and dilation of the proximal bowel.

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2
Q

Hirschsprung’s Disease - peristalsis is normal above the affected area. T/F?

A

True

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3
Q

What are some clinical findings for Hirschsprung’s Disease?

A

Long & ribbon like stools, typically symptoms appear once they start solid foods…
Failure to pass meconium, enlarged/distended abdomen, vomiting, fecal mass, rectum that is empty of stool

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4
Q

How do we test for hirschsprung’s disease?

A

Anorectal manometry (tests the sphincter’s reaction to rectal distention (if stimulated, they should poop), biopsy

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5
Q

How do we manage hirschprung’s?

A

monitor F&E balance, may need regular rectal irrigation, surgical removal of the aganglionic portion of the bowel, may need temporary ostomy proximal to the aganglionic segment, complete correction (pull through)

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6
Q

Hirschprung’s Disease - may be too malnourished to withstand immediate surgery. T/F?

A

True

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7
Q

What diet should a hirschprung’s patient be on?

A

High calorie, high protein, LOW FIBER diet

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8
Q

What is enterocolitis?

A

Inflammation of the small bowel and colon, leads to ischemia and ulceration of bowel wall - - - - it is a surgical emergency is perforation occurs.

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9
Q

Entercolitis - can cause death in kids with Hirschprung’s. T/F?

A

True

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10
Q

What are signs of perforation?

A

Distended + hard abdomen, pain, shocky (rapid HR, 1000 mile stare)

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11
Q

What is gastroesophageal reflux?

A

Retrograde flow of gastric contents in the esophagus - it is normal.

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12
Q

What causes gastroesophageal reflux?

A

Failure of the sphincter mechanism at the junction of the esophagus and the stomach.

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13
Q

GER - normal for children and adults after meals and may randomly improve in kids at age 6-9 months. T/F?

A

True

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14
Q

What are some manifestations of GI reflux?

A

Spitting up, vomiting, weight loss (something isn’t right), gagging/choking at the end of feedings, respiratory problems, heartburn/irritability…

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15
Q

Heartburn and GI reflux - what is the problem with this?

A

Babies can’t tell you they have heartburn!

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16
Q

What are some diagnostic tests for GI reflux?

A

Barium swallow, UGI, scintiscan, flexible endoscopy

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17
Q

How do we manage reflux?

A

Change to soy forumla, frequent burping, small feedings (not anything over 30 minutes), elevate HOB (wedge under mattress), lay on right side after feeding, thicken feeding with rice cereal

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18
Q

What meds manage reflux?

A

H2 Blockers (cimetidine), suppression of gastric acid (prilosec), increase gastric emptying (reglan - metaclopramide), azithromycin, etc.

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19
Q

What is a surgery for management of GI reflux?

A

Nissen fundoplication (wraps fundus around end of esophagus to make it tight) or a G-tube

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20
Q

What is enterobliasis?

A

Pinworms!

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21
Q

What are some signs of pinworms? How are they transmitted? How do we test for them?

A

Signs = intense perianal itching.
transmitted fecal-oral route. :(
Tested with scotch tape test - we stick tape in their undies or diaper and later should find the worms…ewwww!

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22
Q

How do we treat pinworms? Do we treat the whole fucking family? Do we treat 1-2 weeks later?

A

Vermox (Mebendazole)

We treat the whole family, also 1-2 weeks later!

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23
Q

What is colic?

A

Complex of symptoms which include paroxysmal severe crying episodes - apparent abdominal pain and irritability in healthy infants.

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24
Q

When does colic typically happen? What are some clinical findings for colic?

A

presents at 2-4 weeks and resolves by 3-4 moths, face may be flushed, circumoral pallor, abdomen may be distened, legs may be drawn up to the abdomen, episodes are rhythmic, usually occuring evening/lasting 3-5 hours or longer, normal physical exam.

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25
Q

How do we manage colic?

A

Reassure parents, discuss factors that trigger or increase (new bottle? Breast milk? etc), teach soothing techniques, WATCH FOR SBS

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26
Q

What are the inflammatory disorders? Difference?

A

UC and Crohn’s.

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27
Q

UC - inflammation in colitis is limited to the colon and rectum - limited to the mucosa and involves continuous segments. T/F?

A

True

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28
Q

UC - produces what kind of diarrhea? Is there abdominal pain?

A

Bloody diarrhea.

yes for abdominal pain.

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29
Q

Crohn’s disease - chronic inflammation. T/F?

A

True

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30
Q

Crohn’s - involves any part of the GI track. T/F?

A

TRUE

31
Q

Crohn’s - most common where?

A

terminal ileum.

32
Q

Fissures common in Crohn’s ?

A

Yes

33
Q

How do we manage the inflammatory bowel diseases?

A

Directed toward decreasing inflammation, corticosteroids, sulfasalazine (can treat UC), metronidazole (perianal disease or small bowel overgrowth), immunosuppressive drugs, nutritional rehabilitation, surgical treatment (ostomy).

34
Q

What are some structural defects?

A

Cleft lip/cleft palate.

35
Q

What’s the difference between a cleft lip or cleft palate?

A

Lip - failure of fusion of upper lip. May be unilateral or bilateral.

Palate - Results from failure of the hard and soft palates to fuse because of failure of the tongue to descend soon enough. May be MIDLINE or bilateral.

36
Q

What do we do to repair a cleft lip?

A

Cheiloplasty (clean the suture, restrain the kid so they don’t smack it), home within 24 hours.

37
Q

What are some problems associated with a cleft palate?

A

feeding, copious secretions, dental/orthodontic, speech hearing, improper drainage of the middle ear

38
Q

When do they usually fix a cleft palate?

A

usually fixed around a year and a half - may be sooner - don’t wait beyond 18 months!

39
Q

How do we feed the child with a cleft palate?

A

Hold infant in upright position during feeding, support lower jaw, cross cut nipples, obturator (like a retainer)

40
Q

Cleft palate kids - are they at a huge risk for aspiration?

A

YES

41
Q

Post op cleft palate repair - what are they at risk for?

A

respiratory difficulties

42
Q

After cleft palate surgery, what should we do?

A

Tell them NO TOAST, hard cookies, sharp objects, no sippy cup (or take away the valve)

43
Q

What are the obstructive disorders?

A

Pyloric stenosis & intussusception

44
Q

Pyloric stenosis - what is it? Who does it typically occur in?

A

Obstruction of the circular muscle of the pyloris - typically in first born males.

45
Q

Pyloric stenosis - present at birth. T/F?

A

False - typically pops up at 2-4 weeks.

46
Q

What are some clinical findings for pyloric stenosis?

A

Vomiting, hungry infant, visible gastric peristaltic waves, palpable pyloric “olive” that’s right of the umbilicus.

47
Q

how do we diagnose pyloric stenosis? what’s the surgery?

A

Pyloric ultrasound.

pyloromyotomy - widdle obstruction down

48
Q

What is an intussusception?

A

Obstruction caused by invasion of segment of the bowel into the cecum.

49
Q

What are some clinical manifestations of an intussusception? What ages?

A

Pain, diarrhea, (CURRENT/RED JELLY), sausage shaped mass, fever, shock. typically 3mo-5 years.

50
Q

A barium enema can sometimes fix an intussusception?

A

Yes

51
Q

What are some clinical manifestations of appendicitis?

A

Abdominal pain, McBurney point (point by the umbilicus on the right side), rovsing sign (pain in right lower when touching other areas), rebound tenderness, nausea, vomiting, diarrhea

52
Q

how do we diagnose appendicitis?

A

elevated white count, check for UTI, rule out pregnancy, ultra sound, CT

53
Q

how do treat appendicitis?

A

Appendectomy, IV fluids, antibiotics (which might rule out surgery!)

54
Q

What is short bowel syndrome SBS?

A

A malabsorptive disorder, results from decreased mucosal surface area, usually as result of small bowel resection

55
Q

How do we treat/manage SBS?

A

Nutritional support (TPN) first, enteral feeding’s second

56
Q

what are some signs of celiac in kids?

A

Growth problems, N/V, diarrhea, etc.

57
Q

What is hyperbilirubinemia? What type is most common in newborns?

A

Excessive bilirubin in blood.

Unconjugated is most common.

58
Q

Newborns - produce half as much bilirubin as adults. T/F?

A

FALSE - they produce double what adults do!

59
Q

Baby RBC’s last 70-90 days. T/F?

A

True

60
Q

BBB in babies - less permeable. T/F?

A

True

61
Q

How does most of the conjugated bilirubin leave the body?

A

Through poop, so feed feed feed!

62
Q

What is kernicterus? What may it lead to?

A

Yellow staining of brain cells that leads to bilirubin encephalopathy, may lead to brain hemorrhage

63
Q

Hyperbilirubinemia that is due to an overproduction of bilirubin can be seen in which condition?

A

Hemolytic disease

64
Q

The intensity of jaundice is related to the bilirubin levels. T/F?

A

False

65
Q

Bili level greater than 12.9 - BAD?

A

YES

66
Q

What does phototherapy do?

A

Treats excessive bilirubin. Skin must be exposed…it converts the bili to a more soluble form.

67
Q

What is biliary atresia?

A

Disorder of progressive liver fibrosis due to blockage or lack of the common bile duct.

68
Q

What are the two kinds of biliary atresia?

A

Post-natal (65%-90%) - due to infection or immune response.

Fetal embryonic - congenital absence of patency of bile duct.

69
Q

The biliary tract transports bile from the ___ to the ___.

A

liver to small intestine.

70
Q

What are some manifestations of biliary atresia?

A

Jaundice (most common), pale stool and dark urine, hepatomegaly, abdominal distension, splenomegaly, FTT due to poor fat metabolism, pruritus, irritability

71
Q

Early diagnosis - key in biliary atresia. T/F?

A

True

72
Q

Infants who undergo surgery for biliary atresia within 2 months have an 80% chance of reestablishing bile flow. T/F?

A

True

73
Q

Biliary atresia - could lead to what?

A

cirrhosis and death. :(

74
Q

What are some surgical management things for biliary atresia?

A

Hepatic portoenterostomy (kasai procedure - bypass ducts), liver transplant

Peds - Spring 2016 (29 decks)

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