Pediatric Gastrointestinal Problems - Harden Flashcards
What type of infections may cause vomiting?
Any systemic infections!
- Viral gastroenteritis (rotavirus and norwalk)
- Bacterial enterocolitis/sepsis
- Hepatitis
- Food poisoning
- Staphylococcus aureus, Clostridium perfringens, Salmonella
- Pelvic Inflammatory Disease
- Peritonitis
- Pharyngitis
- Pneumonia
- Otitis Media
- Tonsillitis
- Urinary Tract Infection
What cause of vomiting should you NEVER miss in children?
DKA!
(and Pregnancy in adolescants)
What are the clinical symptoms of DKA?
- Polyuria
- Polydipsia
- Weight loss
- Dehydration
- Kussmaul respirations
- Acetone Breath
- Altered mentation
- Profound fatigue, irritability
- Hyperglycemia
- Metabolic acidosis
When does pyloric stenosis present?
- First 2 months of life
- Usually 2-4 weeks
- 1/500 infants
- Male:Female 4:1
What imaging study is used to diagnose Pyloric Stenosis?
Ultrasound
What predisposing pathology may lead to intussusception?
- Infection
- inflammation creates lead point for intestines to catch and telescope on itself
- ⇒ red/black currant jelly stool
What pediatric GI condition typically follows the “Rules of 2’s”?
Meckel’s Diverticulum
- 2 years
- 2% population
- 2 types of tissue
- 2 inches in size
- 2 ft from ileocecal valve
What is 70-80% of acute diarrhea in North America caused by?
Viral gastroenteritis
What are the complications of diarrhea in pediatrics?
- Complications
- Dehydration
- Electrolyte and acid-base disturbance
- Bacteremia and sepsis
- Malnutrition (chronic)
What are the most common causes of bacterial and viral related diarrhea?
- Viral
- Rotavirus
- Norovirus
- Bacteria
- Campylobacter
What clinical features are ATYPICAL in viral gastroenteritis?
- History:
- Fever
- Abdominal pain
- Blood or mucus in stool
- Bilious/projectile vomiting
- >7 days
- INCREASED urine output
- Altered consciousness
- International travel
- Exposures to foods, unsafe water, farm animals, reptiles
- Physical Exam:
- Moderate to severe dehydration (children >2)
- Bulging fontanelle
- Hyponatremia with hyperkalemia
- Respiratory abnormalities
- Abdominal distension/focal tenderness/mass
- petechiae
How do you evaluate dehydration in kids?
- Percentage of weight lost is an objective measure
- No dehydration
- Mild dehydration (3-5%)
- Moderate dehydration (6-9%)
- Severe dehydration (10+%)
- Delayed Capillary Refill (>2 sec)
- Capillary Refill time can be affected by ambient temperature
- Urinary output and specific gravity
- Pulse (high)
- Blood pressure (low)
- Mucous membranes (dry, parched)
- Fontanelles (sunken)
- Skin turgor (tented)
Do Serum electrolytes studies in pediatric patients indicate dehydration?
NO!
They are usually normal since most episodes of dehydration caused by diarrhea are isonatremic.
When should pediatric patients with diarrhea be treated with IV fluids?
- Children who are severely dehydrated and in a state of shock or near shock require IV fluids
- Children who are moderately dehydrated and cannot retain oral liquids because of persistent vomiting also should receive IV fluids.
What do you treat a pediatric patient with severe dehydration (>10% dehydrated based on weight)?
20 mL per kg of Normal Saline (NS) or Normal Saline with %5 dextrose (D5NS) during a one-hour period
