Pediatric GI Flashcards
- severe or increasing abdominal pain with progressive signs of deterioration
- bile stained or feculent vomiting
- involuntary guarding/rigidity
- marked abdominal distention with diffuse tympany
- signs of acute fluid or blood loss
Acute/Surgical Abdomen
red flags for serious medical causes
- poor appetite/ weight loss/ poor growth
- fever
- nocturnal symptoms, pain awakens at night
- Blood or mucous in the stool includes gross or occult blood
- persistent vomiting
- dysuria/hematuria
Often the most important clue to chronic GI illness in children
Growth assesment
*assess proportionality, if less than 2 years of age WHO charts, 2-18- CDC charts
- more common in preterm infants and in males than in females
- symptoms tend to begin at 3-5 weeks of age, rarely after 12 weeks
- pyloric ultrasound tends to be the imaging of choice (also consider UGI- string sign)
- treatment with pyloromyotomy for surgical correction
pyloric stenosis
Bilous vs Nonbilous vomiting
- Assess the color of emesis
Bilous emesis: Intestinal obstruction distal to the ampulla of vater. EX: volvulus, hirschsprung’s disease, intussusception, intestinal atresia
Nonbilous: proximal to the ampulla of vater. EX: infection (gastroenteritis) metabolic cause, central causes (hydrocephalus, migraine, GERD, pyloric stenosis)
- Gastric contenets move into the esophagus
- may occur with our without reguritation or vomiting
- normal process- “happy spitters”
- common occurs daily in 50% of infants under 3 months, resovles in most healthy infants by 12-14 months
GER (gastroesophageal reflux)
Non- pharmalogic interventions of GER
- offer reassurance and education
- position upright 20-30 minutes after feedings
- provide smaller, more frequent feedings
- avoid overfeeding
- consider thickened formula- avoid in preterm or overweight infants
- milk protein- free diet
- avoidance of secondhand smoke
Reflux of gastric contents causes troublesome symptoms or complications
- extreme irritability
- poor feeding
- poor weight gain
- respiratory concerns
First try conservative measures (consider milk protein, freee diet, non-pharmacologic measures)
May consider imaging (UGI) to evaluate anatomy (rule out malrotation)- not diagnostic of GERD
GERD
treatment of GERD
- consider a limited 2 week trial of acid suppresion
- H2 blocker- historically first line, risk of tolerance over time
- PPI therapy- more effective at treating esophagitis (less effective for irritability and regurgitation)
- food protein intolerances can mimic GERD symptoms in infants, dairy is the most common
- not lactose intolerance
- protocolitis is the most common presentation- blood in the stool due to inflammation in the colon and rectum
- dx: 2 week trial of milk (and soy) protein free diet recommended, for the formula fed infant (trail of semi-elemental formula)
- at one year of age, try to introduce milk protein into the diet, most will tolerate well
cow’s milk protein intolerance
- defined as episodes of crying for more than three hours a day for more than three days a week for three weeks in otherwise healthy child between the ages of two weeks and four months
- usually starts around 2-4 weeks, peaks at 6-8 weeks
- tx: reassure parents and provide support; soothing measure 5s’ (swaddle, swing, sshh, suck, side)
- lactobacillus reuteri probiotic may be beneficial to reduce cying time
colic
- passage of stool into the underwear by a child over 4 years developemental age
- 2 types: retentitive- due to functional constipation; nonretentive- constipation not present
- often unknown by the child
encopresis
- episodic or continuous abdominal pain
- no evidence of an organic cause
- pain occurs at least 4 times per month for at least two months
Functional abdominal pain
functional abdominal pain treatment
- Probiotics and added fiber may be helpful
- antispasmodic medications or peppermint oil capsules can reduce bowl cramping
- antinausea medications or homeopathic treatments
- if significant affect to functioning, medications to reduce visceral hypersensitivity (amitriptyline, gabapentin) are sometimes helpful
