Pediatric GI Flashcards
What can Bile-stained emesis indicate
intestinal obstruction
requiring IMMEDIATE evaluation
what is regurgitation of stomach contents
GERD
what is the presentation of GERD in pediatric populations
recurrent splitting up and vomiting of infants
poor feeding and irritability in infants
heartburn in children
abdominal discomfort
what are pathologic symptoms of GERD
FTT, dysphagia or chronic respiratory symptoms, apnea spells
what is the treatment of GERD
Dietary education
acid suppression
surgery
What is Encopresis
involuntary bowel movement
repeated passage of stool into inappropriate places by child who is chronologically or developmentally older than 4 years
what is the presentation of encopresis
avoid having BM due to pain
overflow incontinence
stomach pain and cramps
decrease urge sensations
+/- lower abdominal tenderness or distension
what is the treatment of Encopresis
end tx will be combination of medical and behavioral
behavioral should be first line and is preferred
what is pyloric stenosis
stenosis that occurs due to hypertrophy of muscle surrounding the pylorus
what is the presentation of pyloric stenosis
projectile non-bilious vomiting or regurgitation within 2 hours of feeding
palpable olive-shaped mass in RUQ
peristaltic waves across abdomen prior to vomiting
what are lab abnormalities with pyloric stenosis
increased Cl, decreased K+, increased bilirubin
elevation of Hgb/HcT secondary to dehyrdation
what imaging confirms that diagnosis of pyloric stenosis
Ultrasound
what is the treatment of pyloric stenosis
surgery (pyloromyotomy- Ramstedt procedure)
what is a proximal segment of the intestine that “prolapses” into distal segment of the intestine
intussusception
what is the most common cause of intestinal obstruction in first 2 years of life
intussusception
wehre is the palpable sausage-shaped mass found with intussusception
hepatic flexure (not always present)
what is the preferred imaging for intussusception
Ultrasound
Barium or air enema is diagnostic and therapeutic
what is a life-threatening complication of laprotation of intestine or stomach
volvulus
what is the clinical presentation of volvulus
ill appearing with possible signs of shock; usu acute
sudden abdominal pain; colicky
bilious vomiting
may or may not have a fever
what is a “coffee bean” sign on x-ray indicative of
volvulus
what is the management of volvulus
usu. emergent surgcial intervention (can consider flex sig first but usu used more in adults)
what is atresia
a condition in which an orifice or passage in the body is closed or absent
OR
an absence or abdominal narrowing or an opening or passsage int he body
when do symptoms of atresia usually present
within first few hours of life
what is the presentation of CEA
hypersalivation
choking
cough
respiratory distress
cyanosis
inability to pass nasogastric tube into stomach
congenital esophageal atresia
what is the treatment of CEA
stabilize infant; airway and suction; feeding tube
emergent surgical repair
what needs to be completed prior to surgery for CEA to rule out right-sided heart aortic arch
ECHO
what is a structure of the intestine
bowel atresia
what are the types of bowel atresia
pyloric (rare), duodenal, jeunoileal (4 subtypes)
what is the clinical presentation of Duodenal atresia
vomiting
abdominal bloating
bilious vomiting
scaphoid abdomen (sunken and hollow)
‘double-bubble sign” on XR
what is the treatment of duodenal atresia
nasogastric/orogastric decompression
fluid replacement
treat any life=threatening anomalies
surgery - emergent repair once stabilized
when is it called when the abdominal organs herniate through a defect in the diaphragm
diaphragmatic hernia
what is the presentation of diaphragmatic hernia
respiraotry distress (usu.w/in first 24 hours of life)
scaphoid abdomen
decreased breath sounds
distant heart sounds
what is seen on xray with diaphragmatic hernia
bowel loos seen in chest with medistinal shift
what is the treatment of diaphragmatic hernia
stabilization (intubation, mechanical vent, decompression of GI tract)
Surgery
what are long term complications of diaphragmatic hernias
pulmonary HTN
GERD
neurodevelopmental problems
behavioral problems
hearing loss
poor growth
what is a congenital aganglionic megacolon
Hirschprung’s disease
what is hirschsprungs disease
birthd efect where nerve cells are missing at the end of childs bowel causing bowel to not function correctly, causing blockages
associated with downs
how does hirschprungs disease present
failure to thrive
constipation
delayed passage of meconium (>24 hours)
odorous ribbon-like stools
distended abdomen
hypo-proteinemia
what is the treatment of hirschsprungs
surgery
(surgery - staged procedures depending on area)
what is A-A-I-I-M-M
ddx of pediatric bowel obstruction
Adhesion
appendicitis
intussusception
inguinal hernia
malrotation
miscellaneous
what are signs/symptoms of a emergent surgery
absent bowel sounds
bilious vomiting
blood diarrhea or occult blood in stool
elevated temp
rebound tenderness
rigidity
voluntary guarding
