Pediatric GI Flashcards
What can bile-stained emesis indicate
Intestinal obstruction
Needs immediate evaluation
When does physiologic gastroesophageal reflux resolve?
By 12-15 months
What are the clinical manifestations of GERD?
- Recurrent spitting up and vomiting in infants
- Poor feeding and irritability
- Heartburn
- Abdominal discomfort
In healthy newborns spitting and vomiting after eating that resolves on
What are pathologic symptoms of GERD?
- FTT
- Dysphagia
- Chronic respiratory symptoms (wheeze, cough, recurrent pneumonia, asthma)
- Apnea
What is the diagnosis for GERD?
Usually Clinical
Barium swallow can rule out anatomical abnormalities but isn’t diagnosti
What is the initial treatment of GERD in pediatrics?
Dietary management
- Smaller more frequent feedings
- Thickened feeds
Are reflux medications indicated for children?
No, they are not recommended use requires consult with Peds GI
Can consider short term trial off label
May consider short trial (8-12 weeks) with cimetidine, famotidine, or omeprazole
What is encopresis?
DSM-5 Definition: repeated passage of stool into inappropriate places by child who is chronologically or developmentally older than 4 years
Kids that “poop” their pants
What are the two types of encopresis?
- With Constipation and overflow incontinence
- Without constipation and overlow incontinence
What is the presentation for encopresis?
- Avoid having BM due to pain
- Overflow incontinence
- Stomach pain and cramps
- Decreased urge sensation
PE: +/- lower abdominal tenderness or distention normal rectal exam
What is the treatment for encopresis?
Behavioral interventions are first line
Meds: stool softners or laxatives
When does pyloric stenosis typically present?
First 2-12 weeks of life (usually in first 30 days)
Which of the following is the most likely diagnosis?
A 2-month-old male infant is brought to the clinic by his parents. They report that he has been irritable and fussy for the past week, with occasional crying during feedings. On examination, you note a palpable olive-shaped mass in the right upper quadrant of the abdomen.
Pyloric Stenosis
In an infant who has non-bilious vomiting, what will be palpable on physical exam with pyloric stenosis?
Olive-shaped mass
What is the clinical presentation of pyloric stenosis?
- Dehydration and malnutrition
- Lethargy
- Decreased urinary output
- Changes in stool
- Poor weight gain and/or weight loss (Marasumus)
Marasmus: body weight reduction to < 62% of normal for age
Infants with pyloric stenosis typically have an increased Cl-. decreased K+, and increased bilirubin on labs, should these fluid and electrolyte abnormalities be corrected prior to surgery?
Yes
In pyloric stenosis
What imaging modality confirms diagnosis?
US
What is the surgical repair for pyloric stenosis?
Name of surgery
Pyloromyotomy - Ramstedt procedure
If a child older than 6 years old presents with intussusception what is the most common cause?
Lymphoma
What diagnosis is defined by
A palpable sausage-shaped mass in area of hepatic flexure
Intussusception
Is currant jelly stool considered an early or late finding in intussusception?
Late Finding
Bloody stools with mucus is typically early
US is the imaging modality of choice for diagnosing intussusception
What will be seen on ultrasound in an infant with intussusception?
- Bull’s Eye
- Coiled Spring
- Target Sign
What are the clinical manifestations (presentation) of Volculus?
- Ill appearing with possible signs of shock, usually acute onset
- Sudden abdominal pain; colicky
- Bilious vomiting
- May or may not have fever
- Blood stained stools
An 8-month old presents with fever and sudden onset of colicky abd. pain
What must be included in your differential outside of volvulus
Sepsis
Fever with volvulous symptoms is indicative of sepsis
In a child with volvulus should imaging and lab work be done prior to surgical treatment?
No, child needs emergent surgical intervention
What is congenital esophageal atresia?
Fusion failure between proximal and distal esophagus causing fistula formation
When do symptoms of congenital esophageal atresia present?
Within first few hours of life
In what diagnosis is there bilious emesis present?
- Volvulous
- Duodenal Atresia
What are the common clinical manifestations of congenital esophageal atresia?
- Hypersalivation
- Choking
- Cough
- RDS
- Cyanosis
- Inability to pass nasogastric tube into stomach
In a child with esophageal atresia
Is their an air bubble on CXR
No, there will be no air in stomach but air in esophagus
What should be done prior to surgical repair of esophageal atresia?
CEA requires emergent surgical repair
ECHO
What pediatric GI condition will have a “double-bubble sign” on x-ray?
Duodenal Atresia
What is the clinical presentation of diaphragmatic hernia?
- Respiratory distress (cyanosis, dyspnea)
- Scaphoid abdomen
- Decreased breath sounds
- Distant heart sounds
What will be seen on x-ray in an infant with diaphragmatic hernia?
Bowel loops seen in chest with mediastinal shift
X-Ray confirms diagnosis of diaphragmatic hernia
What are some longterm complications of diaphragmatic hernia?
- Pulmonary HTN
- GERD
- Neurodevelopmental problems
- Behavioral problems
- Hearing loss
- Poor growth
A 2-month-old infant is brought in by her parents due to excessive crying and irritability. She has been feeding poorly and has vomited after each feeding. On physical examination, you observe a “olive-shaped” mass in the right upper abdomen. What is the most likely diagnosis?
Pyloric Stenosis
A 5-year-old patient presents with recurrent abdominal pain and diarrhea. The parents report noticing blood in the child’s stools occasionally. Which of the following conditions is the most likely diagnosis for this patient?
Inflammatory Bowel Disease
A 10-year-old patient presents with chronic diarrhea and failure to thrive. Stool examination shows fatty, foul-smelling stools. What is the most likely diagnosis?
a) Gastroesophageal reflux disease (GERD)
b) Crohn’s disease
c) Celiac disease
d) Hirschsprung’s disease
What is the reason behind the foul-smelling stools?
Celiac Disease
Malabsorption and presence of undigested nutrients in the stool
A 6-year-old child presents with jaundice, dark urine, and pale stools. Physical examination reveals hepatomegaly. What is the most likely diagnosis?
Biliary Atresia
A 3-year-old boy has a history of recurrent respiratory infections and loose, foul-smelling stools. He appears malnourished and has a protuberant abdomen. Which condition is most likely responsible for his symptoms?
What is the diagnostic test to confirm diagnosis?
What GI specific treatment should be prescribed?
Cystic Fibrosis
Sweat Chloride Test
Pancreatic enzymes and nutrition support
A 9-year-old child presents with severe abdominal pain that migrates to different areas of the abdomen and is associated with vomiting. Physical examination reveals a sausage-shaped mass in the right upper quadrant. What is the most likely diagnosis?
What can be both diagnostic and theraputic for this condition?
Intussesseption
Air Enema
A 7-year-old presents with a history of bright red blood in the stools and abdominal pain. The child’s mother reports that the child has been passing mucus in the stools as well. What is the most likely diagnosis?
Inflammatory Bowel Disease
A 12-year-old patient presents with recurrent abdominal pain relieved by defecation and alternating diarrhea and constipation. The patient also reports feeling bloated. What is the most likely diagnosis?
Irritable Bowel Syndrome
A 6-month-old infant is brought in with irritability, poor feeding, and vomiting. Abdominal examination reveals a “currant jelly” stool. What is the most likely diagnosis?
Intussussception
An 8-year-old presents with abdominal pain, nausea, and vomiting. Physical examination reveals a tender mass in the right lower quadrant. Which of the following imaging studies is most appropriate for further evaluation?
What is the likely diangosis?
Abdominal Ultrasound
Acute Appendicitis
A 2-month-old infant presents with poor weight gain, vomiting after feeds, and blood-streaked stools. On physical examination, you hear a “whooshing” sound over the epigastric area. What is the most likely diagnosis?
Pyloric Stenosis
