Pediatric GI Flashcards
embryology: what structures for foregut, midgut and hind gut? blood supply?
F: esophagus, stomach, duodenum I + II - supplied by celiac. M: duodenum III + IV, proximal 1/2 transverse colon - superior mesenteric artery. H: distal colon to anus - inferior mes. artery. all drained by PVS
clinical features of esophageal problems? (4)
swallowing difficulties (dysphagia or odynophagia). vomiting. aspiration. failure to thrive
3 causes of esophagus problems
congenital abnormalities like TE fistula. gastroesophageal reflux. eosinophilic esophagitis.
TE fistula?
communication between esophagus and trachea
diagnosis and clinical findings for TE fistula?
prenatal fetal US: polyhydramnios. drooling, chocking, cyanosis with feeds, noisy breathing, resp. distress. massive abo distension when ventilating or bagging. inability to pass oral/nasal tube into stomach.
management of TE fistula?
medical: stabilise, nutrition, pulm. care. surgical: restore esophageal continuity. emergency gastronomy to decompress abdo + gastronomy for nutrition.
GER vs GERD?
GER = involuntary reflux into esophagus, and is physiologic. becomes GERD = pathologic if they have complications (which can be erosive or non-erosive). lots of GER in 6 mo olds, by 1 year should be very little reflux
GERD: children often have ___ symptoms? ex?
atypical: recurrent abdo pain, heartburn, resp symptoms, regurg, retrosternal pain
GI complications of GERD (6)
heartburn, dysphagia, food refusal, FTT, esophagitis, barrett’s esophagus (very rare)
rep/ent complications of GERD?
laryngitis, sinusitis, chronic cough, repetitive pneumo, worsening of asthma and CG
esophagitis: symptoms and signs?
hematemesis, anemia, heartburn, dysphagia, abdo pain, epigastric pain. no correlation between symptoms + endoscopic lesions
investigations you can do
barium study, pH/impedance, endoscopy, gastric emptying
managment of GER? GERD?
GER: feeding strategies + positioning (upright). GERD: acid suppression w/ H2 blocker/PPI, NG/NJ feeds, surgical fundoplications. considering other diagnoses if not responding
other considerations w/ GER(D)
food allergy. anatonic/malrotation. hypertrophic pyloric stenosis. infections.
eosinophilic esophagitis symptoms
dysphagia, food impaction, vomiting, abdo pain, feeding aversion, FTT
pyloric stenosis
hypertrophy + hyperplasia of circular/longitudinal muscular layers of pylorus; edematous/thickened mucosa, dilated stomach
pyloric stenosis: more common in? presentation when? symptoms + signs?
males. 3 weeks of life (1week to 5 mo). progressive projectile nonbilious vomiting in hungry infant, weight loss, lethargy, jaundice, epigastric distension. visible gastric peristalsis. firm mobile mass (olive). diminished stools. dehydration.
investigations/diagnosis of pyloric stenosis
low Cl, K, metabolic alkalosis (because losing acid). US - 97% sn, 100% sp. can also do upper GI imaging in US not avail.
pyloric stenosis is a _____. immediate treatment? then?
medical emergency: correct fluid loss, electrolytes, acid-base imbalance. then surgery is curative.
primary features of small intestine disease?
abdo pain, vomiting, malabsoprtive features, protein losing enteropathy, occult or obvious blood loss.
primary features of stomach disease?
abdo pain, vomiting, hematemesis, melena stools, FTT, peptic ulcers, pyloric stenosis
3 small intestine diseases
celiac’s. intussussception (telescoping). meckel’s diverticulum
presentation and diagnosis of celiac disease
weight loss, FTT, diarrhea/constipation, protuberant abdo, muscle wasting, iron def, diagnose with transglutaminase antibody (ATA) positive blood or tissue; can also do duodenal biopsy: shortened villi, elongated crypts, intraepithelial lymphocytes
meckel’s: signs
PAINLESS RECTAL BLEEDING.
