Pediatric GI

Question 1

What is the BEST way to diagnose GERD in pediatric patients?

Answer 1

~Esophageal pH monitoring

~Mammometry

Question 2

What is the difference between GER vs. GERD? What are the signs/symptoms of GERD?

Answer 2

GER:
~The passage of gastric contents into the esophagus
~The Happy Spitter

GERD:
~When symptoms and/or complications are present as a result of GER
~Hard to feed, cry a lot, arch and scream, hard to gain wt.

Question 3

What are the characteristics of eosinophilic esophagitis?

Answer 3

Eosinophilic esophagitis
~“Furrowing” of esophagus
~White exudate
~>10 eosinophils/HPF

Question 4

Where is intussusception typically located?

What are the lead points?

Answer 4

~Most are ileocolic
~Ileum invaginates into the colon at the ileocecal valve/junction🌲🌲

Lead point:
~Hypertrophy of the Peyer patches (20 viral infection)
~Mesenteric nodes
~Meckel diverticulum
~Polyps, foreign body, lymphoma

Question 5

What are the clinical signs and symptoms of intussusception?

Answer 5

Clinical:
~Impressive episodes of irritability, colicky pain, and emesis
~80% of children will have rectal bleeding
~Bright red blood and mucus
`~“Currant jelly stools” is actually less common…but classic
~Sometimes striking lethargy is present intermittently
80% of patients have a palpable tubular mass in their abdomen (usually right upper quadrant)

Question 6

What are the clinical manifestations of pyloric stenosis?

What is the classic metabolic picture?

Answer 6

Clinical manifestations
~Projectile vomiting
~Dehydration and poor wt gain
~Especially if the obstruction is severe

Classic metabolic picture:
~Hypochloremic, hypokalemic, metabolic alkalosis🌲🌲

Question 7

What are the classic physical exam findings of Hirschsprung’s disease?

Answer 7

Classic physical findings:
~Dx should be suspected in any infant who fails to pass meconium within the first 24-48 hours of life OR who requires repeated rectal stimulation to induce bowel movements

Evidence of obstruction starts to show up in the first month of life:

~Poor feeding

~Bilious vomiting

~Abdominal distention

Question 8

When should Hirschsprung’s disease be considered?

Answer 8

Dx should be suspected in any infant who fails to pass meconium within the first 24-48 hours of life OR who requires repeated rectal stimulation to induce bowel movements

Question 9

What is the evidence of obstruction (in regards to Hirschsprung’s disease) that starts to show up in the first month of life?

Answer 9

Evidence of obstruction starts to show up in the first month of life

~Poor feeding
~Bilious vomiting
~Abdominal distention