Pediatric GI

Question 1

What is GER (Gastroesophageal reflux)?

Answer 1

Passage of gastric contents into the esophagus

“The Happy Spitter?

Question 2

What is GERD (Gastroesophageal reflux disease)?

Answer 2

When GER causes symptoms and complications

• Hard to feed,
• Cry a lot,
• Arch and screen,
• hard to gain weight

Question 3

What is really important in diagnosing GERD?

Answer 3

HISTORY

Question 4

Is Upper GI used to diagnose GERD?

Answer 4

No. Not specific/sensitive

Question 5

Besy way to diagnose GERD?

Answer 5

24 hour esophageal pH probe + impedance monitoring

• Measures frequency and association of low esophageal pH w/ sx’s
• Impedenance monitoring => measures the DIRECTION of the bolus movement

Question 6

Why is endoscopy not best used to diagnose GERD?

Answer 6

allows you look at the appearance of the esophagus, which can be NL in GERD

Question 7

UGI Radiography to diagnose GERD: good and bad?

Answer 7

1. Useful for detecting anatomic abnormalities, however cannot discriminate between physiologic and non-physiologic GER episodes
2. Timing is not always perfect

Question 8

Treatment for GERD

Answer 8

1. Sleep on back; if sleep on stomach, can get SIDS => worse then reflux, gagging and aspiration that could happen when lying on back
2. Hypoallergenic formula (try to avoid switching formulas);
3. Smaller amounts of formula, more frequently
4. Feed upright and for 30-45 minutes after
5. Meds: H2 R ANT (ranitidine, cimetidine); PPI (omeprazole)

Question 9

What surgery is done for GERD and who is it mostly done in?

Answer 9

Fundoplication => developmentally delayed

Question 10

Intussception causes what?

Answer 10

Impaired venous return, bowel edema, ischemia, necrosis, perforation

Question 11

What is the most common location for intussusception in infancy?

Answer 11

• ileocolic
• Ileum invaginates into colon at the ileocecal valve/junction

Question 12

What are possible lead points in intussception?

Answer 12

• 1. Hypertrophy of Peyers Patches due to viral infection
• 2. Mesenteric nodes
• 3. Meckels diverticulum
• 4. Polyps, FB, lymphoma

Question 13

_________ can increase risk for ileo-ilial intussuception.

Answer 13

HSP (henoch-schoin purpura)

Question 14

Symptoms of Intucessption

Answer 14

1. Irritability, colicky pain, emesis
2. Lethargy
3. 80% bright red/mucus rectal bleeding
4. 80% RUQ tubular mass

Question 15

Which other symptom is often times seen intermittently in children with intussusception?

Answer 15

Striking lethargy is present intermittently

Question 16

Treatment for Intussuception?

Answer 16

Fluids

In 75% of cases, if done in the first 48 hours, intussuption can be reduced by either

1. Hydrostatic reduction w/ a contrast enema (less common)
2. -Pneumatic reduction with an AIR enema

Question 17

when should you not treat intussuption with reduction methods

Answer 17

DON’T DO either if there are peritoneal signs (distension, tympanic, tenderness to palpation/jarring motions)

Question 18

What are the 3 classic metabolic findings associated with Pyloric Stenosis?

Answer 18

1. • Hypochloremic
2. • Hypokalemic
3. • Metabolic alkalosis
4. *Due to all the vomiting!

Question 19

Pyloric stenosis = common cause of gastric outlet obstruction and vomiting seen in the first 2-3 months of life. Sx include:

Answer 19

1. Projectile vomitting
2. Dehydration and poor weight gain
3. Classic metabollic pic

Question 20

Pyloric Stenosis

1. PE
2. Dx
3. Treatment

Answer 20

1. PE: olive sized mass in epigastric area; peristaltic waves; string sign on UGI
2. Dx: US = thick and elongated pylorus
3. Treatment: thick and elongated pylorus