Pediatric GI Lecture

Question 1

What are the clinical findings of Diabetic Ketoacidosis?

Answer 1

Polyuria, Polydipsia, Weight loss, Dehydration, Kussmaul respirations, Acetone Breath (due to ketone bodies in the lungs), Altered mentation, Profound fatigue, irritability, Hyperglycemia, Metabolic acidosis.

Question 2

What is a life threatening condition pediatric patients could die from?

Answer 2

DKA

Question 3

What presentation is associated with Pyloric Stenosis?

Answer 3

First 2 months of life (usually 2-4 wks), 1/500 infants, Male:Female 4:1, May have positive family history, related to Erythromycin, Projectile non-bilious vomiting, Dehydration, Poor weight gain, Hypokalemic, Hypochloremic metabolic alkalosis, RUQ olive-sized muscular, mobile contender mass in epigastrium

Question 4

How do you diagnose Pyloric Stenosis?

Answer 4

US

Question 5

Treatment of Pyloric Stenosis:

Answer 5

Tx with NG tube and pyloromyotomy

Question 6

How does Intussusception present?

Answer 6

Telescoping of bowel (ileal-colic), 80 percent less than 2 yrs, may follow infection, lead point, black current jelly stool, colicky abdominal pain, progressive weakness, lethargy, fever, shock, sausage-shaped abdominal mass cephalocaudal axis, may reduce/may need surgery

Question 7

What is the “Disease of 2s” description for Meckel’s Diverticulum?

Answer 7

2 years, 2 percent of population, 2 types of tissue, 2 inches in size, 2 ft from ileocecal valve

Question 8

What is the presentation of Meckel’s Diverticulum?

Answer 8

Remnant of embryonic yolk sac, Lining similar to stomach, Most frequent congenital GI anomaly, Painless rectal bleeding, May cause obstruction, Lead point intussusception, Diagnosed by Meckel’s scan, Treatment is surgical

Question 9

What is the definition of diarrhea?

Answer 9

Increase in frequency and water content of stools.

Question 10

What causes 70-80 percent of acute diarrhea in North America?

Answer 10

Viral gastroenteritis

Question 11

What is the difference between enteritis and colitis?

Answer 11

Enteritis is small bowel inflammation and colitis is large bowel inflammation.

Question 12

What complications are associated with diarrhea?

Answer 12

Dehydration, Electrolyte and acid-base disturbance, Bacteremia and sepsis, Malnutrition (chronic)

Question 13

What are the most prevalent causes of infectious diarrhea?

Answer 13

Virus - rotavirus, Bacteria - Campylobacter, Parasites - Cryptosporidium

Question 14

What is now the leading cause of viral gastroenteritis in the US?

Answer 14

Norovirus

Question 15

What history features are ATYPICAL of viral gastroenteritis?

Answer 15

Fever, Abdominal pain, blood or mucus in stool, bilious/projective vomiting, greater than 7 days, increased urine output, altered consciousness, international travel, exposures to foods, unsafe water, farm animals, reptiles

Question 16

What exam features are ATYPICAL of viral gastroenteritis?

Answer 16

Moderate to severe dehydration (children greater than 2), Bulging fontanelle, Hyponatremia with hyperkalemia, respiratory abnormalities, abdominal distention/focal tenderness/mass, petechiae

Question 17

What lab features are ATYPICAL of viral gastroenteritis?

Answer 17

Abnormal CBC, Elevated CRP, Fecal leukocytes, Persistent diarrhea

Question 18

How do you classify diarrhea in kids?

Answer 18

No dehydration, Mild (3-5 percent), Moderate (6-9 percent), Severe (greater than 10 percent)

Question 19

What should you remember when evaluating dehydration in kids?

Answer 19

Percentage of weight loss is an objective measure, Delayed capillary refill (capillary refill time can be affected by ambient temperature, urinary output and specific gravity)

Question 20

What should you think if there is blood in the stool?

Answer 20

Bacterial cause

Question 21

When should electrolyte levels be measured?

Answer 21

Serum electrolyte determinations not necessary for mild dehydration. They are usually normal since most episodes of dehydration caused by diarrhea are isonatremia. Electrolyte levels should be measured in moderately dehydrated children whose histories or physical findings are inconsistent with straight forward diarrhea episodes. All cases of severe dehydrated children should be measured.

Question 22

How is diarrhea treated IV?

Answer 22

Children with severe dehydration and in a state of shock or near shock require IV fluids. Children who are moderately dehydrated and cannot retain oral liquids because of persistent vomiting also should receive IV fluids.

Question 23

What is Severe Dehydration in kids?

Answer 23

Greater than 10 precent dehydrated based on weight.

Question 24

What should be given to supplement fluids?

Answer 24

20 mL per kg of Normal Saline (NS) or Normal Saline with 5 percent dextrose (D5NS) during a one-hour period, large quantities and much shorter periods of administration may be required

Question 25

Describe colic in infants:

Answer 25

1/5 infants, inconsolable crying associated with drawing up the legs and gaseous distention, can be anytime, but usually in evening, starts at 3 weeks, peaks at 6 weeks, may be up to 3 hours per day, usually by 3 months of age, pattern normalizes

Question 26

What are frequent causes of abdominal pain in children?

Answer 26

Inflammatory Bowel Disease, including ulcerative colitis and Crohn’s disease

Question 27

What is the pain like associated with Inflammatory Bowel Disease in kids?

Answer 27

Pain, which typically occurs in lower abdomen, is cramping in nature and increases after meals or activity, pain is reduced by eating smaller meals, which contributes to the anorexia and growth impairment that occur in children with IBD.

Question 28

When is the diagnosis of IBD relatively easy?

Answer 28

When child has bloody diarrhea, the need to defecate during the night, perianal disease or an ileal mass on abdominal examination.

Question 29

What are more subtle features of IBD?

Answer 29

Delayed puberty, anemia that is unresponsive to iron therapy, recurring oral aphthous ulcers, chronic liver disease, or large joint synovitis or arthritis

Question 30

What is the number one cause of surgical abdomen in children?

Answer 30

Appendicitis

Question 31

Describe Hirschprungs disease:

Answer 31

Most common reason for bowel obstruction in neonates, Absence of ganglion cells in bowel wall, beginning at internal anal sphincter and extending proximally

Question 32

What is the clinical presentation of Hirschsprung’s disease?

Answer 32

Present at birth, full-term infant with delay in passage of meconium (greater than 24 hours), may have mild case (short ganglionic segment)

Question 33

How do you diagnose Hirschsprung’s disease?

Answer 33

Rectal manometry, Rectal suction biopsy, Barium enema with transition zone

Question 34

What is the treatment for Hirschsprung’s disease?

Answer 34

Surgery - temporary colostomy and then correct

Question 35

What are complications of Hirschsprung’s disease?

Answer 35

Enterocolitis

Question 36

What things can be seen with Hirschsprung Disease?

Answer 36

Onset of constipation at birth, possible failure to thrive, possible enterocolitis, abdominal distention, poor weight gain, normal anal tone, no stool on rectal exam, no sphincter relaxation, transition zone with delayed evaluation on barium enema, rare encopresis

Question 37

What condition will not produce the tenting of the skin that one would expect with intense dehydration?

Answer 37

An infant with hypernatremia dehydration.