Pediatric GI (Newman) Flashcards
problems with free unconjugated bilirubin
- can cross the blood brain barrier
- is toxic to CNS
total serum bilirubin with visible jaundice early in life
> 5 mg/dL
Is conjugated hyperbilirubinemia pathologic?
always
describe breast feeding jaundice
function of dehydration and decreased excretion of bilirubin in the stool (more supply related) *nonpathologic
describe breast milk jaundice
presence of bilirubin deconjugating enzymes in milk *nonpathologic
What type of hyperbilirubinemia does blood group incompatibility cause?
unconjugated
When to test for blood group incompatibility
if mom is type O or mom is Rh(D) negative
How to test from blood group incompatibility
infants cord blood should be evaluated for:
1) direct Ab (Coomb’s test)
2) blood type
3) Rh determination
What type of bilirubin is seen with biliary atresia
conjugated
Signs and Sx of biliary atresia
1) cholestatic jaundice
2) hepatomegaly
3) acholic stools
First phase acute bilirubin toxicity (timing and Sx)
- first 1-2 days
- poor suck
- high pitch cry
- stupor
- hypotonia
- seizures
Second phase acute bilirubin toxicity (timing and Sx)
- middle of first week of life
- hypertonia of extensor muscles
- opisthotonus
- retrocollis
- fever
Third phase acute bilirubin toxicity (timing and Sx)
- after first week of life
- hypertonia
how does jaundice advance in newborns?
cephalo-caudally
Assessing jaundice in newborns
- turn on lights and blanch skin with digital pressure
Some risk factors for hyperbilirubinemia
- jaundice in 1st 24 hours
- previous sibling requiring phototherapy
- exclusive breastfeeding, not going well
treatment of mild jaundice
- increase frequency of feedings
- continue breast feeding
What does phototherapy do?
isomerizes bilirubin, making it water soluble
describe GER
- passage of gastric contents into the esophagus
- the happy spitter
describe GERD
- when symptoms or complications are present as a result of GER
- hard to feed, cry a lot, arch and scream, hard to gain weight
Diagnosis of GER/GERD
- esophageal pH monitoring with impedance testing (direction of bolus movement)
- tells frequency of GER
- association of low esophageal pH with Sx
Treatment of GERD
- kids sleep on back
- smaller amounts of food more frequently
- upright position during feeding and for 30-45 minutes after feeding
- medications (H2 antagonists)
- surgery
Where does intussusception occur most frequently?
most are ileocecal: ileum invaginates into the colon at the ileocecal valve/junction
Frequent physical exam finding with intussuception
palpable tubular mass in their abdomen (RUQ)
