Pediatrics Flashcards
A 4 week old male presents with projectile, non-bilious, vomiting commonly related to feedings.
On physical, the infant has been losing weight since his last appointment, is slightly jaundice, and has a sunken fontanel and skin tenting. On abdominal exam you feel a mass near the epigastric region.
What do you suspect?
Pyloric stenosis
Is pyloric stenosis more common in males or females?
Males
What class of antibiotics can increase the risk of pyloric stenosis?
Marcolides
In a patient with pyloric stenosis, it is common to be able to palpate the pyloris.
This is often described as a “______” mass.
Olive
Pyloric stenosis can often be miss diagnosed as what?
GERD
What is the first line imaging study for pyloric stenosis diagnosis?
Ultrasound
What TWO signs may be seen on a barium swallow in a patient with pyloric stenosis?
- Shoulder Sign
2. String Sign
In a pyloric stenosis patient, a metabolic panel would show what?
(HINT: Remember these patients are projectile vomiting)
Hypochloremic metabolic alkalosis
_____ _____ is an autoimmune disease that arises due to gluten protein sensitivity.
Celiac Disease
A 5 yo female presents with complaints of diarrhea, emesis and after eating a meal containing a high amount of wheat and rye. Their parents have also noticed she has stopped gaining weight.
On physical examination, you note a very thin stature (suspect muscle wasting) and abdominal bloating.
What do you suspect?
Celiac Disease
_______ celiac disease presents with GI symptoms after the introduction of gluten containing foods.
Typical Celiac Disease
_______ celiac disease accounts for 70% of newly diagnosed Celiac Disease and these patient DO NOT present with typical GI symptoms.
Anemia is the most common presentation in teenagers and young adults.
Atypical Celiac Disease
What TWO labs are most diagnostic for celiac disease?
What might the stools be like?
Will the patient have hypo or hyperproteinemia?
Could you see an anemia?
IgA anti TG2 and D-AGA
Steatorrhea
Hypoproteinemia
Anemia due to iron deficiency
What would be the most diagnostic procedure for celiac disease?
Small Bowel Biopsy whil on gluten diet
What scoring system is used in correlation with the small bowel biopsy?
Marsh Grading System
How is celiac disease treated?
Lifelong avoidance of gluten ingestion
This occurs when the intestine ‘telescopes’ into the adjoining intestine.
This is the most common cause of obstruction in children ages 3 months to 6 years old.
Intussusception
Where is the most common site of intussusception?
Ileocecal junction
How is the stool commonly described in a patient with intussusception?
Currant Jelly Stool
A 4 year old male presents with paroxysmal abdominal pain over the last 24 hours that he is able to relieve when he draws his knees into his chest. His mom noticed that his emesis has changed to a green color in the last few hours and his stool have this ‘dark jelly like appearance’.
On exam, he is somnolent with a distended abdomen. You are able to feel a ‘sausage-shaped’ mass in his right mid to upper abdomen.
What is your suspicion?
Intussusception
What would be seen on US in a patient with intussusception?
Ultrasound showing a ‘coiled-spring’ appearance
What would be seen on plain abdominal XRs in a patient with intussusception?
Lack of colonic gas
What is used for diagnosis and treatment of intussusception
Contrast enema
Other than reduction, when is surgery indicated in intussusception?
If the bowel requires resection due to ischemia
