Pediatrics: GI

Question 1

Regurgitation of stomach secretions into the esophagus through the lower esophageal (cardiac) sphincter

Answer 1

Gastroesophageal reflux

Question 2

A normal physiologic process that occurs throughout the day in infants, children, and adults

Answer 2

Gastrointestinal reflux

Question 3

In patients with GERD, diagnostic workups include

Answer 3

1. Upper GI series to look for anatomic abnormalities such as intestinal malrotation
2. pH probe
3. Esophageal manometry
4. Endoscopy

Question 4

Therapeutic Management for GERD

Answer 4

1. Feed infants small frequent feedings of formula thickened with rice cereal

2.The infant should be held upright for 30 minutes after feeding if possible

3. The infant should not be placed in a car seat at home
4. Tight clothing and diapers should be avoided
5. Avoid to any exposure of cigarette smoke

Question 5

PPI are best taken

Answer 5

30 minutes before breakfast (generally prescribed 8-12 week)

Question 6

Therapeutic Management for GERD

Infants experiencing irritability and poor feeding due to esophagitis

Answer 6

Administration of H2-receptor antagonist
1. Famotidine
2. Ranitidine

Administration of proton pump inhibitor (PPI)
1. Omeprazole
2. Rabeprazole

To reduce the possibility of the stomach acid contents irritating the esophagus

Question 7

Timeframe of GERD to disappear in infants

Answer 7

6 months

Question 8

If medical therapy is not effective, what would be the next course of management?

Answer 8

Laparoscopic or surgical fundoplication

Question 9

Symptoms of the infant that requires surgical interventions

Answer 9

1. Poor weight gain
2. Esophageal irritation

Question 10

A procedure where it involves the wrapping the upper portion of the stomach (fundus) around the lower esophagus to prevent regurgitation of stomach contents

Answer 10

Fundoplication procedure

Question 11

After the fundoplication procedure, the child will receive

Answer 11

A temporary nasogastric tube attached to provide intermittent low suction

Question 12

After the first 24hrs post-operation, what should be monitored?

Answer 12

1. Nasogastric tube drainage
2. Coffee-colored vomitus

this would indicate bleeding from the surgical site

Question 13

When the infant receives first feeding after surgery, they may display the signs of:

Answer 13

1. Abdominal discomfort - gagging and abdominal distention because food can no longer reflux into the esophagus

Question 14

If the abdominal distention worsens, what condition this could bring to the infant?

Answer 14

Bradycardia and Dyspnea

Question 15

Opening between the lower portion of the stomach and the beginning portion of the intestine

Answer 15

Pyloric sphincter

Question 16

Hypertrophy or hyperplasia of the muscle surrounding the sphincter occurs, it is difficult for the stomach to empty

Answer 16

Pyloric stenosis

Question 17

It tends to occur most frequently in first born white male infants

Answer 17

Pyloric stenosis

Question 18

What would be the presumed etiology for pyloric stenosis?

Answer 18

Multifactorial inheritance

Question 19

Assessment

Infants around 4-6 weeks, typically begins to

Answer 19

Vomit almost immediately after each feeding

Question 20

Assessment

The vomiting grows increasingly forceful until it is

Answer 20

Projectile

Question 21

Assessment

Pyloric stenosis occurs less frequently what type of feeding

Answer 21

Breast or chest feed

Question 22

Assessment

Breast of chest fed infants shows symptoms

Answer 22

6 weeks

Question 23

Assessment

Formula fed infants shows symptoms

Answer 23

4 weeks

Question 24

Assessment

Vomitus has what kind of smell

Answer 24

Sour smell

Question 25

Assessment After the infant vomits, what would happen

Answer 25

Usually is hungry immediately after vomiting

Question 26

Assessment Since it is difficult to assess whether the infant is nauseous, these are the signs that should be monitored

Answer 26

1. Disinterest in eating 2. Excessive drooling 3. Chewing on the tongue

Question 27

Assessment Infants has signs of dehydration

Answer 27

Dry mucous membranes of the mouth, sunken fontanelles, fever, decreased urine output, poor skin turgor, weight loss

Question 28

Assessment Excessive loss of chloride from the loss of stomach fluid

Answer 28

Alkalosis along with accompanying hypochloremia, hypokalemia, starvation

Question 29

Assessment A presumptive diagnosis can be made by watching the infant do what

Answer 29

Drink

Question 30

Assessment If the infant has pyloric stenosis, the sphincter should

Answer 30

The sphincter should feel round and firm, approximately the size of an olive

Question 31

Assessment What would confirm the diagnosis

Answer 31

ultrasound or endoscopy

Question 32

Treatment for pyloric stenosis

Answer 32

Surgery or laparoscopic correction (pyloromyotomy)