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Pediatrics > Pediatrics GI > Flashcards

Pediatrics GI Flashcards

1
Q

What is a common co-morbidity of T1DM?

A

Celiac disease

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2
Q

Child 6-12 months old presents with pale/bulky/frothy/greasy/foul-smelling diarrhea or constipation, abdominal pain, and vomiting. What do you suspect?

A

Celiac disease

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3
Q

How is celiac disease diagnosed?

A
  • measure fecal fat (increased fecal fat in most cases)
  • hypoproteinemia
  • edema d/t decreased albumin level
  • Tissue transglutaminase Ab (IgA)/Endomysial Ab
  • intestinal biopsy (celiac mucosa w/ shortened/absent villi)
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4
Q

What should be initially restricted in pts diagnosed with Celiac?

A

lactose

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5
Q

What is indicated for celiac crisis?

A

corticosteroids

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6
Q

Patient presents with profound malnutrition, diarrhea, edema, and hypokalemia. What do you suspect?

A

celiac crisis

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7
Q

3 wk old infant presents w/ bile stained vomiting, colicky episodic abdominal pain, and decreased feeding. Upper GI shows partial/complete SBO. What do you suspect?

A

malrotation

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8
Q

pt presents w/ intermittent abdominal obstruction, diarrhea and malabsorption. Upper GI shows partial/complete SBO. what do you suspect?

A

malrotation

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9
Q

What is the treatment for malrotation?

A

surgical emergency (time is of the issue)

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10
Q

What accounts for 10% of neonatal intestinal obstructions?

A

malrotation w/ or w/o volvulus

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11
Q

what is intussusception?

A

condition in which one segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage)

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12
Q

What is the most common cause of intestinal obstruction in children < 2yrs old and seen predominantly in males?

A

intussusception (peak 5-9 months)

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13
Q

What are predisposing factors to intussusception?

A

Meckel Diverticulum, Henoch-Schonlein Purpura, Polyps, lymphoma (most common cause over 6 yrs old), parasites, foreign bodies, CF (thick sludgelike stool), Celiac, rotavirus vaccine

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14
Q

pt presents with intermittent abdominal pain, vomiting, diarrhea, bloody currant jelly stools with mucus, fever, and lethargy. what do you suspect?

A

intussusception

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15
Q

upon PE, abdominal distention, tenderness, and sausage-shaped mass is found at the upper-mid abdomen. what do you suspect?

A

intussusception

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16
Q

what are complications of intussusception?

A

hemorrhage, incarceration and necrosis of intussuscepted bowel , perforation, peritonitis

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17
Q

how is intussusception diagnosed?

A

ultrasound, barium enema, air contrast enema

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18
Q

what is the treatment for intussusception?

A

barium enema, air contrast enema, surgery

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19
Q

What is Meckel Diverticulum?

A

congenital, a slight bulge in the small intestine present at birth and a remnant of the omphalomesenteric duct; often asymptomatic

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20
Q

When does Meckel Diverticulum become problematic?

A

when mucosa has gastric cells that secrete HCl in an improper area (ileum) causing ulceration and bleeding

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21
Q

pt has PAINLESS PASSAGE of maroon/MELANOTIC STOOL, SHOCK secondary to acute bleeding, ANEMIA, intestinal obstruction/volvulus, perforation resulting in peritonitis, and chronic recurrent abdominal pain. what do you suspect?

A

Meckel Diverticulum

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22
Q

How is Meckel Diverticulum treated?

A

surgical resection

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23
Q

what is the most common cause of abdominal pain in children?

A

constipation

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24
Q

if infants below 3 months old are grunting/straining with passage of soft stools, what should be done?

A

nothing, this is normal

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25
Q

what are complications of constipation?

A

anal fissures, fecal retention leading to encopresis (fecal soiling), dysfunctional voiding

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26
Q

4-7 yr old has hard stools and stool is palpable on PE, what do you suspect?

A

constipation

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27
Q

what are treatment options for constipation?

A

increased fluids/fiber- add prune juice (1 tsp/oz formula/breastmilk)
Miralax 1g/kg once daily
establish regular toileting times

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28
Q

what is the fiber recommendation for children?

A

5g + age (yrs)

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29
Q

what is encopresis?

A

involuntary fecal soiling in child >4 yrs old (more prevalent in boys)

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30
Q

what is retentive encopresis?

A

most common
stool retention leads to constipation –> fecal impaction, leakage of liquid feces around impaction
large, infrequent stools (painful defacation)

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31
Q

what is continuous encopresis?

A

no hx of achieving primary bowel control (e.g., spina bifida)

32
Q

what is discontinuous encopresis?

A

loss of normal bowel control occurs in response to episodic stress (shit your pants)

33
Q

what are associated findings of encopresis?

A 
large fecal mass palpable in rectum
occult blood
pilonidal dimple 
absent "anal wink"
lower extremity weakness
34
Q

what is the treatment for encopresis?

A

miralax 1-2 caps w/ 8 oz water daily (may add senekot)
increase fiber
encourage routine postprandial toilet sessions
positive reinforcement for successes

35
Q

what are causes of chronic recurrent abdominal pain (CRAP)?

A

constipation
stress/school phobia/anxiety
family hx

36
Q

child presents with central abdominal pain of variable duration and intensity during the day. this has not impacted their physical activity. PE and lab testing are normal. what do you suspect?

A

CRAP

37
Q

what is the treatment for CRAP?

A

increase fiber
decrease lactose
coping strategies for stressors
may consider tricyclic antidepressants or stool softeners
reserve antispasmodic meds (hycoscyamine) for IBS

38
Q

when should a child w/ CRAP be referred to a specialist?

A 
weight loss
nocturnal pain
focal pain
GI bleeding
vomiting
fever
arthritis
family hx of IBD or ulcers
39
Q

happy spitting is normal until what age?

A

18 months

40
Q

regurgitation with inadequate weight gain may be caused by what?

A

cow’s milk protein intolerance

41
Q

what are treatment options for regurgitation and irritability in an infant?

A

frequent, smaller feedings and thickened feedings w/ rice cereal
trial eliminating cow’s milk protein from infant/mother
upright positioning
avoid tobacco smoke exposure

42
Q

in infants and toddlers with mild esophagitis/significant symptoms, what is the tx?

A

trial acid suppression meds for 2 weeks

43
Q

in infants and toddlers w/ moderate-severe esophagitis documented w/ endoscopic biopsies, what is the tx?

A

3-6 months PPI

44
Q

what should you treat an older child w/ mild/infrequent heartburn?

A

antacids/histamine type 2 receptor antagonists (famotidine) PRN

45
Q

what should you treat an older child w/ moderate-severe heartburn?

A

trial 4-8 wks PPI

46
Q

what should you treat an older child w/ mild esophagitis?

A

4-8 wks PPI

47
Q

what should you treat an older child w/ erosive esophagitis?

A

3-6 months PPI

48
Q

what should you treat an older child w/ persistent moderate-severe asthma AND symptoms suggesting GERD?

A

3 months PPI trial (GERD can exacerbate asthma)

49
Q

What’s the difference between PPIs and H2RAs?

A

PPIs can take up to 4 days for full acid suppression, but keeps pH higher and longer (better healing of esophagitis) and doesn’t lose effectiveness

50
Q

what are H2RA drugs?

A

famotidine (pepcid) and cimetidine (tagamet)

51
Q

What are adverse affects of acid suppressors?

A

HA, diarrhea, constipation, nausea
B12, calcium malabsorption
may increase infectious risk

52
Q

when are prokinetic agents recommended?

A

GENERALLY NOT RECOMMENDED d/t adverse affects

cisapride, erythromycin, metoclopramide, baclofen

53
Q

what prokinetic agent can be considered for trial prior to anti-reflux surgery in children?

A

baclofen

54
Q

can antacids be used in infants?

A

NO

55
Q

can antacids be used in children/adolescents?

A

can be used short-term
aluminum can increase risk of bone disease
magnesium typically causes diarrhea

56
Q

why is sucralfate not recommended in pediatrics?

A

Al toxicity, minimal efficacy

57
Q

what are risks of anti-emetics in pediatrics?

A

sedation, respiratory depression, extrapyramidal symptoms, lack of data

58
Q

which anti-emetic is first line therapy?

A

ondansetron (zofran)

59
Q

what are adverse effects of ondansetron?

A

headache, QTc prolongation

may increase diarrhea in gastroenteritis

60
Q

which anti-emetics have a BW warning and should be avoided?

A

promethazine and metoclopramide

61
Q

what are the adverse effects of promethazine?

A

respiratory depression, over-sedation
may be fatal
can cause extrapyramidal symptoms

62
Q

when should anti-diarrheal agents be d/c’d?

A

if no benefit w/in 24-48 hrs

63
Q

what are adverse effects of anti-diarrheal agents?

A

abdominal distention, ileus, toxic megacolon

xerostomia, dry skin

64
Q

when should anti-diarrheal agents be avoided?

A

in pts <3 yrs of age for acute gastroenteritis

65
Q

loperamide is contraindicated in?

A

pts <2 yrs d/t cardiac adverse rxns (Torsades des pointes)
enterocolitis
caution w/ bloody diarrhea and high fevers

66
Q

what is the dosing for loperamide (imodium)?

A

0.08-0.24 mg/kg/day divided in 2-3 doses per day

67
Q

what anti-diarrheal medication is not recommended in children <6 yrs old?

A

diphenoxylate/atropine (lomotil)

68
Q

what agents can be used for constipation treatment in infants?

A

glycerin (tolerance may develop)
lactulose
polyethylene glycol (miralax)

69
Q

what is the dosing for glycerin in infants?

A

0.5-1 pediatric suppository daily PRN

70
Q

what is the dosing for lactulose in infants?

A

1 ml/kg/day added to formula

71
Q

what is the dosing for polyethylene glycol (miralax) in infants?

A

0.2-0.8 g/kg/day OR 4.25 g (1/4 cap) mixed in 2 oz fluid daily PRN

72
Q

what is the dosage of polyethylene glycol (miralax) for disimpaction?

A

1-1.5 g/kg daily (max 17g)

73
Q

what population should sodium phosphate enemas be avoided in?

A

children <2 yrs old

74
Q

what is the recommended dosage of polyethylene glycol (miralax) in children ages 2-4 yrs?

A

8.5g (1/2 cap) mixed in 4 oz fluid 1-2x/day

75
Q

what is the recommended dosage of polyethylene glycol (miralax) in children ages 5+ yrs?

A

17g (1 cap) mixed in 8 oz fluid 1-2x/day

76
Q

what is the recommended dosing of lactulose in children ages 2 yrs and up?

A

1-2g/kg 1-2x/day

Pediatrics (7 decks)

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