Pediatrics: Jaundice & GI Flashcards
what is the most helpful study to quantify the severity of reflex?
24-Hr intraesophageal pH &
Impediance monitoring- measures the direction of bolus movement in the esophagus via measurements of changes in resistance to alternating electrical current when a bolus passes by a pair of metallic ring
where does intusussusception happen the most
at ileocecal jxn
(ileo-colic w/ the the ilium invaginating into the colon)
what labs will present in a pt w/ pyloric stenosis
hypochloremic
hypokalemic
metabolic alkalosis
what is abnormal in the first 24-48 hrs in hirschsprung dz
failure to pass meconium
What symptoms are very suggestive of hirschsprung dz
palpable stool throughout the abdomen
empty rectal vault
never able to have an unassisted stool
what is needed for definitive diagnosis of hirschsprung dz
rectal Bx
what is the direct coombs test
performed directly on RBCs from the pt
used when suspicious of hyperbilirubinemia is due to hemolysis, esp ABO incompatibility in newborns
look at Abs directly on RBC of baby
Babies are at most risk for hyperbilrubinemia when…
the mom is type O or Rh (-)
what is at the top of your DDx if an infant presents w/ elevated conjugated bilirubin
biliary atresia
what signs/Sxs present w/ biliary atresia
cholestatic jaundice (conjugated hyperbilirubinemia)
hepatomegaly
acholic stool
how will a pt present if they have GERD
what are possible complications
loss of tone of LES
cant keep food down - slowdown wt gain, possible wt loss
hard to feed, cries a lot, arch and scream, hard to gain wt
reflux of acidic stomach can go up the esophagus and cause esophagitis
what is GER and how does it present
Passage of gastric content into the esophagus
“happy spitter”, gaining wt, reflux while smile
what are characterisitics of intusussception
blood supply to intestine is compromised
pt has rectal bleeding (jelly stool), sudden onset of intermittent severe abd pain & emesis, RUQ mass
= MCC of intestinal obstruction in infancy
fix w/ air enema
what are symptoms/PE findings of pyloric stenosis
2-4 wks old (M > F)
projectile vomit, dehydreated, poor wt gain/losing wt
palpable olive in epigastric pain
what is the cause of hirschsprung dz
failure of ganglion cells to migrate to developing colon
75% limited to rectosigmoid colon
what are consequences of very high levels of unconjugated bilirubin
can cross the BBB and deposit in the basal ganglia & brainstem
this can result in bilirubin induced neurologic dysfxn (kernicterus)
what is the significance of stool passage as it relates to enterohepatic circulation and bilirubin in a newborn
passage of stool is imp to get rid of excess bilirubin
stool remaining in the gut for a longer period of time allows for more breakdown on conjugated bilirubin and more reabs into the blood
Compare/contrast Crigler-Najjar Type 1 and Type 2
Type 1: (total UDPGT deficiency) = SEVERE hyperbilirubinemia w/ high
risk of BIND/Kernicterus
Type 2: (partial UDPGT deficiency) = mild hyperbilirubinemia w/ low risk of BIND/Kernicterus
what is breast feeding jaundice
A combination of baby knowing how to nurse and mom’s milk not coming in right away
= physiologic jaundice thats exacerbated by mild-mod dehydration & increased enterohepatic circulation
what is breast-milk jaundice
some factor in breast milk that inhibits the conjugation of bilirubin
lasts 3-6 weeks
if it lasts beyond the 6-8 week period, consider other things
how does phototherapy decrease bilirubin levels in infants
isomerizes unconjugated bilirubin and make it water soluble
