Pediatrics: Jaundice & GI Flashcards

1
Q

what is the most helpful study to quantify the severity of reflex?

A

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

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2
Q

where does intusussusception happen the most

A

at ileocecal jxn

(ileo-colic w/ the the ilium invaginating into the colon)

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3
Q

what labs will present in a pt w/ pyloric stenosis

A

hypochloremic

hypokalemic

metabolic alkalosis

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4
Q

what is abnormal in the first 24-48 hrs in hirschsprung dz

A

failure to pass meconium

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5
Q

What symptoms are very suggestive of hirschsprung dz

A

palpable stool throughout the abdomen

empty rectal vault

never able to have an unassisted stool

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6
Q

what is needed for definitive diagnosis of hirschsprung dz

A

rectal Bx

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7
Q

what is the direct coombs test

A

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

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8
Q

Babies are at most risk for hyperbilrubinemia when…

A

the mom is type O or Rh (-)

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9
Q

what is at the top of your DDx if an infant presents w/ elevated conjugated bilirubin

A

biliary atresia

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10
Q

what signs/Sxs present w/ biliary atresia

A

cholestatic jaundice (conjugated hyperbilirubinemia)

hepatomegaly

acholic stool

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11
Q

how will a pt present if they have GERD

what are possible complications

A

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

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12
Q

what is GER and how does it present

A

Passage of gastric content into the esophagus

“happy spitter”, gaining wt, reflux while smile

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13
Q

what are characterisitics of intusussception

A

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

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14
Q

what are symptoms/PE findings of pyloric stenosis

A

2-4 wks old (M > F)

projectile vomit, dehydreated, poor wt gain/losing wt

palpable olive in epigastric pain

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15
Q

what is the cause of hirschsprung dz

A

failure of ganglion cells to migrate to developing colon

75% limited to rectosigmoid colon

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16
Q

what are consequences of very high levels of unconjugated bilirubin

A

can cross the BBB and deposit in the basal ganglia & brainstem

this can result in bilirubin induced neurologic dysfxn (kernicterus)

17
Q

what is the significance of stool passage as it relates to enterohepatic circulation and bilirubin in a newborn

A

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

18
Q

Compare/contrast Crigler-Najjar Type 1 and Type 2

A

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

19
Q

what is breast feeding jaundice

A

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

20
Q

what is breast-milk jaundice

A

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

21
Q

how does phototherapy decrease bilirubin levels in infants

A

isomerizes unconjugated bilirubin and make it water soluble