Peds - Gastrointestinal Flashcards
Gastroenteritis defined
Non-specific term for acute syndrome of nausea, vomiting, and diarrhea
Caused by acute irritation/inflammation of the gastric mucosa
Most common cause of gastroenteritis?
other causes?
Viral causes
Especially ROTAVIRUS
bacterial
parasitic
inorganic food contents
emotional stress
Examples of bacteria which may cause gastroenteritis and associated symptoms?
(4)
Salmonella
Campylobactor (particularly odorous stool)
Shigella (bloody stools, fever spikes, seizures)
E. coli (mild, loose stools)
Classification of dehydration #
mild (loss of 3 - 5 % of body weight)
moderate (loss of 6 - 9 %)
severe (loss of 10% or more)
Diagnostics for gastroenteritis
None unless bloody stools or persists beyond 72 hours
then:
Stool studies for guaiac, culture, ova and parasites
WBC
When can a child return to school after E. coli or Shigella?
after 2 negative stool cultures
Management of gastroenteritis #
Oral rehydration therapy
moderate: 50 mL/hr
severe: 100 mL/hr
Resume regular diet gradually
Should anti-motility drugs be used for gastroenteritis?
Generally avoided.
Can prolong illness.
When is ABT considered for gastroenteritis?
8 - 10+ stools per day
when bacterial cause is isolated
when symptoms are not resolving
First line ABT for gastroenteritis?
Trimethoprim/sulfamethoxazole (TMP/SMZ)
aka BACTRIM
Pediatric GERD -
3 classifications
physiological - infrequent, episodic vomiting
functional - painless, effortless vomiting
pathological - frequent vomiting with failure to thrive, aspiration pnuemonia
By what age does GERD typically resolve?
18 months
GERD -
What causative agent should be suspected in children of color?
H. pylori
GERD - signs and symptoms
obvious ones +
choking, coughing, wheezing
otitis media
dental erosion
GERD - diagnostics
CBC - r/o anemia
UA, UC
Stool for occult blood
Abdominal US - r/o pyloric stenosis
GERD - in infants
non-pharmacologic management
small, frequent meals burp often continue breastfeeding weighted formula medication
GERD - pharmacotherapy
first line - H2 antagonist (blocker)
if needed, add PPI and refer
H2 antagonist examples
“histamine –> -tidine”
ranitidine (Zantac)
famotidine (Pepcid)
PPI example
omeprazole (Prilosec)
PPI may cotribute to what condition
anemia
others? <
Pyloric stenosis -
description?
age?
typical infant?
“baby disease”
obstruction from thickening of pylorus (distal stomach)
usually from 3 weeks to 4 months of age
white male
Pyloric stenosis -
symptom
PROJECTILE vomiting (NON-bilious)
hungry afterward
palpable mass immediately after vomiting (pyloric olive)
Pyloric stenosis -
diagnostics and management
ultrasound
if not definative, upper GI imaging which commonly shows “string sign”
surgery has very good success
Intussuception -
description?
age?
telescoping of one part of the intestine onto itself
“baby disease” - up to 2 years
can be fatal
Intussuception -
symptoms
previously healthy infant develops sudden colicky pain
sausage shape mass in RUQ
current jelly stool (late)
Intussuception -
diagnotics and management
radiograph
barium enema (may produce reduction)
surgery
Hirschprung’s disease
AKA?
sequelae?
aganglionic megacolon
enterocolitis may develop; can be FATAL
Hirschprung’s disease -
symptoms
BILIOUS vomiting (serious) infrequent, explosive BM
Hirshprung’s disease -
diagnostics
radiograph - by FNP then refer to GI for:
barium enema
rectal colon biopsy
surgery
Appendicitis -
SIGNS
PROM
Psoas
Rebound
Obturator
McBurney’s Point
Appendicitis -
symptoms
colicky, vague around umbilicus shifts to RLQ worsens with cough nausea with up to 1-2 vomits low grade fever
Psoas sign
pain with R thigh extension
positive for appendicitis
Obturator sign
pain with internal rotation of R thigh
positive for appendicitis
McBurney’s point tenderness
1/3 the distance from iliac crest to umbilicus
Appendicitis -
diagnostics
WBC 10,000 to 20,000
ESR elevated
US or CT
Malabsorption -
possible causes
cystic fibrosis
celiac disease
IBD
hepatic disease
Celiac disease -
AKA
sprue
Malabsorption -
signs and symptoms (5)
severe, chronic diarrhea steatorrhea cheilosis fatigue pallor
Malabsorption -
diagnostics
Hint SBBBS
Wide net - many differentials
STOOL - BLOOD - BONE - BREATH - SKIN
- stool: culture, hemoccult, O&P
- blood: calcium, phosphorus, alkaline phosphatase, total protein, ferritin, folate, liver function tests
- bone age
- lactose and sucrose breath hydrogen testing –> H. pylori
- sweat chloride test –> CF
Celiac disease must avoid what?
wheat, oats, rye, barley
CF treatment (2)
pancreatic enzyme replacement
vits A D E K (fat soluble)
Neuroblastoma -
what is typical age?
Prior to Kindergarten
Neuroblastoma -
description
tumor arising from neural tissue
frequently from adrenal gland
can spread to bone marrow, liver, lymph nodes, skin, and orbits of eyes
Neuroblastoma -
signs and symptoms (4)
profuse sweating
tachycardia
enlarged abdominal mass
failure to thrive
Neuroblastoma -
diagnostics and treatment (4)
urine catecholamines (elevated) abdominal CT surgical biopsy
refer to pediatric oncologist
Examples of catecholamines? (3)
epinephrine (adrenaline)
norepinephrine
dopamine
Hepatitis in pediatric population?
A - B - C
until age 10, usually do not see icteric state (liver hasn’t matured yet)
Hep A -
transmission route
frequent sources of infection
oral -fecal
contaminated water and food, esp. raw shellfish
Hep A -
incubation period
2 - 6 weeks
blood and stool are infectious during this time
Can Hep A become chronic?
No
chronic carrier state does not exist
Hep B -
transmission route
blood and body fluids - saliva, semen, vaginal secretions
spread by contact with blood, sexual activity, and mother to fetus
vertical transmission
transmission from mother to fetus/baby during pregnancy or childbirth
Hep B -
incubation period
6 weeks to 6 months
Does Hep A or Hep B tend to have more insidious onset?
Hep B
Can Hep B become chronic?
Yes, Hep B can cause ACUTE and CHRONIC disease
Hep B -
mortality rate
risk of fulminant hepatitis is <1%
BUT when it occurs, mortality is 60%
Hep C -
transmission route
blood - transfusion, IV drug use
Risk of sexual transmission is small, vertical transmission rare
Hep C -
incubation period
4 weeks to 3 months
Hepatitis -
pre-icteric symptoms
(almost like early pregnancy) fatigue malaise anorexia n/v headache aversion to certain odors taste changes (salty tastes sweet, etc.)
Hepatitis -
icteric symptoms
jaundice clay colored stool dark urine pruritis weight loss RUQ pain
Hepatitis -
additional symptoms
low grade fever
hepatosplenomegaly
Hepatitis -
diagnostics
CBC
UA - proteinuria, bilirubinuria
elevated AST and ALT - PRIOR to onset of jaundice
lactate dehydrogenase (LDH), bilirubin, alkaline phosphatate, and prothrombin test time are NORMAL or SLIGHTLY elevated
Anti-HAV, IgM
Active Hep A
IgM = iMmediate infection
Anti-HAV, IgG
Recovered Hep A
IgG = Gone infection
HBsAg, HBeAg, Anti-HBc, IgM
Active Hep B
HBsAg = surface antigen HBeAg = envelope -->> ACTIVE REPLICATION Anti-HBc = core
IgM = iMmediate infection
HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG
Chronic Hep B
IgM and IgG indicate that it’s ongoing because it’s iMmediate and Gone
Anti-HBc, Anti-HBsAg
Recovered Hep B or Immunized against Hep B
Anti-HCV, HCV RNA
Indicates both acute and chronic Hep C
there is no recovery
Hepatitis management
rest increase fluids Vit K for prolonged PT avoid alcohol low to no protein rebetron (interferon and ribavirin) for Hep C
Bilious vomitus suggests:
obstruction below the ampulla of Vater
