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NP > Peds - Gastrointestinal > Flashcards

Peds - Gastrointestinal Flashcards

1
Q

Gastroenteritis defined

A

Non-specific term for acute syndrome of nausea, vomiting, and diarrhea

Caused by acute irritation/inflammation of the gastric mucosa

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2
Q

Most common cause of gastroenteritis?

other causes?

A

Viral causes

Especially ROTAVIRUS

bacterial
parasitic
inorganic food contents
emotional stress

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3
Q

Examples of bacteria which may cause gastroenteritis and associated symptoms?
(4)

A

Salmonella
Campylobactor (particularly odorous stool)
Shigella (bloody stools, fever spikes, seizures)
E. coli (mild, loose stools)

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4
Q

Classification of dehydration #

A

mild (loss of 3 - 5 % of body weight)
moderate (loss of 6 - 9 %)
severe (loss of 10% or more)

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5
Q

Diagnostics for gastroenteritis

A

None unless bloody stools or persists beyond 72 hours

then:
Stool studies for guaiac, culture, ova and parasites
WBC

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6
Q

When can a child return to school after E. coli or Shigella?

A

after 2 negative stool cultures

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7
Q

Management of gastroenteritis #

A

Oral rehydration therapy

moderate: 50 mL/hr
severe: 100 mL/hr

Resume regular diet gradually

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8
Q

Should anti-motility drugs be used for gastroenteritis?

A

Generally avoided.

Can prolong illness.

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9
Q

When is ABT considered for gastroenteritis?

A

8 - 10+ stools per day

when bacterial cause is isolated

when symptoms are not resolving

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10
Q

First line ABT for gastroenteritis?

A

Trimethoprim/sulfamethoxazole (TMP/SMZ)

aka BACTRIM

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11
Q

Pediatric GERD -

3 classifications

A

physiological - infrequent, episodic vomiting
functional - painless, effortless vomiting
pathological - frequent vomiting with failure to thrive, aspiration pnuemonia

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12
Q

By what age does GERD typically resolve?

A

18 months

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13
Q

GERD -

What causative agent should be suspected in children of color?

A

H. pylori

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14
Q

GERD - signs and symptoms

A

obvious ones +
choking, coughing, wheezing
otitis media
dental erosion

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15
Q

GERD - diagnostics

A

CBC - r/o anemia
UA, UC
Stool for occult blood
Abdominal US - r/o pyloric stenosis

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16
Q

GERD - in infants

non-pharmacologic management

A 
small, frequent meals
burp often
continue breastfeeding
weighted formula
medication
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17
Q

GERD - pharmacotherapy

A

first line - H2 antagonist (blocker)

if needed, add PPI and refer

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18
Q

H2 antagonist examples

A

“histamine –> -tidine”

ranitidine (Zantac)
famotidine (Pepcid)

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19
Q

PPI example

A

omeprazole (Prilosec)

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20
Q

PPI may cotribute to what condition

A

anemia

others? <

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21
Q

Pyloric stenosis -
description?
age?
typical infant?

A

“baby disease”

obstruction from thickening of pylorus (distal stomach)

usually from 3 weeks to 4 months of age

white male

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22
Q

Pyloric stenosis -

symptom

A

PROJECTILE vomiting (NON-bilious)
hungry afterward
palpable mass immediately after vomiting (pyloric olive)

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23
Q

Pyloric stenosis -

diagnostics and management

A

ultrasound

if not definative, upper GI imaging which commonly shows “string sign”

surgery has very good success

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24
Q

Intussuception -
description?
age?

A

telescoping of one part of the intestine onto itself

“baby disease” - up to 2 years

can be fatal

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25
Q

Intussuception -

symptoms

A

previously healthy infant develops sudden colicky pain
sausage shape mass in RUQ
current jelly stool (late)

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26
Q

Intussuception -

diagnotics and management

A

radiograph
barium enema (may produce reduction)
surgery

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27
Q

Hirschprung’s disease
AKA?
sequelae?

A

aganglionic megacolon

enterocolitis may develop; can be FATAL

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28
Q

Hirschprung’s disease -

symptoms

A 
BILIOUS vomiting (serious)
infrequent, explosive BM
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29
Q

Hirshprung’s disease -

diagnostics

A

radiograph - by FNP then refer to GI for:
barium enema
rectal colon biopsy
surgery

30
Q

Appendicitis -

SIGNS

A

PROM

Psoas
Rebound
Obturator
McBurney’s Point

31
Q

Appendicitis -

symptoms

A 
colicky, vague around umbilicus
shifts to RLQ
worsens with cough
nausea with up to 1-2 vomits
low grade fever
32
Q

Psoas sign

A

pain with R thigh extension

positive for appendicitis

33
Q

Obturator sign

A

pain with internal rotation of R thigh

positive for appendicitis

34
Q

McBurney’s point tenderness

A

1/3 the distance from iliac crest to umbilicus

35
Q

Appendicitis -

diagnostics

A

WBC 10,000 to 20,000
ESR elevated
US or CT

36
Q

Malabsorption -

possible causes

A

cystic fibrosis
celiac disease
IBD
hepatic disease

37
Q

Celiac disease -

AKA

A

sprue

38
Q

Malabsorption -

signs and symptoms (5)

A 
severe, chronic diarrhea
steatorrhea
cheilosis
fatigue
pallor
39
Q

Malabsorption -
diagnostics

Hint SBBBS

A

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
40
Q

Celiac disease must avoid what?

A

wheat, oats, rye, barley

41
Q

CF treatment (2)

A

pancreatic enzyme replacement

vits A D E K (fat soluble)

42
Q

Neuroblastoma -

what is typical age?

A

Prior to Kindergarten

43
Q

Neuroblastoma -

description

A

tumor arising from neural tissue
frequently from adrenal gland
can spread to bone marrow, liver, lymph nodes, skin, and orbits of eyes

44
Q

Neuroblastoma -

signs and symptoms (4)

A

profuse sweating
tachycardia
enlarged abdominal mass
failure to thrive

45
Q

Neuroblastoma -

diagnostics and treatment (4)

A 
urine catecholamines (elevated)
abdominal CT
surgical biopsy

refer to pediatric oncologist

46
Q

Examples of catecholamines? (3)

A

epinephrine (adrenaline)
norepinephrine
dopamine

47
Q

Hepatitis in pediatric population?

A

A - B - C

until age 10, usually do not see icteric state (liver hasn’t matured yet)

48
Q

Hep A -
transmission route
frequent sources of infection

A

oral -fecal

contaminated water and food, esp. raw shellfish

49
Q

Hep A -

incubation period

A

2 - 6 weeks

blood and stool are infectious during this time

50
Q

Can Hep A become chronic?

A

No

chronic carrier state does not exist

51
Q

Hep B -

transmission route

A

blood and body fluids - saliva, semen, vaginal secretions

spread by contact with blood, sexual activity, and mother to fetus

52
Q

vertical transmission

A

transmission from mother to fetus/baby during pregnancy or childbirth

53
Q

Hep B -

incubation period

A

6 weeks to 6 months

54
Q

Does Hep A or Hep B tend to have more insidious onset?

A

Hep B

55
Q

Can Hep B become chronic?

A

Yes, Hep B can cause ACUTE and CHRONIC disease

56
Q

Hep B -

mortality rate

A

risk of fulminant hepatitis is <1%

BUT when it occurs, mortality is 60%

57
Q

Hep C -

transmission route

A

blood - transfusion, IV drug use

Risk of sexual transmission is small, vertical transmission rare

58
Q

Hep C -

incubation period

A

4 weeks to 3 months

59
Q

Hepatitis -

pre-icteric symptoms

A 
(almost like early pregnancy)
fatigue
malaise
anorexia
n/v
headache 
aversion to certain odors
taste changes (salty tastes sweet, etc.)
60
Q

Hepatitis -

icteric symptoms

A 
jaundice
clay colored stool
dark urine
pruritis
weight loss
RUQ pain
61
Q

Hepatitis -

additional symptoms

A

low grade fever

hepatosplenomegaly

62
Q

Hepatitis -

diagnostics

A

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

63
Q

Anti-HAV, IgM

A

Active Hep A

IgM = iMmediate infection

64
Q

Anti-HAV, IgG

A

Recovered Hep A

IgG = Gone infection

65
Q

HBsAg, HBeAg, Anti-HBc, IgM

A

Active Hep B

HBsAg = surface antigen
HBeAg = envelope -->> ACTIVE REPLICATION
Anti-HBc = core

IgM = iMmediate infection

66
Q

HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG

A

Chronic Hep B

IgM and IgG indicate that it’s ongoing because it’s iMmediate and Gone

67
Q

Anti-HBc, Anti-HBsAg

A

Recovered Hep B or Immunized against Hep B

68
Q

Anti-HCV, HCV RNA

A

Indicates both acute and chronic Hep C

there is no recovery

69
Q

Hepatitis management

A 
rest
increase fluids
Vit K for prolonged PT
avoid alcohol 
low to no protein
rebetron (interferon and ribavirin) for Hep C
70
Q

Bilious vomitus suggests:

A

obstruction below the ampulla of Vater

NP (76 decks)

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