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Senoir 21-2 > PEDS GI > Flashcards

PEDS GI Flashcards

1
Q

What is the Physiological GER in infants

A

Effortless retrograde movement of gastric contents upwards into the esophagus or oropharynx

Physiologic GER (“spitting up”)
-Normal in infants under 12 months old

Criteria: must maintain adequate nutrition & no signs of respiratory complications or esophagitis

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2
Q

What defines gastro reflux DISEASE in peds

A

GER leading to symptoms or complications:

  • Poor growth/Failure to Thrive
  • Pain
  • Breathing difficulties
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3
Q

What is the dx testing for Reflux Disease in Peds

A

None needed, its a clinical Dx

24 hour Ph pride (previous gold standard)

Upper GI fluoroscopy (barium) (r/o anatomical causes)

Upper Endoscopcy (most invasive)

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4
Q

Rx for GERD treatments

A 
H2 Blockers (i.e., Ranitidine)**
Prokinetic agents (i.e.,Metoclopromide) 
Proton pump inhibitors (PPIs)

If fail-> surgical referral

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5
Q

What is the characteristic feature of Functional GI d/o

A

Characterized by daily pain

Not associated with meals

Often not relieved with defecation (does improve with IBS)

Often tendency toward anxiety and perfectionism

Pain worse in the morning

Can affect school attendance

Examples: IBS, Dyspepsia, Functional Diarrhea, ect

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6
Q

GERD S/s

A

GERD symptoms vary with organs affected

Systemic
-Lack of weight gain (FTT)

Esophagitis

  • Pain/irritability
  • Iron deficiency anemia

Pulmonitis
-Apnea, wheezing, cough, stridor

As children age, classic GERD sxs start to predominate
(i.e. dyspepsia)

Increased risk of esophageal stricture, asthma and Barrett’s esophagus

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7
Q

Visceral vs Somatic Pain

A

Visceral pain
->Autonomic nerves in the gut detect injury → transmit sensation by nonmyelinated fibers
Pain: vague, dull, slow onset, poorly localized
Overactive sensation → basis for functional abdominal pain & irritable bowel syndrome

Somatic Pain
Injury to overlying structures (i.e., parietal peritoneum, fascia, muscles, & skin of the abdominal wall)
->Myelinated somatic fibers → rapid transmission of well-localized pain

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8
Q

Define Encopresis

A

Regular, voluntary or involuntary passage of feces into inappropriate places

at least once a month for 3 consecutive months once a chronologic or developmental age of 4 yr has been reached

Liquid stool seeps around impacted stool

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9
Q

Physical exam for Encopresis

A

Exam should follow that of constipation

  • > 50% children have fecal mass on abd exam
  • > 90% children have stool in vault

Assess for rectal disease
(anal fissures, etc.)

Assess neuro & lumbosacral area for abnormalities

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10
Q

W/u if Hirschsprungs dz

A

Anal manometry, colonoscopy and / or barium enema should only be ordered if Hirschsprung’s disease is suspected

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11
Q

REcommended imaging for Encopresis

A

Abdominal Radiograph->KUB is recommended (esp. if abd mass felt) to confirm fecal mass size, placement and rectal dilation

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12
Q

Dz assoc with celiacs

A

Associated with DM1, Thyroiditis, Turner Syndrome & Trisomy 21

Strong genetic component

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13
Q

Clinical presentation for Celiacs

A

Diarrhea or constipation
->Constipation mostly from reduced food intake

Abdominal bloating

Failure to Thrive

Irritability

Decreased appetite

Extraintestinal manifestations

  • Osteopenia
  • Arthritis/arthralgia
  • Ataxia
  • Elevated liver enzymes
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14
Q

How do you Dz Celiacs

A

(Must be eating gluten products when testing occurs or IgA will not be present)

IgA antiendomysial antibody and IgA tissue transglutaminase antibody (sen/spec 95%)

Total serum IgA
(common to be deficient)

Confirm dx: Endoscopic small intestinal biopsy
(done by Gastroenterologist)
->Villous atrophy, mucosal inflammation, crypt hyperplasia, increased intraepithelial lymphocytes

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15
Q

Define Allergic colitis

A

Milk or soy protein induced colitis

Common cause of bloody stools in infants

Typically resolves between 6-18 mos of age

Less common in breast-fed infants

S/s

  • Blood streaked stool
  • Typically no N/V or abdominal pain
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16
Q

A child presents with blood streaked stools with NO abd pain or N/V.

Think

A

Allerigic colitis 2/2 milk or soy protein

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17
Q

Dx for allergic colitis

A

Clinical on the basis of blood streaked stools without N/V and ABD pain and a Hx of soy or cows milk protein

CAN order feces biopsy (unnecessary) -> show eosinophilia

18
Q

Tx for Allergic Colitis

A

Maternal diet modification for breastfed infants (mom restricts milk and soy)

Hydrolyzed protein formula
(casein hydrolysate)

19
Q

What is acute gastroenteritis in peds

A

AGE: rapid onset diarrheal illness ± fever, abd pain, nausea/vomiting

Diarrhea: 3+ loose, watery stools/24 hours

20
Q

Chief concern in a gastroenteritis peds pt

A

level of dehydration & toxic-appearing (admit)

21
Q

Two classifications of diarrhea

A

Invasive/Inflammatory

Or

Secretory—epithelial cells’ ion transport processes turned on to active secretion (various mechanisms present)

  • Bloody—often cramping and fever present as well
  • Watery—large quantity
22
Q

What is the common bacterial agent that is common in Daycares and presents with SZR

A

Shigella

23
Q

Should kids under 2 yrs be tested for C. Diff

A

NO, common for them to be colonized but not infected

24
Q

3 most common parasites for diarrhea

A

Entamoeba histolytica
-Amebiasis—warmer climates

Giardia lamblia
-Endemic to US–daycare

Cryptosporidium
-Mild illness in most; severe prolonged diarrhea in immunocompromised

25
Q

When should we get labs for diarrhea

A

Consider if: fever, bloody diarrhea, prolonged diarrhea, significant dehydration
-Electrolytes, BUN, creatinine, UA (specific gravity → indicator of hydration)

26
Q

Do we give ABX for e coli

A

NO NO. NO

Can lead to HUS
Hemolytic Uremic Syndrome

27
Q

What are the ABX to use in Diarrhea

A

Shigella—abx can reduce symptoms and transmissibility
-Tx with azithromycin oral

Salmonella—under 3 months of age ok to treat
-Tx with azithromycin oral
(avoid fluoroquinolones in children)

Traveler’s Diarrhea—only if bloody or febrile

  • Tx with azithromycin
  • Higher risk areas: Asia, Africa, South America

C. difficile—discontinue offending agent!
-Tx with metronidazole oral

28
Q

Severe Dehydration

A

Apathetic, unconscious

Drinks poorly / unable to drink

Tachycardia with brady in severer cases

Weak thready pulses

Deep breathing
Deeply sucked eyes
Cold mottled extremities

29
Q

DDx for Chronic Diarrhea

A

Enzyme deficiencies

  • Disaccharidase deficiencies (lactase)
  • Cystic fibrosis (lipase)

Allergies
-Celiac disease (gluten enteropathy)
-Milk protein allergy
(children <12 mos age)

Chronic GI infections

  • Giardia lamblia
  • Other parasitic infections

Inflammatory bowel diseases

  • Crohn’s disease
  • Ulcerative colitis

Extrinsic
-Laxative abuse

30
Q

Specific tests for IBD and Hirschprungs

A

Endoscopy with Bx

31
Q

Special Tests for Cystic Fibrosis

A

Sweat-chloride testing

32
Q

Special tests for celiac dz

A

Endomysial, antigliadin & transglutaminase antibodies

33
Q

What is the Rome IV criteria

A

Dx for Functional Gastro D/o

recurrent abd pain lasting at least 1 day/week in the past 3 months, with at least 2 of the following
associated with defecation (better or worse)
change in stool frequency
change in stool form

34
Q

Define functional diarrhea

A

Must include all of the following:

  1. Daily painless, recurrent passage of 4 or more large, unformed stools
  2. Symptoms last more than 4 wk
  3. Onset between 6 and 60 mo (5 yrs) of age
  4. No failure to thrive if caloric intake is adequate

Key here is that growth is usually NOT affected

35
Q

Define constipation

A

Definition: ≤ 2 stools per week OR passage of hard, pellet-like stools for at least 2 wks

36
Q

Constipation red flags

A

Passage of meconium >48 hours after birth

Constipation in the 1st month of life

FMHx of hirshsprungs

Ribbon Stools

Blood

Failure to thrive

Vomitting

Distention

Abnml Thyroid

ABNML anatomy (anus)

Absent reflexes

Floppy Baby, weak baby

Tuft of hair on the spine

Gluteal cleft deviation

Anal scars

37
Q

Common diarrheal day care out breaks

A

Shigella, Cryptosporidium

38
Q

When to get stool evaluation in kids with diarrhea

A

If not resolved after 2 weeks

39
Q

Rehydration methods for mild and moderate dehydration

A

Mild dehydration = 50 mL/kg over 4hrs

Moderate dehydration = 100 mL/kg over 4hrs

Supplemental rehydration for ongoing losses (i.e., diarrhea, emesis): 10 mL/kg per each stool

Then maintenance: 100 mL/kg over 24hrs daily until diarrhea resolves

40
Q

Viral vs bacterial diarrhea

A

Viral: vomiting followed by watery non-bloody stools, +/- fever
Diarrhea: lacks leukocytes, 20% has mucus
Recovery usually within 7 days

Bacterial: fever >40 C/104 F, overt fecal blood, abdominal pain, often no vomiting prior to diarrhea, high stool frequency (>10/day)

Senoir 21-2 (77 decks)

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