Peds GI 2

Question 1

What is the physiologic cause of neonatal jaundice

Answer 1

Unconjugated hyperbilirubinemia because glucuronate activity is low at birth, but rises by 1 week old

Question 2

If unconjugated bili stays high, it can result in

Answer 2

brain injury (kernicterus)

Question 3

How do you treat unconjugated hyperbilirubnemia

Answer 3

expose newborn to bright lights (phototherapy)
unconjugated bili absorbs visible light, becomes more water soluble, and is easily excreted in bile!
If this doesn’t work, may need transfusion

Question 4

What is Gilbert’s syndrome

Answer 4

Mild auto dom hyperbilirubinemia (unconjugated bili high- nl is <3-6)
More rapid increase in jaundice as a newborn
Jaundice more noticeable during puberty and acute illness
M>F
Normal liver Bx and LFT’s!

Question 5

How do you diagnose and treat Gilbert’s syndrome

Answer 5

2 day fast, then measure unconj. bili: if 1.4mg increase, this indicates Gilbert’s
No Tx necessary

Question 6

CF primarily affects

Answer 6

lungs

pancreas: diarrhea, steatorrhea, malnutrition, FTT, fat soluble vitamin deficiency
intestine: intussusception, carb intolerance, meconium ileus, rectal prolapse (risk of digestive tract cancer!)
liver: steatosis, hepatic fibrosis, cirrhosis, neonatal jaundice

Question 7

How do you diagnose CF

Answer 7

Sweat chloride test
can do newborn screening
Suspect in any kid with meconium ileus, cholestasis, recurrent URI/lung disease, or malabsorption

Question 8

How do you treat CF

Answer 8

Oral supplement pancreatic enzymes
Ursodiol to relieve cholestasis Sx
Life expectancy 30+ y/o!!

Question 9

What is a pilonidal cyst

Answer 9

Infx of skin or SubQ tissue at or near upper natal cleft of buttock (butt crack)
Develop from ingrown hairs causing cyst causing sinus and becoming infected (hair and debris)

Question 10

RF for a pilonidal cyst are

Answer 10

Overweight 
Local trauma 
Sedentary lifestyle 
Deep natal cleft 
FHx

Question 11

How can you treat a pilonidal cyst

Answer 11

Soak in warm water
Surgical opening and drain
Surgical removal if recurrent

Question 12

What is enterobiasis

Answer 12

worms in stool or eggs on perianal skin
cause intense anal pruritis
female pinworms deposit eggs on perianal skin and cause a vicious cycle of kid itching, auto-infecting, etc.

Question 13

How do you diagnose enterobiasis

Answer 13

Scotch tape test

*Strep anc also cause a rash around the bottom. If they test negative for strep, treat for enterobiasis empirically!

Question 14

How do you treat Enterobiasis

Answer 14

Tx entire house! 
Repeat therapy after 2 weeks 
Pyrantel pamoate 11mg/kg OTC 
keep nails short and clean 
wash sheets in hot water

Question 15

What is Encopresis

Answer 15

Repeated passing of feces into inappropriate places (clothing, floor, etc) involuntary or intentional for min. 3 months
At least 4 y/o

Question 16

Behavioral education Tx of Encopresis includes

Answer 16

Educating child and parent
Design feasible program of consistent toilet use
Positive reinforcement for successful use of toilet (schedule toilet after meals, chart toileting and successful defecation attempt)
Mild punishment like having child clean their own clothes after soiling

Question 17

Other Encopresis Tx options are

Answer 17

Suppositories and enemas (Miralax*), Maintain w/ laxatives

Biofeedback therapy

Question 18

Chronic constipation is defined as 2+ of the following, for min. 2 months

Answer 18

<3 BM x week
>1 episode of encopresis per week
impaction of stool in rectum
passage of stool so large it obstructs the toilet
retentive posturing and fecal witholding
pain w/ defecation

Question 19

Causes of constipation are

Answer 19

dehydration 
excess milk intake 
lack of fiber 
Antihistamines, narcotics 
thyroid disease 
cerebral palsy 
anal fissures

Question 20

How do you treat constipation

Answer 20

Diet changes “P” fruits

Miralax, Lactulose, Milk of magnesia (2+ y/o)