Peds GI 2 Flashcards
What is the physiologic cause of neonatal jaundice
Unconjugated hyperbilirubinemia because glucuronate activity is low at birth, but rises by 1 week old
If unconjugated bili stays high, it can result in
brain injury (kernicterus)
How do you treat unconjugated hyperbilirubnemia
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
What is Gilbert’s syndrome
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!
How do you diagnose and treat Gilbert’s syndrome
2 day fast, then measure unconj. bili: if 1.4mg increase, this indicates Gilbert’s
No Tx necessary
CF primarily affects
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
How do you diagnose CF
Sweat chloride test
can do newborn screening
Suspect in any kid with meconium ileus, cholestasis, recurrent URI/lung disease, or malabsorption
How do you treat CF
Oral supplement pancreatic enzymes
Ursodiol to relieve cholestasis Sx
Life expectancy 30+ y/o!!
What is a pilonidal cyst
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)
RF for a pilonidal cyst are
Overweight Local trauma Sedentary lifestyle Deep natal cleft FHx
How can you treat a pilonidal cyst
Soak in warm water
Surgical opening and drain
Surgical removal if recurrent
What is enterobiasis
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.
How do you diagnose enterobiasis
Scotch tape test
*Strep anc also cause a rash around the bottom. If they test negative for strep, treat for enterobiasis empirically!
How do you treat Enterobiasis
Tx entire house! Repeat therapy after 2 weeks Pyrantel pamoate 11mg/kg OTC keep nails short and clean wash sheets in hot water
What is Encopresis
Repeated passing of feces into inappropriate places (clothing, floor, etc) involuntary or intentional for min. 3 months
At least 4 y/o
Behavioral education Tx of Encopresis includes
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
Other Encopresis Tx options are
Suppositories and enemas (Miralax*), Maintain w/ laxatives
Biofeedback therapy
Chronic constipation is defined as 2+ of the following, for min. 2 months
<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
Causes of constipation are
dehydration excess milk intake lack of fiber Antihistamines, narcotics thyroid disease cerebral palsy anal fissures
How do you treat constipation
Diet changes “P” fruits
Miralax, Lactulose, Milk of magnesia (2+ y/o)
