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Pediatrics Module > Peds GI > Flashcards

Peds GI Flashcards

1
Q

causes of projectile vomit

A

obstruction, pyloric stenosis, GERD

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2
Q

bilious vomit

A

green is pathologic!

Obstruction beyond the duodenal ampulla of Vater

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3
Q

Treatment of GER

A 
Reassurance and education
Positional changes (sit up after feeds)
Appropriate amount of food (Smaller feeds, more freq)
Formula change
Formula-thickened (Rice cereal)
Medications: Empirical (H1-block, PPI)
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4
Q

Most common cause of non-bilious vomiting in infants

A

overfeeding

typical infant needs 100-120 kcal/kg/day

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5
Q

Pathophysiology of GER

A

immature LES muscle, so passive vomiting after feeds

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6
Q

How is GERD different than GER?

A

projectile vomiting
weight loss
abd distention

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7
Q

DDX of GERD in infants

A

milk protein allergy
anatomical problem
eosinophilic esophagitis

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8
Q

How to dx GERD?

A

primarily clinical

upper GI pH probe

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9
Q

Pathophysiology of pyloric stenosis

A

hypertrophy of pylorus muscle (elongated and thickened) eventually it can obstruct gastric outlet to duodenum

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10
Q

What age does pyloric stenosis usually occur?

A

4-6 weeks old; rarely after 12 weeks

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11
Q

palpable “olive-shaped” mass in RUQ

A

pyloric stenosis

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12
Q

Vomit of pyloric stenosis patient?

A

non-bilious
projectile
coffee ground appearance

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13
Q

Classic lab findings of pyloric stenosis

A

Hypochloremic, hypokalemic metabolic alkalosis

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14
Q

How is pyloric stenosis dx’d?

A

Abdominal U/S: Hypertrophic Pylorus

Upper GI: string sign

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15
Q

Tx of pyloric stenosis

A

surgical - pyloromyotomy

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16
Q

What is necrotizing enterocolitis (NEC) and who gets it?

A

inflamm of intestinal wall in premature and SGA infants

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17
Q

signs/sx’s of necrotizing enterocolitis (NEC)

A

Bilious vomiting, poor feeding, abdominal distention in premature neonate

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18
Q

NEC diagnosis

A

KUB XR: Dilated bowel, pneumatosis of the intestines (air within bowel wall)

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19
Q

NEC treatment

A

Bowel rest
Restore Fluid and electrolyte status
Often need surgical resection

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20
Q

Pathophysiology of midgut volvulus

A

abnormal rotation of small bowel, causing cecum to rest in RUQ and mesentery to twist (Ladd’s bands)

constriction of superior mesenteric artery and small bowel ischemia

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21
Q

signs/sxs of midgut volvulus and malrotation

A

Sudden onset severe abdominal pain, distension, and bilious vomiting
Can present as cyclic vomiting in an older child

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22
Q

dx of midgut volvulus

A

Corkscrew appearance of duodenum/jejunum

Small bowel completely on right

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23
Q

currant jelly stools =

A

intussusception

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24
Q

How is midgut volvulus different than NEC

A

occurs at any age (NEC only premies)

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25
Q

Tx of midgut volvulus

A

Surgery

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26
Q

Pathophysiology of intussusception

A

Telescoping of a proximal segment of bowel into a distal segment

most commonly ileocolic (small intestine into colon)

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27
Q

Anatomical lead points that cause intussusception

A

viral infection, Meckel’s diverticulum (most common), intestinal polyp, intestinal lymphoma (think older kids)

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28
Q

Classic triad of intussusception

A

Triad: sudden intermittent abd pain, vomiting, sausage mass in RUQ

  • if blood in rectum found then definitive
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29
Q

Intussusception imaging

A
  • U/S diagnostic “target sign”

- Water soluble contrast or air reduction enema both tx and dx

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30
Q

intussusception treatment

A 
Stabilize patient
IV fluids / IV antibiotics
Water / air reduction enema
~10 % recurrence after radiologic reduction
Surgical de-telescoping
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31
Q

Meckel’s Diverticulum Rule of 2’s

A

2% of the population
2 feet from the ileocecal valve (located in the distal ileum)
2 inches in length
2% are symptomatic
2 years is the most common age at clinical presentation
Boys > girls, 2:1 ratio

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32
Q

Define Meckel’s Diverticulum

A

A congenital vascular out-pouching in the small intestine. Most commonly presents as painless rectal bleeding.

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33
Q

Bilious vomiting is ________ until proven otherwise.

A

small bowel obstruction

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34
Q

Acute abdominal pain in neonate DDX

A

colic

life-threatening: volvulus, NEC, adhesions

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35
Q

Acute abd pain in 2-5 yo DDX

A

acute gastroenteritis, pharyngitis, constipation

Life-threatening: trauma, adhesions, appendicitis, HUS intussusception, foreign body

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36
Q

How do infants manifest abd pain?

A

crying episodically and drawing up legs

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37
Q

jaundice + abd pain =

A

infectious hepatitis

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38
Q

PE tests for appendicitis

A

McBurney Point tenderness
Involuntary guarding
Rovsing sign (palp of LLQ produces pain in RLQ)
Psoas Sign (with patient L. side down, extension of hip produces increased pain)
Obturator sign (increased pain with passive flexion and internal rotation of hip)
Rebound Tenderness
The “Appy Waddle” (Child does NOT want to aggravate pain and reluctant to movement)

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39
Q

Define diarrhea

A

3 or more loose or watery voluminous stools per day

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40
Q

acute vs chronic diarrhea

A

acute < 2 weeks

chronic > weeks

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41
Q

osmotic diarrhea

A

Due to presence of unabsorbed or under-absorbed solute in the intestinal lumen pulling fluid out of the interstitium into the lumen.

Lactose Intolerance, excess mannitol, or sugar substitutes

Elevated Stool Ion gap > 100 mOsm/kg

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42
Q

secretory diarrhea

A

Occurs when there is active secretion of water/electrolytes into the lumen

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43
Q

inflammatory diarrhea

A

Intestinal Inflammation resulting in exudation of mucus, protein, and blood into the lumen which leads to water and electrolyte loss
EHEC, EPEC, Salmonella

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44
Q

motility diarrhea

A

Rapid transit through intestines leading to inadequate absorption
Metoclopramide, hyperthyroid, some laxatives

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45
Q

Appearance of acute diarrhea and associated symptoms

A

bloody, greasy, watery

sweats, palpitations

46
Q

Acute diarrhea management

A 
Remove the underlying cause
Treat dehydration
Oral rehydration therapy preferred
Occasionally IV fluids
Do not use antibiotics unless a treatable specific pathogen has been isolated (stool culture)
Advance diet as soon as tolerated
Probiotics proven to be beneficial
47
Q

Causes of infectious chronic diarrhea

A

Post infectious: Occurs after acute infection damages mucosa; recommend probiotics to facilitate recovery

Bacterial: Children treated with antibiotics

Parasites / protozoal infections

48
Q

Immune mediated cause of chronic diarrhea

A

Celiac disease
Inflammatory bowel disease
Allergic enteropathy

49
Q

Malabsorption syndromes of chronic diarrhea

A

Cystic fibrosis
Pancreatic Insufficiency
“Short gut” syndromes

50
Q

Toddler’s Diarrhea signs/symptoms

A

Chronic, painless passage of 3 or more large or unformed stools during waking hours x 4+ weeks

Normal weight gain and growth

Excessive high fructose juices intake

51
Q

Toddler’s diarrhea management

A

Stop the juices
Provide other rehydration solutions including milk and water
Increase solid foods

52
Q

Post-infectious diarrhea symptoms and management

A

Acute infection damages intestinal mucosa, causing chronic diarrhea

Still well hydrated, improves with fasting

Management

  • Hold the dairy and high fructose juices
  • Rehydration solution
  • Probiotics
  • Gradual advancement of foods
53
Q

Define constipation

A

Having a bowel movement fewer than three times per week with stools which are usually hard, dry, small in size, and difficult to eliminate

54
Q

DDX of constipation

A
  • Functional constipation (most common)
  • Hirschsprung Disease
  • Small Left Colon Disease
  • Celiac Disease
55
Q

Vicious cycle of functional constipation in children

A

Most commonly caused by painful bowel movements with resultant voluntary withholding of feces by child who wants to avoid unpleasant defecation; this causes more pain as colon dilates

56
Q

encopresis

A

leakage of stool around hard ball of stool

57
Q

Etiology of functional constipation

A 
Poor diet high in fats and low in fiber
Withholding
Pain
Embarrassment and social stress
School “Dirty Toilets”
Improper toilet training
Developmental delays / cerebral palsy
58
Q

Location of pain in functional constipation

A

periumbilical or LUQ/LLQ

59
Q

functional constipation treatment

A

Mild: Increase fluids, fiber; increase activity; may add juice; bowel training (am and post-meals)

Severe: Meds - Fleets Enemas, Miralax. Milk of Magnesia, Mineral Oil; at worst admit for Go-lytely (polyethylene glycol)

TREAT FOR 3 MONTHS!

60
Q

Etiology and pathophysiology of Hirschsprung Disease

A

Congenital aganglionic megacolon
Failure of colonic nerve cells to migrate to rectum and anus during development
Lack of neuroganglia causes the involved segment of bowel to constrict and be unable to relax
Leads to severe dilatation proximal to the affected bowel

61
Q

signs of Hirschsprung Disease

A

Sx: Failure to pass meconium during 1st 24 hours of life, consistent ribbon-like stools, +/- bilious vomiting
PE: And distension, rectal exam is “empty”

62
Q

Dx of Hirschsprung Disease

A

ano-rectal biopsy showing absence of nerve ganglion

63
Q

Treatment of Hirschsprung Disease and small left colon syndrome

A

surgical resection

64
Q

“bird’s beak” appearance of colon

A

Hirschsprung Disease

65
Q

How to differentiate between Hirschsprung Disease and Small left colon syndrome?

A

Biopsy

66
Q

Increased risk of Small Left Colon Syndrome

A

poorly controlled maternal diabetes

67
Q

Signs of incomplete development of colon

A

chronic constipation in infancy, pencil-like stools, distended abdomen, empty rectal vault

68
Q

How is small left colon syndrome dx’d?

A

Barium enema

+/- biopsy

69
Q

Differences btw functional constipation and Hirschsprung Disease?

A

Hirschsprung Disease: meconium passes > 24 hrs, vomiting, begins after birth, toxic megacolon, no stool in rectal vault, no soiling, FTT

Functional constipation: meconium passes < 24 hrs, vomit unlikely, begins with toilet training, fecal soiling, no enterocolitis, stool in rectal vault, dilated anal canal, no FTT

70
Q

How can fluids be lost in the body?

A

vomiting, diarrhea, sweating, fever, burns, polyuria

low eating/drinking

71
Q

What indicates that dehydration is compensated in infant?

A

good urination/wet diapers

Normal vitals

72
Q

Labs to eval hydration status

A

bicarb
Na, K
Urine: color, specific gravity, ketones

73
Q

Low bicarb indicates what acid/base state and GI symptom?

A

metabolic acidosis

diarrhea

74
Q

High bicarb indicates what acid/base state and GI symptom?

A

metabolic alkalosis

vomiting

75
Q

Acute volume resuscitation

A

Mild: home management, electrolyte solution (Pedialyte, Rehydralyte, Oral Rehydration Salts), fluid challenge
* No free water, apple juice, soda, +/- gatorade

Mod: IV fluid bolus, NS bolus; if good response and no vomiting send home

Severe: IV fluids, transport to ER

76
Q

Mild, moderate, severe dehydration %

A

mild: 5% (fairly asx)
moderate: 10%
severe: 15%

77
Q

Signs of severe dehydration in infant (15%)

A 
increased, thready pulse
tenting skin
No tears
Cracked oral mucosa
Sunken anterior fontanelle
Sunken eyes
Clammy skin
>3 sec cap refill
Anuria
Lethargy
78
Q

Maramus nutritional deficit and symptoms

A

Severe caloric, protein, vitamin, and mineral deprivation

Marked emaciation: loss of cutaneous fat, brittle/sparse hair, poor nail growth, diarrhea, hypothermia

79
Q

Kwashiorkor nutritional deficit and symptoms

A

Diet deficit in protein but adequate caloric intake

signs: edematous child, hepatomegaly, poor wound healing

80
Q

Effects of Vit A deficiency

A 
Lack of carotenoids
Blindness (Starts as night blindness)
Brittle hair and nails
Dry skin
Chronic diarrhea
81
Q

Effects of Vit D deficiency

A

fragile bones - Rickets

82
Q

Effects of Vit E deficiency

A

Hyporeflexia, loss of peripheral vision, peripheral neuropathy, hemolytic anemia

83
Q

Effects of Vit K deficiency

A

bleeding disorders

84
Q

All breast fed infants need Vitamin __ supplementation shortly after birth.

A

D

85
Q

Thiamine deficiency causes and effects? common in what patients?

A

“Beriberi”
Lack of whole grains, legumes, dairy
Neuro symptoms: arrhythmias, neuropathies, muscle weakness

Alcoholics / Jejunal resection

86
Q

Effects of folate deficiency

A

Macrocytic Anemia

87
Q

Effects of Cobalamin (B12) deficiency

A

Pernicious Anemia
Macrocytic anemia
Neuropathies

88
Q

How to calculate total fluid deficit?

10 kg patient who is 5% dehydrated

A
  1. 5 kg = (10 kg x .05%)

1 kg of water = 1000 mL

Thus the patient has lost 500 mL of water weight
0.5 kg x (1000 mL/kg)

Patient has total fluid deficit of 500mL

89
Q

Holliday-Segar Rule to calculate maintenance fluids

A

0 – 10 kg: 100 mL/kg per day

> 10 – 20 kg: 1000 mL + [(50 mL/kg/day) x (#kg over 10)]

> 20 kg, 1500 mL + [(20 mg/kg/day) x (#kg over 20)

90
Q

How do you know how much fluids child needs? How fast is this corrected?

A

maintenance fluids + total fluid deficit

1st half over 8 hours, then 2nd half over remaining 24 hrs (16 hrs)

ex: if 1500 mL deficit, then 90 mL/hr x 8 hrs (750 mL) and 45 mL/hr x 16 hrs (750 mL)

91
Q

How many mLs in an ounce?

A

30 mL

92
Q

Vitamin C (ascorbic acid) deficiency

A

“Scurvy”
Lack of Citrus Fruits and veggies
Small intestinal disease
Sx: Irritability, bleeding problems, bony abnormalities

93
Q

Zinc deficiency effects

A

Mutation in zinc transport protein
Incidence 1 in 500,000
Glossitis, photophobia, nail dystrophy
Acrodermatitis enteropathica

94
Q

4 yo boy with fever, cramp abdominal pain, and loose, guiac positive stool. Parents just bought him a pet turtle. dx and tx?

A

Salmonella (reptiles, exotic pets)

No abx given

95
Q

16 yo healthy adolescent boy eats left out rice. Then gets nausea, non-bilious vomiting, abd cramps and loose stool shortly after. No fever. What is dx?

A

“food poisoning” (Enterotoxin from Staph aureus or Bacillus)

ABRUBT and short-lived

96
Q

3 yo girl with apparent febrile seizure. Went on camping trip with no running water. mucoid appearing stool. Temp 101F, bicarb 20, glucose 110, white count elevated at 15,000, Guiac+ stool. Dx?

A

seizures + bloody diarrhea = Shigella

contaminated water, tenemus, painful rectal exam

97
Q

5 yo girl with 1 day of stomach ache and loose diarrhea. 4 days ago at petting zoo. Give Bactrim and sent home. 2 days later HA and nausea. Decreased urine output. BP 124/86. Likely dx?

A

HUS

due to abx treatment of E. coli 0157:H7

DDx: MAHA, thrombocytopenia, acute renal failure

98
Q

clear watery diarrhea, undercooked seafood, rapid and severe dehydration, coastal waters. what organism?

A

Vibrio cholerae

99
Q

campers, infected water source, lakes

chronic diarrhea, bloating, flatulence. what organism?

A

Giardia

100
Q

Tx for Giardia and entamoeba Histolytica

A

Flagyl (metronidazole)

101
Q

Diarrhea with recent abx use

A

C. diff

102
Q

C. diff treatment

A

stop antibiotic use, Flagyl

103
Q

Diarrhea with pork

A

Yersinia

104
Q

Charcot’s triad for ascending cholangitis

A

fever, RUQ pain, jaundice

105
Q

How is pancreatitis diagnosed?

A

upper abdominal pain that radiates to back
vomiting
elevated lipase
TG > 1000

106
Q

Loose bloody stool after eating uncooked poultry or unpasteurized milk. Dx and Tx?

A

Campylobacter

Tx: macrolides or quinolones

107
Q

Most common viral diarrhea in infants and young children

A

Rotavirus

108
Q

Giardia

A

campers, beaver dams, lakes

cysts/trophozoites in stool

109
Q

Inflammatory colitis that is continuous only from rectum to colon is _______ and colitis with “skipped” lesions that can affect any part of GI tract is _________.

A

Ulcerative colitis

Crohn’s

110
Q

Inflamm bowel disease that causes severe weight loss and growth failure.

A

Crohn Disease

Pediatrics Module (15 decks)

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