Peds GI Flashcards
causes of projectile vomit
obstruction, pyloric stenosis, GERD
bilious vomit
green is pathologic!
Obstruction beyond the duodenal ampulla of Vater
Treatment of GER
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)
Most common cause of non-bilious vomiting in infants
overfeeding
typical infant needs 100-120 kcal/kg/day
Pathophysiology of GER
immature LES muscle, so passive vomiting after feeds
How is GERD different than GER?
projectile vomiting
weight loss
abd distention
DDX of GERD in infants
milk protein allergy
anatomical problem
eosinophilic esophagitis
How to dx GERD?
primarily clinical
upper GI pH probe
Pathophysiology of pyloric stenosis
hypertrophy of pylorus muscle (elongated and thickened) eventually it can obstruct gastric outlet to duodenum
What age does pyloric stenosis usually occur?
4-6 weeks old; rarely after 12 weeks
palpable “olive-shaped” mass in RUQ
pyloric stenosis
Vomit of pyloric stenosis patient?
non-bilious
projectile
coffee ground appearance
Classic lab findings of pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
How is pyloric stenosis dx’d?
Abdominal U/S: Hypertrophic Pylorus
Upper GI: string sign
Tx of pyloric stenosis
surgical - pyloromyotomy
What is necrotizing enterocolitis (NEC) and who gets it?
inflamm of intestinal wall in premature and SGA infants
signs/sx’s of necrotizing enterocolitis (NEC)
Bilious vomiting, poor feeding, abdominal distention in premature neonate
NEC diagnosis
KUB XR: Dilated bowel, pneumatosis of the intestines (air within bowel wall)
NEC treatment
Bowel rest
Restore Fluid and electrolyte status
Often need surgical resection
Pathophysiology of midgut volvulus
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
signs/sxs of midgut volvulus and malrotation
Sudden onset severe abdominal pain, distension, and bilious vomiting
Can present as cyclic vomiting in an older child
dx of midgut volvulus
Corkscrew appearance of duodenum/jejunum
Small bowel completely on right
currant jelly stools =
intussusception
How is midgut volvulus different than NEC
occurs at any age (NEC only premies)