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z S15 HEHI 4 > peds gi > Flashcards

peds gi Flashcards

1
Q

cleft lip

A

congenital fissure in the upper lip

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2
Q

cleft palate

A

congenital fissure in either the soft palate alone or both hard and soft palates

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3
Q

most common craniofacial malformation

A

cleft lip with or without cleft palate

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4
Q

cleft lip: pathophysiology

A

occurs at 6 weeks gestation

- maxillary process fails to merge with the medial nasal elevation on one or both sides

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5
Q

cleft lip: when does it occur?

A

6 weeks gestation

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6
Q

cleft palate: pathophysiology

A

occurs 7 to 12 weeks gestation

- lateral palatine processes fail to meet and fuse with each other, the primary palate, or nasal septum

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7
Q

cleft palate: when does it occur?

A

7 to 12 weeks gestation

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8
Q

cleft lip/palate: etiology

A
  • multifactorial mode of inheritance
  • maternal nutrition: FOLIC ACID
  • maternal medication 1st trimester
  • occurrence of fever, flu 1st trimester
  • maternal prenatal cigarette smoking
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9
Q

cleft lip/palate: clinical manifestations

A

generally evident at birth, if not:

  • feeding difficulties
  • chronic upper airway congestion/infection
  • 7 to 14% have other anomalies!
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10
Q

cleft lip/palate: therapeutic management

A
  • team approach!
  • surgical repair PRIORITY ideally before child speaks
    cleft lip @ 10 wks or 10 lbs
    cleft palate @ 6 months
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11
Q

cleft lip: when should surgical repair be done?

A

10 weeks or 10 pounds

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12
Q

cleft palate: when should surgical repair be done?

A

6 months

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13
Q

nutrition considerations for babies with cl/cp

A
  • inability to suck = possible undernutrition
  • elevate head during feeds
  • special nipples
  • gentle, steady pressure on bottle base
  • frequent burping
  • daily weight: nutritional eval, fluid volume status
  • nipple way back in oral cavity
  • breck feeder
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14
Q

breck feeder

A

syringe with feeding tube expansion appropriate for feeding babies with difficulty feeding due to cl/cp

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15
Q

significance of otitis media and cleft palate

A

improper middle ear drainage due to inefficient eustachian tube function s/t cp = increased middle ear pressure

  • recurrent otitis media
  • can lead to HEARING IMPAIRMENT
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16
Q

tracheoesophageal fistula aka

A

esophageal atresia

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17
Q

tef/esophageal atresia

A

aka tracheoesophageal fistula (tef)

failure of trachea to differentiate and separate from esophagus into separate, distinct structures

failure of esophagus to develop as continuous passage

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18
Q

tef/esophageal atresia % affected with associated anomalies

A

30-40%

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19
Q

tef/esophageal atresia: clinical manifestations

A
  • inability to swallow saliva, increase in drooling, frothy saliva in mouth/nose
  • gastric tube/suction catheter can’t be passed
  • choking, cyanosis with feedings; cyanotic or apneic s/t aspiration
  • recurrent pneumonia (typically will be caught before this)
  • triad: excessive secretions, reflux, respiratory distress
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20
Q

tef/esophageal atresia: hallmark sx triad

A

excessive secretions + reflux + respiratory distress

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21
Q

tef/esophageal atresia: diagnosis

A

diagnose before feeding by catching clinical s/s

xray after passing radiopaque catheter into esophagus

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22
Q

tef/esophageal atresia: classic presentation

A

significant choking, cyanosis with feeds

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23
Q

tef/esophageal atresia: why frequent suctioning?

A

keeps blind pouch empty; secretions develop even though it is a pouch!

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24
Q

tef/esophageal atresia: gastric decompression

A

catheter in blind pouch to low wall suction, g tube inserted and open to drain

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25
Q

tef/esophageal atresia: suction considerations

A

prn with EXTREME CAUTION

- possible interference with fresh postop repair!

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26
Q

tef/esophageal atresia: post operative feeding considerations

A

with no connection between sucking and satiety, oral aversion is possible; no drive to eat

  • start g tube feeds slowly
  • start oral feeds slowly after healed
  • feeding difficulties not uncommon! MONITOR!
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27
Q

hernia

A

protrusion of organ through an abnormal opening; become dangerous when constriction leads to impaired circulation or impaired respiration

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28
Q

when do abdominal wall defects occur?

A

3rd week of gestation

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29
Q

omphalocele

A

herniation of abdominal contents through umbilical ring; intact peritoneal sac

75%ish survival (associated anomalies)

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30
Q

gastroschisis

A

herniation of abdominal contents lateral to umbilical ring, no peritoneal sac

85-100% survival

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31
Q

abdominal wall defects: therapeutic management

A

high risk of infection!! cover with sterile wrap, give abx

IVFs to prevent fluid loss

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32
Q

umbilical hernia

A

incomplete fusion of umbilical ring where umbilical vessels leave abdominal wall.

most common type of hernia. complications rare. surgery if still present at 2-3 years.

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33
Q

most common type of hernia

A

umbilical hernia

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34
Q

surgery on umbilical hernia when?

A

if still present at 2-3 years

35
Q

congenital diaphragmatic hernia

A

SIGNIFICANT!

diaphragm not completely formed allowing intestines and/or organs to enter thoracic cavity; restricted lung growth due to competition for space

36
Q

cdh: manifestations

A

acute respiratory distress during newborn period; can have significant decreased cardiac output + possible shock

37
Q

cdh: prenatal diagnosis

A

media stinal shift, see loops of bowel in chest wall

- ideally picked up in week 20 ultrasound

38
Q

cdh: postnatal diagnosis

A

chest x-ray = loops of bowel in chest

39
Q

cdh: management

A
  • respiratory support via hood or intubation (no bagging because that can introduce air into stomach which will then go into bowel!)
  • gi decompression via ngt
  • hob elevated
40
Q

cdh: possible associated outcomes

A

chronic lung disease, gastroesophageal reflux, growth failure

41
Q

inguinal hernia

A

protrusion of small intestines/fluid into groin through a weakness or tear in the abdominal wall

m>f ; premie > term

42
Q

inguinal hernia: manifestation

A

mass in groin, can present as painless inguinal swelling; CAN be painful

sac is present at birth but inguinal hernia may not manifest until 2-3 months

43
Q

inguinal hernia may not manifest until…

A

2-3 months, though sac IS present at birth

44
Q

inguinal hernia: surgical considerations

A

put surgery off until 10 pounds because bigger, stronger babies do better in surgery

surgery is outpatient and not very scary!

45
Q

hirschsprung’s disease aka

A

congenital aganglionic megacolon

46
Q

hirschsprung’s disease

A

congenital anomaly that results in mechanical obstruction from inadequate motility in part of the intestine; no innervation = no peristalsis AND decreased relaxation of internal rectal sphincter; collapsed rectum can also result

megacolon occurs due to obstruction in portion directly above part of tract with no ennervation

47
Q

hirschsprung’s: pathophys*

A

absence of autonomic parasympathetic ganglion cells (of the submucosal plexus of Meissner and the myenteric Auerbauch plexus) in one or more segments of the colon

48
Q

hirschsprung’s: clinical manifestations - newborn

A

41-64%; abdominal distension, vomiting, no meconium in 48 hours

big, shiny basketball tummy

49
Q

hirschsprung’s: clinical manifestations - older infancy/childhood

A

21-35%/15-26%

chronic constipation, ftt, foul smelling and ribbonlike stools, abdominal distension

50
Q

hirschsprung’s: classic poo for infancy/childhood diagnosis*

A

foul smelling and ribbonlike*

51
Q

hirschsprung’s: stage I management

A

surgical removal of aganglionic bowel, temporary 6 mo ostomy over stretched out area - it needs to rest

52
Q

hirschsprung’s: stage II management

A

8mo - 1yo -OR- 20 lbs

“pull” the end of intact bowel down to rectum for reanastomosis

53
Q

hirschsprung’s: stage III management

A

closure of colostomy, usually 3 mo after stage II

54
Q

hirschsprung’s: conservative therapy for mild

A

occasional enemas, develop regular poo pattern, at continued risk for development of enterocolitis

(population with mild sx very small)

55
Q

enterocolitis

A

inflammation of bowel, esp small intestine

signs: explossive, watery diarrhea, fever, appears significantly ill

56
Q

hirschsprung’s: high risk for…?

A

SEPSIS! (prior to surgery)

57
Q

acute intestinal obstruction: manifestation

A
  • abdominal pain
  • distension
  • nausea, vomiting
  • change in stool
58
Q

pyloric stenosis: manifestations*

A

early, nonbilious vomiting beginning around 3 weeks of age, progressing to projectile

olive shaped mass in epigastrum palpable*; can see waves of peristalsis too

59
Q

pyloric stenosis: classic sign*

A

olive shaped mass in epigastrum palpable*

60
Q

pyloric stenosis

A

narrowing of the pyloric sphincter at the outlet of the stomach, obstructing the flow of food into the small intestines

61
Q

pyloric stenosis: pathophys

A

muscle of pyloric sphincter becomes thick, elongated, narrowing the pyloric channel

62
Q

pyloric stenosis: manifestations*

A

early, nonbilious vomiting beginning around 3 weeks of age, progressing to projectile

olive shaped mass in epigastrum palpable*; can see waves of peristalsis too

63
Q

epigastrum

A

upper, central region of abdomen

64
Q

pyloric stenosis: diagnosis

A
  • often made by hx, pe
  • ultrasound
  • possible metabolic alkalosis, severe volume depletion
65
Q

pyloric stenosis: metabolic consideration

A

metabolic alkalosis possible, correct before surgery!

66
Q

pyloric stenosis: postop considerations

A
  • feed 4-6 hours after
  • vomiting is not uncommon
  • manage pain
67
Q

intussusception

A

telescoping of the bowel upon itself

after fixing, only 10% reoccur

68
Q

intussusception: acute clinical manifestations

A

triad!

  • pain: sudden onset of crampy abdominal pain
  • sausage shaped abdominal mass
  • currant jelly stool
69
Q

intussusception: triad - what & when

A

pain, sausage, currant jelly stool

if ACUTE intussusception

70
Q

intussusception: chronic clinical manifestations

A

diarrhea, anorexia, weight loss, vomiting, periodic pain

71
Q

intussusception: therapeutic management

A

barium/hydrostatic reduction (ie, enema) - 75% success
surgical manipulation
surgical resection

72
Q

ger considered gerd when these complications are seen

A

failure to thrive, anorexia, irritability, recurrent pneumonia (aspirating feedings)

73
Q

celiac disease

A

permanent intestinal intolerance to dietary wheat and related proteins that produce mucosal lesions in genetically susceptible individuals

malabsorption syndrome second to cf in cause of malabsorption in children

74
Q

celiac disease: clinical manifestations

A
  • impaired fat absorption (steatorrhea, foul-smelling poo)
  • impaired nutrient absorption (malnutrition, muscle wasting esp in legs/butt, anemia, anorexia, abdominal distension)
  • behavioral changes (irritable, uncooperative, apathy)
75
Q

celiac disease: diagnosis & tx

A

withdraw gluten from diet = full remission of sx

tx 100% dietary management

76
Q

steatorrhea

A

excessively largel pale, oily, frothy stools

- see in children with celiac disease

77
Q

gastroesophageal reflux

A

?

78
Q

ger: diagnostic eval

A

upper gi swallow study

79
Q

ger: therapeutic management

A

feed at higher angle, sit up 30 min after feeds, feed small amount more often, burp a lot, med management possible

80
Q

ger: therapeutic management

A

feed at higher angle, sit up 30 min after feeds, feed small amount more often, burp a lot, med management possible, nissen fundoplication

81
Q

nissen fundoplication

A

after eating, environment, medication management all tried

stomach is its own cardiac sphincter! (wrap around bottom of esophagus)

82
Q

gastroesophageal reflux

A

transfer of gastric contents into esophagus; physiologic phenomenon occurring throughout the day (most frequently after meals and at night)

usually resolves spontaneously by 1 year of age

83
Q

ger vs gerd

A

gerd is sx/tissue damage that result FROM ger. ger -> gerd when complications seen:
- failure to thrive, bleeding, dysphagia, anorexia, irritability, recurrent pneumonia (aspirating feedings)

84
Q

silo

A

mesh used to house omphalocele that is extremely large or that can’t be pushed back into abdominal cavity because cavity is small.

can be suspended using mild tension. antibacterial ointment applied to prevent infection. compressed on a daily basis. ideally accomplished within 7 to 10 days.

z S15 HEHI 4 (7 decks)

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