Peds GI Flashcards
Pyloric stenosis- Eti
- Narrowing outlet of stomach- fails to relax after meal
- Unknown cause
- 3:1000
- M>F
- Fam hx
Pyloric stenosis- Sx
- 2-4 wks of age
- Post-prandial distension, visible peristaltic wave
- Olive like mass
- Regurgitation, nonbilious vomiting, projectile
- Hungry
- severe dehydration, lytes imbalance, oliguria
Pyloric stenosis- Dx
- Upper GI with barium: sting sign
- US
Pyloric stenosis- Tx
- Most common cause for surg
Intussusception- Eti
- Telescoping of bowel into distal segment
- Most common cause of intestinal obstruction in 1st 2 yrs
- Idiopathic
Intussusception- Sx
- Current jelly stool - 12 hrs
- V/D
- Severe cycles of pain, appear well between
- Sausage shaped mass
- Tender to palpation, distension
Intussusception- Dx
- Saline/ contrast/ air enema
- 3% risk of recurrence
Intussusception- Tx
- Enema to reduce
- Surgery if perforation, peritonitis, necrosis
Intussusception- Tx
- Enema to reduce
- Surgery if perforation, peritonitis, necrosis
Meconium Ileus- Eti
- Bowel obstruction from thickened meconium
- CF until proven otherwise
Meconium Ileus- Sx
- Normal wt
- Distended abd
- Failure to pass meconium
- Loops of thick, distended bowel on exam
Meconium Ileus- Dx
- Abd film: Soap bubble in RLQ
- Gold standard: Water soluble contrast enema
- Sweat chloride for CF
Meconium Ileus- Tx
- Enema
- NG suction
- IV fluids
Meconium Ileus- Tx
- Enema
- NG suction
- IV fluids
Malrotation- Eto
- Twisting of intestinal loop due to embryonic development
- Partial or complete obstruction
Volvulus- Eti
Complication of malrotation- 50% children
- Sm bowel around mesenteric artery
- Ischemia & necrosis
Malrotation/ Volvulus- Sx
- Look well then ill quickly
- Extreme pain
- Hemodynamic deterioration
- Bulging typanic mass
- Frank blood per rectum
Malrotation/ Volvulus- Sx
- Look well then ill quickly
- Extreme pain
- Hemodynamic deterioration
- Bulging tympanic mass
- Frank blood per rectum
Malrotation/ Volvulus- Dx
- ABd xray: coffee bean sigmoid
- Double bubble sign- dilated stomach & duodenum
- UGI: corkscrew
- Barium: birds beak
Malrotation/ Volvulus- Dx
- ABd xray: coffee bean sigmoid
- Double bubble sign- dilated stomach & duodenum
- UGI: corkscrew
- Barium: birds beak
Malrotation/ Volvulus- Tx
- Decompression
- Abx
- Surgery if ischemic
Malrotation/ Volvulus- Tx
- Decompression
- Abx
- Surgery if ischemic
Hirschprungs- Eti
- Failure of enteric NS to develop
- Absence of ganglion in colon- absence of peristalsis
- M>W
- ## Down syndrome assoc
Hirschprungs- Sx
- Failure to pass meconium
- Vomiting, abd distension, no feeding
- Enterocolitis: fever, inflammation, diarrhea
- Ischemia, perforation & sepsis
- Fecal masses, peristalsis palpable
Hirschprungs- Dx
Abd film: loops of distended bowel, retained stool
- Barium enema- narrowed, irregular
Hirschprungs- Tx
- Resection of aganglionic segment
Inperforate anus- Eti
- Infra or supralevator
- Infra in girls, supra in boys
- Abn anorectal termination
- M>W
- Tethered spinal cord, GI abn assoc with
Inperforate anus- Sx
- Bilous vomiting
- ## Lack of anal opening
Inperforate anus- Sx
- Bilous vomiting
- Lack of anal opening
Inperforate anus- Tx
Surgery
Constipation- Eti
- Peak during pre-school
- 3-5% of visits
- BMs change with age
- Organic: dietary, structural, metabolic, skeletal or psych
Constipation- Sx
- Distended abd
- Stool in distended rectum
- Hemoccult testing
Constipation- Dx
2 for 1 to 2 months:
- 2 or fewer BM /week
- 1 episode of incontinance
- Hx of retention
- Hx of painful or hard bowels
- Presence of mass in recturm
- Large diameter of stools obstruction toilet
Constipation- Dx
2 for 1 to 2 months:
- 2 or fewer BM /week
- 1 episode of incontinance
- Hx of retention
- Hx of painful or hard bowels
- Presence of mass in recturm
- Large diameter of stools obstruction toilet
Constipation- Tx
- Remove impaction
- Increase fiber/ liquids
- Laxatives
Anal fissure- Eti
- Most common cause of rectal bleeding
Anal fissure- Sx
- Crying with defecation
- BRBPR
- See fissure
Anal fissure- Tx
- Tx underlying constipation
- Sitz baths
Encopresis- Eti
- Repeated passage of feces in inappropriate places
- > 4 yrs, not related to med disorder
- 1% school aged
- Boy>girls
Encopresis- Sx
- Retentive most common- Constipation with overflow
- Continuous- never gained control over bowel function
- Discontinuous- hx of normal control, loss during stress
- Toile phobia- frightening structure, fear of being swept down
Encopresis- Sx
- Retentive most common- Constipation with overflow
- Continuous- never gained control over bowel function
- Discontinuous- hx of normal control, loss during stress
- Toile phobia- frightening structure, fear of being swept down
Encopresis- Tx
- Tx underlying cause
Colic- Eti
- 9-17%
- Idiopathic
- Benign/ self limited
- 2 wks - 3 months
Colic- Sx
- Paroxysmal crying- in afternoon and evening
- Minmal response to soothing
- Cries for > 3 hrs/ day, >3days / week, > 3 weeks
Colic- Tx
- Parental support, reassurance
- Take breaks from baby
Colic- Tx
- Parental support, reassurance
- Take breaks from baby
Normal Amt of crying
- 2 hrs at 2 wks
- 3 hrs at 6 wks
- 1 hd by 3 months
Normal Amt of crying
- 2 hrs at 2 wks
- 3 hrs at 6 wks
- 1 hd by 3 months
Recurrent abd pain- Eti
- 1/ mo x 3 mo
- Affects activities
- 4-6 yrs of age
- Organic v fxn, organic
