PEDS GI Flashcards
What causes pyloric stenosis?
Thickening of the pyloric muscle causes narrowing of the pyloric sphincter just above the duodenum.
Who is pyloric stenosis most common in?
a. first born male
b. First born female
first born male
How old is the child when they usually present with pyloric stenosis?
3 weeks to 4 months of age.
Is pyloric stenosis present at birth?
No, may occur in 1st week, but usually presents at 3 weeks to 4 months of age.
What are the signs and symptoms of pyloric stenosis?
- Projectile non-bilious vomiting (not acidic yellow color) after eating.
- “Hungry” after emesis, progressing to lethargy and irritability
- visible peristalsis from left to right across abdomen - darken room, shine bright light on abdomen of naked, supine baby, feed bottle of sugar water, peristaltic waves visible
- Palpable pyloric olive after vomiting - palpate epigastrium in RUQ deep under liver edge, need very relaxed abdomen; hard smooth mobile, non tender mass may be palpable.
- Wt. loss, constipation, dehydration as obstruction increases.
Visible peristalsis from left to right across abdomen in infants is seen in:
a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GERD
Pyloric Stenosis
Palpable olive-like mass right after vomiting is seen in:
a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GERD
Pyloric Stenosis
Projectile Vomiting right after eating that is non-bilious and hungry right after vomiting is seen in:
a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GERD
Pyloric Stenosis
What is the 1st line diagnostic test to determine size of pylorus in pyloric stenosis? What if 1st line is not diagnostic, what would you use and what would you see?
a. Ultrasound
b. X-ray
c. CT
d. GI imaging
1st line abdominal ultrasound
2nd line GI imaging through endoscopy or barium enema, would show “string sign” (narrowed pyloric channel)
Where do you see “string sign” with GI imaging in children?
a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GER (gastroesophageal reflux in infancy)
Pyloric Stenosis
How is pyloric stenosis managed and what is the prognosis?
Refer for Surgical correction: Pyloromyotomy (laparoscopic), excellent prognosis.
How is feeding determined for ounces up to age 5 months in most infants?
age in months + 3 = number of ounces every 3 - 4 hrs for most infants till 5 months.
So a 2 month old will have 2 + 3= 5 oz. every 3-4 hrs.
How should infants be laid to sleep when they have GER?
a. Supine (chest up and back down)
b. Prone (back up and chest down)
Supine to reduce risk of SIDS
What is GER?
Gastroesophageal reflux in infants with frequent regurgitation in the absence of anything pathological. Usually goes away by 1 year of age.
How do you manage GER conservatively?
Conservative Therapy:
Small, frequent thickened feeding with rice cereal, burp frequently during feeding continue to breast feed, place supine to sleep, post prandial prone position for 1-2 hours if infant can be observed.
What does thickening agents like rice cereal do for GER? how much should be mixed in the formula?
Rice cereal does not decrease reflux, but may decrease vomiting.
One tablespoon of rice cereal per ounce of formula.