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Pediatrics > PEDS GI > Flashcards

PEDS GI Flashcards

1
Q

What causes pyloric stenosis?

A

Thickening of the pyloric muscle causes narrowing of the pyloric sphincter just above the duodenum.

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2
Q

Who is pyloric stenosis most common in?

a. first born male
b. First born female

A

first born male

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3
Q

How old is the child when they usually present with pyloric stenosis?

A

3 weeks to 4 months of age.

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4
Q

Is pyloric stenosis present at birth?

A

No, may occur in 1st week, but usually presents at 3 weeks to 4 months of age.

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5
Q

What are the signs and symptoms of pyloric stenosis?

A
  1. Projectile non-bilious vomiting (not acidic yellow color) after eating.
  2. “Hungry” after emesis, progressing to lethargy and irritability
  3. 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
  4. 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.
  5. Wt. loss, constipation, dehydration as obstruction increases.
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6
Q

Visible peristalsis from left to right across abdomen in infants is seen in:

a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GERD

A

Pyloric Stenosis

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7
Q

Palpable olive-like mass right after vomiting is seen in:

a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GERD

A

Pyloric Stenosis

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8
Q

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

A

Pyloric Stenosis

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9
Q

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

A

1st line abdominal ultrasound

2nd line GI imaging through endoscopy or barium enema, would show “string sign” (narrowed pyloric channel)

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10
Q

Where do you see “string sign” with GI imaging in children?

a. Intussusception
b. Gastroenteristis
c. Pyloric Stenosis
d. GER (gastroesophageal reflux in infancy)

A

Pyloric Stenosis

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11
Q

How is pyloric stenosis managed and what is the prognosis?

A

Refer for Surgical correction: Pyloromyotomy (laparoscopic), excellent prognosis.

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12
Q

How is feeding determined for ounces up to age 5 months in most infants?

A

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.

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13
Q

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)

A

Supine to reduce risk of SIDS

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14
Q

What is GER?

A

Gastroesophageal reflux in infants with frequent regurgitation in the absence of anything pathological. Usually goes away by 1 year of age.

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15
Q

How do you manage GER conservatively?

A

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.

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16
Q

What does thickening agents like rice cereal do for GER? how much should be mixed in the formula?

A

Rice cereal does not decrease reflux, but may decrease vomiting.
One tablespoon of rice cereal per ounce of formula.

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17
Q

How do you manage GER if conservative methods fail?

What is the first line and what is the second line? Why is follow up needed?

A

First line:
H2- receptor blockers (histamine receptor antagonists)
to inhibit gastric acid secretion caused by histamine. (The tidines, Ranitidine (zantac) Famotidine (Pepcid AC).

Second line:
PPI: to block gastric acid secretion caused by histamine, acetylcholine or gastrin (The parasols… omeprazole (Prilosec).

Follow up frequently to follow growth parameters, consider referral to GI specialist.

18
Q

Palpable olive like mass seen in _______, palpable sausage like mass seen in _______

A

Olive mass in pyloric stenosis

Sausage mass in Intussusception

19
Q

What is the classic triad presentation in intussusception?

A

Intermittent colicky abdominal pain
vomiting
Bloody mucous stools (currant jelly stools, stools composed of mucus and blood).

20
Q

Management of intussusception

A
  1. Reduction via barium/air enema under fluoroscopy, non-operative.
  2. Surgical correction
  3. Emergency surgery (common pediatric abdominal emergency)
21
Q

How old are the kids for intussusception?

A

under 2 years old, mostly males.

22
Q

Intussusception may be caused by

A

Mostly idiopathic, but can also be caused by adenovirus and rotavirus (vaccine). acute prolapse of one part of intestine into another adjacent segment of the intestine (telescoping).

23
Q

Diagnostics for intussusception:

A

barium enema diagnosis and also reduction.
radiograph to clarify diagnosis:
CBC and electrolytes: dehydration and anemia
Ultrasound: tubular mass longitudinal image, doughnut on transverse view.

24
Q

What is the main goal for gastroenteritis?

A

Correct fluid deficit and prevent electrolyte imbalance.

25
Q

How many teaspoons per pound over how many hours for
Mild dehydration:
Moderate dehydration

A

Mild dehydration: replace with 5 tspns/pound over 4 hours

Moderate dehydration: replace with 10 tsp’s/pound over 4 hours.

26
Q

Replacement fluids: how do you count it for ml/kg over how many hours?

A

Mild dehydration: 50 ml/kg over 4 hours

Moderate dehydration: 100 ml/kg over 4 hours

27
Q

Hirschsprung’s disease (aganglionic megacolon) symptoms:

A

Symptoms that may be present in newborns and infants include:

Difficulty with bowel movements
Failure to pass meconium shortly after birth
Failure to pass a first stool within 24 - 48 hours after birth
Infrequent but explosive stools
Jaundice
Poor feeding
Poor weight gain
Vomiting
Watery diarrhea (in the newborn)

Symptoms in older children:

Constipation that gradually gets worse
Fecal impaction
Malnutrition
Slow growth
Swollen belly
28
Q

When should meconium be passed, what happens if not passed?

A

within 24 - 48 hours.

If not passed can lead to Hirschsprung’s disease

29
Q

What causes Hirschsprung’s disease (aganglionic megacolon)?

A

Children with Hirschsprung’s disease are missing the nerve cells (ganglion cells) within the wall of their colon or rectum. These cells are responsible for the normal wave-like motion of the bowel (peristalsis). This lack of ganglions causes stool obstruction.

Hirschsprung’s disease is a congenital disease. That means a person is born with it. The disease may also be hereditary, which means a parent can pass it to a child.

30
Q

What lab diagnostics are needed? Select all that apply

  1. Abdominal X ray
  2. Barium
  3. Anorectal manometry
  4. Biopsy of the rectum or large intestine
A

Abdominal X-ray. A diagnostic test which may show a lack of stool in the large intestine or near the anus and dilated segments of the large and small intestine.

Barium enema. A procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and dilated intestine above the obstruction.

Anorectal manometry. A test that measures nerve reflexes which are missing in Hirschsprung’s disease.

Biopsy of the rectum or large intestine. A test that takes a sample of the cells in the rectum or large intestine and then looks for nerve cells under a microscope.

31
Q

What are the complications of hirschsprungs disease that can be fatal?

A

Enterocolitis:
Infection or inflammation of the intestines continues to be the major cause of complications in Hirschsprung’s disease.
Symptoms may worsen over the course of hours and include “explosive”, foul smelling or bloody diarrhea, abdominal distension, lethargy and fever. If a rectal exam is performed there may also be an “explosive” release of gas or stool. In some cases of enterocolitis, bacteria can enter the blood stream from the bowel to cause sepsis, a problem that can be fatal.

32
Q

The nurse practitioner is evaluating a 6-year-old admit- ted with a diagnosis of acute appendicitis. Which finding requires an immediate intervention?
A. Nausea and vomiting
B. Dry mucous membranes and scant urine output
C. Abdominal pain and cramping
D. Anorexia and constipation

A

The correct answer is B. The other options are expected clinical manifestations in patients with appendicitis. Option B indicates a complication; the patient is showing signs of dehydration secondary to the vomiting, anorexia, and decreased oral intake. This type of question asks the nurse to find something in the answer choices that requires an action or intervention.

33
Q

Appendicitis in children physical findings:

A

Physical Findings: Depends upon the stage of appendicitis
1. Observe child—may be motionless, with legs flexed
2. Tenderness localized to RLQ; intense at McBurney’s point, halfway between umbilicus and anterior superior iliac crest
3. Rebound tenderness
4. Rovsing’s sign—pain RLQ with left-side pres-
sure; highly indicative of appendicitis in
children
5. Local, right-sided tenderness or mass on rectal
examination
6. Won’t jump/difficulty ambulating
7. Obturator sign—rotating thigh may produce
pain in RLQ
8. Complete examination to rule out other causes
of abdominal pain, especially throat, chest,
testicles
9. Perforation and peritonitis within 24 to 48
hours
a. Rigidity
b. Higher fever
c. Pain improves
d. Generalized tenderness
e. Increased vomiting
f. 40% incidence in young children

34
Q

What is Rovsings sign and where is it found?

A

Rovsing’s sign—pain RLQ with left-side pressure; highly indicative of appendicitis in
children and adults

35
Q

What is Obturator sign and where is it found?

A

Obturator sign—rotating thigh may produce
pain in RLQ (think of orbiting/rotating)
Appendicitis

36
Q

What is rebound tenderness and where is it found?

What is the other name for it?

A

Rebound tenderness: Where pain is felt on the release of applied pressure upon the abdomen. felt on peritonitis and appendicitis
positive Blumberg sign: pain worse on release of hand.

37
Q

What is psoas sign and what does a positive test result indicate?

A

Pain with right thigh extension.
The patient is asked to lie on the unaffected side and extend the other leg at the hip against the resistance of the examiner’s hand. A positive psoas sign is abdominal pain with this maneuver indicating appendicitis

38
Q

What is Mcburney’s point and what does pain here indicate

A

McBurney’s point: 1/3rd or halfway between umbilicus and anterior superior iliac crest. Involuntary guarding or Pain at this point or tenderness when palpating indicates appendicitis.

39
Q

What signs should be positive for Appendicitis? What labs are ordered?

A
  1. Pain at McBurney’s point.
  2. Positive Psoas sign
  3. Positive Obturator sign
  4. rebound tenderness
  5. Rovsings sign or Blumberg sign
    Labs:
    Elevated WBC 10,000 to 20,000
    ESR elevated
40
Q

What diagnostic test for Appendicitis?

A

Ultrasound in children and CT in adults (less radiation to children)

41
Q

How do you manage Appendicitis?

A

Surgical treatment, prognosis very good.

pain management and wound healing from surgery outpatient.

42
Q

What is the Markle sign and what is it also known as?

A

The Markle sign or jar tenderness heel tap/slap test is a clinical sign in which pain in the RLQ of the abdomen is elicited by dropping from standing on the toes to the heels with a jarring landing. It is found in patients with localised peritonitis due to acute appendicitis.

Pediatrics (9 decks)

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