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Clin Med Peds > Peds GI > Flashcards

Peds GI Flashcards

1
Q

pyloric stenosis more common in what gender and what child?

A

males and first born child

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2
Q

at what age is pyloric stenosis typically seen and at what age is it rare? kids born with it?

A

seen 3-5 weeks of life

rare after 12 weeks

KIDS ARE BORN WITH THIS AND IT WORSENS VERY QUICKLY

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3
Q

causes of pyloric stenosis?

A

don’t know

  • multifactorial
  • genetic predisposition
  • environmental (mom doing something that causes thickening of the pyloric musculature)

Erythromycin in first 2 weeks of life or late pregnancy

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4
Q

symptoms of pyloric stenosis?

A

PROJECTILE VOMITING AFTER EATING (Hallmark)
-nonbilious

Weight loss (b/c vomiting up food)

HUNGRY AFTER VOMITING

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5
Q

what is found on PE for pyloric stenosis?

A

Palpable OLIVE at the lateral edge of the rectus abdomens muscle RUQ (where pyloric is) - felt best after vomitting

peristaltic waves may be visualized pre-emesis

child is thin or emaciated

may have jaundice from starvation

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6
Q

what is the GOLD STANDARD for dx of Pyloric Stenosis?

A

U/S

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7
Q

when do you do endoscopy for Pyloric Stenosis?

A

if U/S or UGI is inconclusive

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8
Q

lab studies for Pyloric Stenosis

A

Check electrolytes to measure dehydration status

CBC (anemia)
CMP (LFTs, electrolytes)

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9
Q

what is seen on U/S of pyloric stenosis?

A

thickening and elongation of the pyloric

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10
Q

what’s the first treatment for pyloric stenosis

A

First - correct hydration status (Fluids)

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11
Q

what is the surgical treatment of pyloric stenosis?

A

Pyloromyotomy

-relieves the constriction

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12
Q

what is intussusception?

A

invagination of the colon into itself

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13
Q

at what age is intussusception most commonly seen?

A

3 months - 5 y/o

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14
Q

site of intussusception is typically near what junction in the colon?

A

ileocecal junction

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15
Q

how does intussusception occur?

A

(1) Have surgery and then have adhesions, which cause catch point
(2) Proximal bowel segment telescopes into distal segment
(3) Associated mesentery dragged along
(4) Venous and lymphatic congestion
(5) Intestinal edema -> POSSIBLE ischemia and perforation peritonitis

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16
Q

what causes intussusception?

A

75% of cases of intussusception are ideopathic

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17
Q

Pain in intussusception is…

A

sudden, severe, crampy, progressive

kids looks sick and in pain

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18
Q

Child in intussusception is…

A

inconsolable, LEGS DRAWN UP, episodes last 15-20min

non-bilious vomiting post pain but may worsen to bilious

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19
Q

what’s the HALLMARK of intussusception?

A

Child has legs drawn up b/c having cramps and trying to relieve it

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20
Q

b/w episodes of intussusception, what are the s/s?

A
  • normal and pain free
  • stool may contain gross or occult blood
  • CURRENT JELLY STOOL (mucous)
  • may feel sausage shaped abd mass in R side of abd
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21
Q

what is the TRIAD of intussusception?

A

pain, palpable mass, current jelly stool (only 15% present with this triad)

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22
Q

when is x-ray done for dx of intussusception? what is seen on x-ray?

A

to r/o obstruction or other dx

see lack of colonic gas with massively distended loops of bowel (air levels under the diaphragm)

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23
Q

what signs on x-ray on seen for intussusception?

A

Target sign

Crescent sign

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24
Q

what is the Target sign for intussusception?

A

over right kidney (peritoneal fat surrounding intuss)

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25
Q

what is the Crescent sign for intussusception?

A

soft tissue density protruding into gas of large bowel

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26
Q

how is dx of intussusception usually made?

A

Clinically

-kids go from looking fine to looking they like they are in extreme pain

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27
Q

what is the GOLD STANDARD for dx of intussusception? what’s seen on it?

A

U/S
-classic appearance is “bull’s eye” or “coiled spring”

-Doppler may show poor/absent perfusion

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28
Q

what is the non-operative treatment for intussusception?

A

Give barium enema or pneumatic air pressure to release the intussusception

done under fluoroscopic or U/S guidance

SURGEON MUST BE PRESENT FOR YOU TO DO IT IN CASE OF PERFORATION

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29
Q

what is the treatment of choice in intussusception stable pt w/out signs of perforation?

A

Non-operative tx

-barium enema

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30
Q

when is the surgical tx for intussusception indicated?

A

if failed non-operative approach

suspected or proven perforation or bowel necrosis

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31
Q

whether acute or intermittent and presently asymptomatic intussusception, who MUST you consult?

A

Surgery

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32
Q

what is Phenylketonuria (PKU)?

A

a d/o that affects the amino acid Phenylalanine

deficiency of Phenylalanine Hydroxylase (PAH) - can’t break down phenylalanine to tyrosine -> INCREASE PHENYLALANINE -> INTELLECTUAL DISABILITY

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33
Q

what does an increased phenylalanine lead to and interfere with?

A

leads to intellectual disability

interferes with brain growth, myelination, and neurotransmitter synthesis

HAVE NEUROLOGIC COMPLICATIONS

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34
Q

etiology of PKU?

A

autosomal recessive genetic mutation

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35
Q

what are the clinical findings in PKU in patients that are untreated?

A
  • mental disability and impaired IQ
  • epilepsy
  • abnormal gait
  • pigmentation issues (decreased pigment - hair, eyes, skin)
  • eczema
  • blood and urine may smell “mousy”
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36
Q

what do the blood and urine smell like in PKU?

A

“mousy”

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37
Q

how do you dx PKU?

A

newborn screening at birth

done on dried blood sample obtained from heel (like in CF)

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38
Q

when should tx for PKU be initiated?

A

by 1 week of life (ASAP)

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39
Q

what’s the tx for PKU?

A

eliminate phenylalanine from your life completely

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40
Q

how long is the tx for PKU?

A

throughout life

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41
Q

what needs to be monitored in PKU?

A

levels of phenylalanine

42
Q

when is the monitoring for phenylalanine levels in PKU?

A
  • weekly first year of life
  • twice a month years 1-12
  • monthly after age 12 for life
43
Q

how <5 y/o kids present with appendicitis?

A

fever, diffuse pain, anorexia, vomiting, rebound guarding

HAVE PERFORATED APPENDIX

44
Q

how do kids 5-12 y/o present with appendicitis?

A
  • abd pain, anorexia and vomitting
  • maybe migratory paining RLQ
  • KEEP high level of suspicion
45
Q

temperature of kids with appendicitis?

A

low grade 100.2-101 F

46
Q

how may kids with appendicitis appear?

A

limping or bending over

tired or irritable

47
Q

wha are the appendicitis diagnostics in kids?

A
  • CBC/diff (elevated WBCs and polys - left shift)
  • UA (r/o UTI, see sterile pyuria)
  • UHCG (r/o pregnancy in child bearing girls)
48
Q

if moderate risk of appendicitis, do you go further with workup?

A

NO

49
Q

when do you consider U/S for appendicitis? also consult who?

A

if young, thin, female or male that are at less than or equal to moderate risk after exam and labs

consult pedi surgeon

50
Q

when consider CT w/out rectal contrast for appendicitis?

A
  • U/S inconclusive
  • not a good U/S candidate
  • the surgeon requests the CT
51
Q

what is high risk appendicitis? what to do if high risk?

A

classic exam, classic hx, classic labs

  • surgeon may take to OR immediately
  • consult surgeon
52
Q

what’s the tx for NON-PERFORATED appendicitis before the OR?

A
  • Fluids
  • Pain control (anti-pyretics, anti-emetics)
  • NPO (4-6 hrs before surgery)
  • Pre-op abx (cefoxitin, but ask surgeon)
53
Q

what’s the tx for PERFORATED appendicitis?

A

May get admitted for a couple of days before surgery

  • fluids, pain control, NPO
  • Abx Triples (amp/gent/flagyl)
54
Q

what abx used for perforated appendicitis?

A

amp/gent/flagyl

55
Q

when is surgery for appendicitis?

A

6-8 hrs of dx if non-perforated

24-48 hrs of IV abx first if perforated

56
Q

post-op appendicitis tx

A
  • Pain control
  • PO when pt awake
  • d/c post-op day 1 if not ruptured
  • 3-5 days IV abx if perforated
57
Q

never ask a kid you think is constipated what?

A

are you constipated?

58
Q

what should you ask the kid that you think is constiapted?

A

what are the stools like? (give choices)

59
Q

what’s the normal stooling pattern of newborn?

A

normal stool w/in 36 hours

60
Q

what’s the normal stooling pattern of 0-3 months?

A

3-4 stools/day

61
Q

what’s the normal stooling pattern < 2 y/o?

A

1-2 per day

62
Q

what’s the normal stooling pattern by 4 y/o?

A

1 per day

63
Q

what are organic causes of constipation in kids?

A

Anatomic, metabolic, Neuropathic, Intestinal nerve, Abd musculature d/o, Food intolerance

64
Q

what are functional causes of constipation in kids?

A

Painful defecation (so don’t poop and get constipated)

Toilet training issues (fighting toilet training)

Dietary issues (cheese, milk, etc.)

65
Q

what’s the tx of constipation in kids?

A

treat the cause

ensure enough fluids, dietary fiber

NO COW’S MILK UNTIL 1 Y/O

Don’t force toilet training

66
Q

what are kids NOT ALLOWED to have before 1 y/o? why?

A

COW’S MILK

-will have micro bleeding in their intestines -> can cause significant anemia

67
Q

interventional tx for constipation in infants

A

Glycerine suppository (only works at the rectum)

Lubricated thermometer

68
Q

interventional tx for constipation in older children

A
  • glycerine suppository
  • Miralax
  • enema
  • laxative
69
Q

what is Encopresis?

A

the involuntary leakage of stool into the underpants with or w/out constipation

70
Q

what gender gets Encopresis?

A

males

71
Q

what is the MOST COMMON cause of Encopresis?

A

Constipation

-causes leakage of watery stool from cecum and proximal colon

72
Q

is Encopresis dangerous?

A

NO, but it is serious and is socially stigmatizing and causes a vicious cycle

73
Q

when does Encopresis occur?

A

around times of toilet training, teasing about stooling and a school onset (pooping avoidance)

can be at times of social stress at home/school

74
Q

Encopresis is a ___ dx

A

psychiatric dx

75
Q

criteria for Encopresis dx?

A

(1) Voluntary/involuntary passage of stool outside of bathroom or diaper
(2) One event a month for at least 3 months
(3) >4 y/o
(4) Stooling not a result of laxative or illness involving colon such as colitis, etc.

76
Q

tx of Encopresis

A

Clean out: LOTS OF MIRALAX (or other laxative, enema, etc.)

Stool softeners

Scheduled stooling

Parental and patient education

GET KIDS ON THE CYCLE OF REALLY POOPING

77
Q

what is Hirschprung’s disease?

A

congenital genetic abnormality
-mutations of the RET pro-oncogene

-incomplete migration of neural cells in the myenteric and submucosal plexus

78
Q

what part of the colon lack in Hirschprung’s disease? what does this result in?

A

Part of the colon LACKS GANGLION CELLS

Results in the affected segment constriction, thus the normal PROXIMAL segment becomes distended with feces

79
Q

where in the colon does Hirschprung’s disease most commonly occur?

A

rectosigmoid

80
Q

newborn s/s of Hirschprung’s disease

A

failure to complete stooling or stool

81
Q

child s/s of Hirschprung’s disease

A
  • swollen belly/distended, vomiting, constipation, diarrhea

- failure to thrive (b/c not eating well), fatigue

82
Q

what’s the GOLD STANDARD dx of Hirschprung’s disease?

A

Bx

83
Q

dx of Hirschprung’s disease

A

X-ray -> Barium enema (shows huge rectosgimoid colon) -> bx and looking for aganglion cells

84
Q

tx of Hirschprung’s disease?

A

surgical excision of the affected area with anastomosis of the healthy ends

85
Q

what is Meckel’s diverticulum?

A

congenital diverticulum of the small intestine

86
Q

what’s the Rule of 2’s for Meckel’s?

A 
2% of population
2:1 males to females
2 y/o M/C time of presentation
2 feet proximal to the ileocecal valve
2 inches in length
87
Q

most common age for Meckel’s?

A

2 y/o

88
Q

where is Meckel’s seen? what is also here?

A

2 feet proximal to the ileocecal valve

appendix is also here, so if 18 y/o male and pain in RLQ then probably appendicitis

89
Q

how is Meckel’s typically diagnosed?

A

incidentally - b/c most children asymptomatic

90
Q

if Meckel’s symptomatic, what may they present with?

A

GI bleeding, intestinal obstruction, diverticulitis, bezoar

91
Q

how is Meckel’s treated?

A

with excision

92
Q

what is Malrotation?

A

intestines are rotated

congenital anomaly of the mid gut that occurs embryologically

93
Q

what is situs inverses

A

everything is inverted

94
Q

where are small intestines found in malrotation?

A

small intestine found on right side abdomen

95
Q

where is cecum found in malrotation?

A

cecum displaced into epigastric region

96
Q

what else is displaced in malrotation besides small intestines and cecum?

A

ligament of treitz

97
Q

what forms in malrotation?

A

fibrous bands leading to obstruction

narrow base of small intestine -> volvulus

98
Q

what is volvulus?

A

twisting that can cause ischemia, perforation, death

99
Q

how do infants with malrotation present?

A

Infants present with sx’s of volvulus or obstruction

  • BILIOUS vomiting
  • abd pain (fussy, crying, not eating/drinking)
  • abd distention
  • melena and/or mucous stool
100
Q

if have clinical suspicion of malrotation, what is the dx?

A

surgery

101
Q

may support suspicions of malrotation with what?

A
  • abd x-ray (obstruction)
  • UGI series (if not emergent) - see corkscrew appearance of the distal duodenum
  • contrast enema if very doubtful

Clin Med Peds (10 decks)

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