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Summer Disciplines 3 > Peds GI > Flashcards

Peds GI Flashcards

1
Q

What is esophageal atresia

A

An esophageal pouch that doesn’t actually lead to the stomach; may or may not have a fistula connection to the trachea
MC fistula is between distal esophagus and trachea
M>F

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2
Q

How does congenital esophageal atresia present

A 
Polyhydramnios (in utero) 
Copious secretions, choking, cyanosis, and respiratory distress within hours of birth (slower presentation with fistula) 
Excess saliva 
Choke and cough with oral feeding 
Can't pass orogastric tube to stomach 
Cyanosis or PNA form GI secretions
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3
Q

How do you diagnose EA

A

Prenatal US, then MRI
Postnatal CXR after NG placement (tip in blind pouch)
If fistula is distal to esophagus, XR will show gas in bowel (no fistula= no gas)

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4
Q

How do you treat EA

A

NG tube in proximal pouch on low intermittent suction
Elevate head of bed to prevent reflux
IV glucose, fluids, O2
Surgery

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5
Q

When is mortality with EA the highest

A

When infant <2000g or with serious heart defects

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6
Q

How do most esophageal FB resolve

A

Spontaneously pass- most are ASx

MC 6mo-3 y/o

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7
Q

Most common FB Sx are

A 
Dysphagia 
Odynophagia 
Drooling 
Regurgitation
CP 
Abd pain 
(other: cyanosis, drooling, wheezing, stridor, choking)
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8
Q

What is the MC FB ingested

A

coin!
Visible on neck, chest, or abd XR
Protect the airway and give continuous suction

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9
Q

When would you retrieve a FB

A

If it is a button battery (emergency!! 2 hrs to perforation)
If it has not passed into stomach
If they are multiple magnets

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10
Q

How do you remove a FB

A

Endoscopic retrieval if in esophagus

if in stomach, watch for 24-48 hours if it passes. If not, endoscopic removal

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11
Q

Why are multiple magnets dangerous

A

Can lead to fistula formation in bowel wall

Surgical intervention

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12
Q

What is the difference between GER and GERD

A

GER is uncomplicated recurrent spitting and vomiting that resolves spontaneously
GERD is when reflux causes secondary Sx or complications (FTT, food refusal, GI bleeding, U/L airway Sx)

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13
Q

When does reflux occur

A

During LE sphincter relaxation if:

Small stomach capacity, large volume feedings, short esophageal length, supine positioning

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14
Q

Sx of reflux are

A

postprandial regurg (effortless or forceful)- MC infant Sx

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15
Q

How do you Tx reflux

A

should resolve spontaneously in by 12-18 mo.

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16
Q

High risk individuals for GERD are

A 
Asthmatics 
CF
Developmental handicaps 
hiatal hernia 
repaired TE fistula
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17
Q

Complications of GERD are

A

esophagitis
recurrent PNA/cough
dental erosions

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18
Q

Sx of GERD in older kids are

A

Dysphagia, heart burn

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19
Q

Warning signs for GERD that warrant further workup are

A 
bile stained emesis (obstruction)
GI bleeding 
Onset vomiting after 6 months 
FTT
diarrhea, fever, hepatosplenomegaly 
Abd ttp/distention 
Neuro changes
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20
Q

How do you diagnose GERD

A

Clinically!

Upper GI series is not a test for GERD

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21
Q

How do you treat GERD

A

Spontaneous resolution by 12 mo. old in 85%
Thicken feeds w/ oatmeal (1tbsp/2oz formula)
Milk/Sy free diet for 2 weeks
H2 blocker/PPI
Surgery: Nissen fundoplication

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22
Q

Pros and Cons to PPI

A

Pro: significantly heal and improve GERD Sx w/in 8-12 weeks
Con: high risk infection w/ long term use

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23
Q

Two MC complications of Eosinophilic Esophagitis are

A

Esophageal food impaction

Esophageal stricture

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24
Q

Sx of Eosinophilic Esophagitis are

A

Feeding dysfunction
Non-specific GERD Sx
Long meal times (have to wash food down w/ liquids)
Avoid highly textured foods
No response to GERD Tx
FHx of atopy, asthma, dysphagia, or food impaction

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25
Q

How do you diagnose Eosinophilic Esophagitis

A

Endoscopy!
Esophageal mucosa thickening, fissures, strictures, and rings
Esophagus sprinkled w/ pinpoint white exudates (looks like candida) made of eosinophils

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26
Q

How do you Tx Eosinophilic esophagitis

A

Eliminate food allergens

Swallow topical steroids (2 puffs fluticasone BID) and do NOT rinse mouth. Avoid eating

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27
Q

What is Pica

A

Eating non-nutritive substances (animal feces, clay, dirt, hair, ice, paint, sand) for at least 1 month, inappropriately to developmental level
Associated w/ iron and zinc deficiency
Can also be a manifestation of iron deficiency anemia

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28
Q

What labs should you get for Pica

A

CBC

Zinc and Lead levels

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29
Q

How do you treat Pica

A

Address nutrient deficiency or lead poisoning
Behavioral therapy
Family Education

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30
Q

What is rumination

A

repeated regurg and re-chewing of food, MC 3-12 mo. old

In older kids, associated w/ depression and ED

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31
Q

Rumination can lead to

A 
Malnutrition 
FTT
Weight loss 
Bad breath 
Tooth caries
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32
Q

CHO malabsorption can be due to

A 
Lactose intolerance (celiac disease, transient gastroenteritis) 
Lactose deficiency (cystic fibrosis)
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33
Q

Fat malabsorption is associated with

A

Cystic fibrosis

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34
Q

Protein malabsorption is associated with

A

Cystic fibrosis

Milk protein allergy (cow milk, even soy milk)

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35
Q

How does malabsorption present

A 
weight loss
malnutrition 
diarrhea/steatorrhea 
n/v
abdominal pain
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36
Q

How can you assess malnutrition

A

stool sample, substance removal challenge, or work up celiac disease or cystic fibrosis

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37
Q

What is the MC inborn error of amino acid metabolism

A

Phenylketonuria;
Auto Recessive d/o where Phenylalanine hydroxylase has decreased activity, so phenylalanine does not get converted to tyrosine= build up of Phenylalanine

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38
Q

How does PKU present clinically

A 
Intellectual disability (MC*) 
Fair skin and hair (impaired melanin synthesis) 
Atopic dermatitis 
Hyperactivity 
Seizures 
Musty odor 
Epilepsy
39
Q

When is intervention preferred with PKU

A

as early as possible for best outcome!

This is why PKU is part of the newborn screen

40
Q

How can you treat PKU

A

*Diet restriction of phenylalanine and aspartame (<6mg/day)
Tyrosine supplementation
Eliminate high protein foods (legumes, meat, dairy, nuts)
Restrict starches
Essential AA, vitamin, and mineral supplementation

41
Q

What are most kids allergic to

A 
Cow's milk
Fruit (citrus, strawberry) 
Veggies (tomato) 
Egg
Fish
Nuts
Cereals
42
Q

What mediated food allergies

A

IgE- Sx in min-hours

43
Q

How do food allergies manifest

A

Urticaria and angioedema
Allergic rhinitis, pruritis, lip/tongue swelling, irritation
Asthma, Anaphylaxis
N/V, abdominal pain, cramping, diarrhea

44
Q

How do you diagnose a food allergy

A

In vivo IgE against specific foods (skin test)
In vitro for IgE (radioallergosorbent testing-FEIA)
Remove and re-challenge
Clinical reactivity vs IgE antibodies
-BUT- food allergen testing overestimates the prevalence!

45
Q

How do you treat food allergies

A

Avoid and re-introduce annually
Epinephrine
H1 blocker

46
Q

What is celiac disease

A

Immune mediated enteropathy triggered by gluten (wheat, barley, rye)
Causes abd pain and bloating, diarrhea, vomiting, +/- constipation
associated oral ulcers, pruritic rash, growth/puberty delay, iron deficiency anemia, decreased BMD, and arthritis

47
Q

RF for celiac disease are

A 
T1DM 
Down syndrome 
Turner syndrome 
AI thyroiditis 
FHx of celiac disease
48
Q

What are GI manifestations of celiac disease

A

6-24 mo old with poor weight gain, diarrhea, abd distention

older kids w/ chronic abd pain, v/d, constipation, bloating- may be confused w/ lactose intolerance or IBS

49
Q

Non-GI manifestations of celiac disease are

A

delayed puberty, short stature, delayed menarche

50
Q

How do you diagnose celiac disease

A 
serology 
duodenal biopsy (villous atrophy, increased intraepithelial lymphocytes)
51
Q

How do you treat celiac disease

A

gluten restrict for life
intestinal mucosa improves in 6-12 mo.
supplement calories, vitamins, and minerals in acute phase

52
Q

What are some abdominal wall defects

A

Gastroschisis and Omphalocele
M>F
usually discovered on pre-natal US in 1st trimester; also shows high AFP!!

53
Q

Complications of gastroschisis and omphalocele are

A

GERD
Volvulus
Malabsorption
-Must deliver via c-section for surgical correction after birth

54
Q

What is an Omphalocele

A

Hernia of abdominal contents into base of umbilical cord, covered by a membrane (can also contain liver and spleen)
MC with extreme gestation ages (<20 or >40)

55
Q

What is Gastroschisis

A

Herniation of intestines through abdominal wall to RIGHT of umbilical cord, w/o a sac covering them

56
Q

What factors are increasing the prevalence of Gastroschisis

A

illicit drug use (meth, cocaine)
ASA/Ibuprofen use during pregnancy
Young maternal age

57
Q

What are the types of congenital hernias

A 
Inguinal hernias (direct or indirect) 
Umbilical hernia 
Femoral hernia 
Diaphragmatic hernia 
-Can be reducible, Incarcerated (bad), or Strangulated (worse bc of vascular compromise)
58
Q

Info about diaphragmatic hernias

A

usually LEFT sided 2/2 posterolateral diaphragm defect
8-10 weeks gestation
Diagnosed on prenatal US
May be associated with polyhydramnios

59
Q

How do diaphragmatic hernias present

A

Respiratory distress (retractions, cyanosis, grunting) in first min-hours of life
+/- aggressive resuscitation
Scaphoid abdomen (caves in) and Barrel chest
Decreased BS on ipsilateral side (PTX!)
Dysmorphisms
Chromosomal abnormalities

60
Q

What CXR findings are associated with diaphragmatic hernia

A

bowel loops seen in chest w/ mediastinal shift to opposite side on CXR

61
Q

How do you treat a diaphragmatic hernia

A

Intubation
Mechanical vent
Decompress GI tract with OG tube
Surgery to reduce abd contents and close diaphragm once infant is stable and pulm HTN/compliance improve (24-48 hours after birth)

62
Q

Long term complications of diaphragmatic hernia are

A 
Pulmonary HTN 
Severe GER/GERD 
behavior problems 
hearing loss
poor growth
63
Q

What is an indirect inguinal hernia

A

passes lateral to deep epigastric vessels but IN the inguinal canal
MC than direct! also MC in children (M>F)
Usually on RIGHT side

64
Q

What is a direct hernia

A

Passes medial and inferior to deep epigastric vessels and does NOT go through inguinal canal
2/2 to weakness in Hasselbach triangle or s/p indirect hernia repair later in life
NOT common in kids!

65
Q

What are the borders of Hasselbach’s triangle**

A

Lateral: inferior epigastric artery
Medial: lateral border of rectus abdominis
Inferior: inguinal ligament

66
Q

What is a femoral hernia

A

Follows tract below inguinal ligament, through femoral canal
Medial to femoral vein, Lateral to lacunar ligament
Frequently become incarcerated or strangulated
MC in women!!

67
Q

What is an umbilical hernia

A

MC in full term, african american babies
Contents go through umbilical fibromuscular ring
Most regress spontaneously, esp. if fascial defect is <1cm
If they last past 4 y/o, repair surgically

68
Q

What is pyloric stenosis

A

post-natal muscular hypertrophy of pylorus leading to gastric outlet obstruction
MC in first born kids, and caucasians
M>F
Low mortality rate!

69
Q

What are Sx of pyloric stenosis

A

Projectile vomiting but hungry vomiters- they want to eat but can’t keep it down
Start around 3-6 weeks old
Upper abd distention after feeding
prominent peristaltic waves
Olive mass: 5-15mm mass in RUQ, more prominent after vomiting. This is the stricture!

70
Q

How do you diagnose pyloric stenosis

A 
Pyloric US (hypOechoic muscle ring >4mm w/ hyperdense center and channel length >15mm) 
Barium upper GI (string sign**, contrast retained in tummy)
71
Q

What is String sign

A

long, narrow pyloric channel w/ double track of barium

pyloric stenosis

72
Q

How do you treat pyloric stenosis

A

Surgical repair: Pyloromyotomy

Good outcome, but higher risk for chronic abd pain in adulthood

73
Q

What is duodenal atresia

A

blind pouch or stenosis of the duodenum
associated w/ trisomy 21
Causes *bilious vomiting hours after birth, dehydration, weight loss, electrolyte abnormalities

74
Q

How do yuo diagnose and treat duodenal atresia

A

Abd XR: double bubble sign dilated stomach and proximal duodenum
Surgical correction

75
Q

What is short bowel syndrome

A

condition resulting from reduced intestinal absorptive surface
Causes alteration in intestinal function= compromised growth, fluid/electrolyte balance, or hydration status

76
Q

When does short bowel syndrome usually occur

A

S/p surgical resection of intestines (necrotizing enterocolitis, intestinal atresia, gastroschisis, volvulus, intussusception)

77
Q

Sx of short bowel syndrome are

A

diarrhea
dehydration
electrolyte or micronutrient deficiency
excess gas, foul smelling stool

78
Q

How do you Tx short bowel syndrome

A 
we want to promote growth so: 
diet, TPN, G tube, meds to slow motility, antacids/H2 blocker/PPI 
Abx to prevent or Tx bacterial growth 
Surgery 
last resort: intestine transplant
79
Q

What is intussusception

A

telescoping of one segment of intestine into another segment MCC of bowel obstruction <2 y/o
Starts at ileocecal valve usually
M>F

80
Q

What causes intussusception

A 
**Idiopathic!!** 85%
Viral (rotavirus) 
Meckel diverticulum
Small bowel polyp
carcinoma
celiac disease 
crohn's 
henoch-schonlein purpura
81
Q

Is there a rota virus vaccine

A

yes but they should only be given to infants w/ pre-existing GI conditions not on immunosuppressives

82
Q

What are Sx of Intussusception

A

Recurrent paroxysms of abdominal pain (screaming, drawing up knees) in previously healthy infants
intermittent, severe cramping abdominal pain followed by vomiting/diarrhea
Red current jelly poop
palpable right sided sausage shaped mass
NO right sided and cecal gas shadow on abd XR

83
Q

How do you diagnose intussusception

A

Abd XR: target sign (2 concentric radiolucent circles superimposed)
Barium and air enema (diagnostic AND therapeutic!)
**US

84
Q

When should you NOT reduce intussusception by enema

A

if there are signs of strangulated bowel, perforation, or toxicity

85
Q

How do you treat intussusception

A

Non-operative reduction (contrast enema, hydrostatic pressure, pneumatic pressure)
*Air enema best in stable pt (best if w/in 24 hrs)
-low risk of bowel perforation and recurrence
Surgery if non-op reduction unsuccessful, or if there is a mass present

86
Q

What is Hirschsprung disease

A

When an area of the colon does not have ganglionic cells
Causes a functional obstruction=massive dilation and accumulation of gas and feces
Associated with trisomy 21

87
Q

How does Hirschsprung disease present

A

Newborn does not pass meconium, then has vomiting, abdominal distention, and reluctance to feed
Constipation
Empty, contracted distal rectum
Bilious emesis
DRE causes explosive expulsion of gas and stool
Older kids: constipation, foul smelling gas, ribbon stools, no visible stool on anal and rectal exam

88
Q

How do you diagnose Hirschsprung disease

A
  • Rectal Bx: lack of neurons, absent ganglion cells in submucosal and muscular layers of bowel
  • Plain XR: dilated proximal colon, no gas in pelvic colon
  • Barium enema: Dilated colon, narrow distal segment w/ sharp transition to proximal dilated but normal colon
  • Anorectal manometry
89
Q

How do you treat Hirschsprung disease

A

Surgically remove anganglionic bowel w/ temp colostomy

Surgical reconstruction

90
Q

MC long term complications of Hirschsprung disease are

A

*Fecal incontinence

Fecal retention, constipation, enterocolitis

91
Q

What is Meckel’s diverticulum

A

out-pouching or bulge lower part of small intestine- Leftover internal umbilical cord
Contains cells from stomach and pancreas= secretes acid= causes ulcers and bleeding

92
Q

What is the rule of 2’s (Meckel’s)

A 
2% of population 
M:F is 2:1
50% of complications in first 2 years of life 
within 2 feet from ileocecal valve 
2 inches in length
93
Q

How does Meckel’s present

A 
ASx 
PainLESS lower GI bleeding
Can look like appendicitis!! 
Recurrent atypical intussusception 
obstruction
94
Q

How do you diagnose and treat Meckel’s

A

Arteriography or CTA, Meckel’s scan (radionuclide scan)

Surgical resection if symptomatic

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