peds GI Flashcards
1
Q
when does pyloric stenosis occur
A
- weeks 3-5
- rare after 12 weeks
2
Q
clinical manifestations of pyloric stenosis
A
- post prandial non-bilious projectile vomiting
- hungry after vomiting
- may appear thin or emaciated
- palpable olive in RUQ/ epigastric region
3
Q
diagnosis of pyloric stenosis
A
- US
- endoscopy- only if US inconclusive
- labs to assess for dehydration
4
Q
treatment of pyloric stenosis
A
- correct hydration status first*
- ranstedt pyloromyotomy
5
Q
intussusception
A
- invagination/ telescoping of intestines into itself
- most common cause of obstruction in 6 mo- 3 yrs
6
Q
pathogenesis of intussusception
A
- usu near ileocecal junction
- prox bowel segment and messentary telescope into distal segment
- fluid congestion and edema -> possible ischemia -> perf
7
Q
etiology of intussusception
A
- mostly idiopathic
8
Q
clinical manifestations of intussusception
A
- sudden, severe pain
- crampy
- may be progressive or self resolving
- inconsolable, legs drawn up
- episodes last 15-20 min
- non bilious vomiting
- stool may be bloody and with blood- currant jelly stool
- sausage shaped mass
9
Q
triad of intussusception
A
- pain
- palpable mass
- currant jelly stool
- only occurs in 15% of pts
10
Q
dx of intussusception
A
- clinical dx or suspcion
- xray: mainly r/o obstruction
- US
11
Q
US findings for intussusception
A
- bull’s eye
- coiled spring
- doppler -> poor/ absent perfusion
12
Q
treatment of intussusception
A
- non-operative most common
- enema with hydrostatic or pneumatic pressure (risk of perf), usu successful
- surgery if failed non-operative
13
Q
what should you do if a patient has spontaneous or intermittent intussusception
A
- refer to surgery
14
Q
phenylketonuria (PKU)
A
- def of phenylalanine hydroxylase (PAH) -> inability to bkdn phenylalanine to tyrosine
- autosomal recessive disorder
15
Q
clinical manifestations of PKU
A
- intellectual disability*
- epilepsy
- abnormal gait
- blood and urine may smell “mousy”
- pigmentation issues
- eczema
16
Q
dx of PKU
A
- routine newborn screening at birth
- dried blood sample from heel
17
Q
treatment of PKU
A
- dietary restriction of phenylalanine
- start tx ASAP- within one week of life
- frequent monitoring of phenylalanine
18
Q
how often do you monitor phenylalanine levels
A
- weekly for first year
- twice a month for years 1-12
- monthly after 12
19
Q
appendicitis in kids < 5
A
- listless, feverish
- diffuse pain
- anorexia, vomiting
- rebound, guarding
- typically present with perf
20
Q
appendicitis in kids 5-12
A
- abd pain
- anorexia, vomiting
- +/- migratory pain to RLQ
- much more common than kids < 5
21
Q
other clinical manifestations of appendicitis
A
- temp low grade: 100.2- 101
- limp or bend over
- complain of hip pain
- tired or irritable
- NO rectal exam
22
Q
dx of appendicitis
A
- CBC with diff
- UA, HCG
- if mod risk additional work up not usually needed
- consider US if young, thin, no more than mod risk
- CT without rectal contrast
23
Q
tx of non-perfed appendicitis
A
- fluids
- pain control, anti-pyretics, anti-emetics
- NPO
- pre op abx- usu cefoxitin
- surgery- usu within 6-8 hours
24
Q
tx of perfed appendicitis
A
- fluids
- pain control, anti-emetics, anti-pyretics
- NPO
- amp/ gent/ flagyl
- surgery
- surgeon may want 34-48 hours of IV abx before surgery
25
post-op care for appendicitis
- pain control
- typically d/c post op day 1 if not ruptured
- 3-5 days IV abx if perfed
26
normal stooling patterns in newborns
- within 36 hours of birth
27
normal stooling patterns of 0-3 mo old
- 3-4 stools/day
28
normal stooling patterns of kids < 2 y/o
- 1-2 stools/day
29
normal stooling patterns by age 4
- 1/day
30
organic causes of constipation
- anatomic causes
- metabolic causes
- neuropathic
- intestinal nerve or muscle disorders
- food intolerance*
- heavy metal ingestion, meds
31
functional causes of constipation
- painful defecation
- toilet training issues
- dietary issues*
- trauma
32
tx for constipation
- tx cause*
- ensure enough fluids, fiber
- no cows milk until age 1
- dont force toilet training
- glycerine suppository or lubricated thermometer
- miralax
- enema, laxative
33
encoparesis
- involuntary leakage of stool into underwear
- +/- constipation
- occurs more frequently in males, kids over 4
34
possible causes of encoparesis
- trauma
- neurologic: peripheral vs central
- psychologic
35
when does encoparesis typically occur
- time of toilet training
- teasing about stooling
- school onset- poop avoidance
- times of social stress at home/ school
36
dx of encoparesis
- psych dx
- voluntary/ involuntary passage of stool outside of bathroom or diaper
- one event for at least 3 mo
- age > 4
- stooling not d/t laxatives or illness
37
tx of encoparesis
- a lot of miralax
- use stool softeners
- scheduled toileting
- parental and pt education
38
hirschprung's disease
- congenital genetic abnormality
- incomplete migration of neural cells in myenteric submucosal plexus
- part of colon lacks ganglion cells
39
where does hirschprung's disease usually occur
- rectosigmoid
40
what does the affected colon of hirschprung disease look like
- constricted
| - normal proximal segment gets distended
41
si/sx of hirschprung in a newborn
- failure to have complete stool
42
si/sx of hirschprung in a child
- swollen belly
- vomiting
- constipation
- diarrhea
- failure to thrive
- fatigue
43
dx of hirschprung
- biopsy*- gold std
- manometry of anorectum
- barium enema
- xray
44
treatment of hirschprung
- surgical excision of affected area
| - anastamosis of healthy ends
45
meckel's diverticulum
- congenitl diverticulum of small intestine
46
what is the rule of 2's
- used for meckels
- 2% of population
- 2:1 males to females
- 2 years old
- 2 ft proximal to ileocecal valve
- 2 inches long
47
treatment of meckel's diverticulum
- excision
| - treat any assoc pathology
48
clinical presentation of meckel's
- usu asymtpomatic** incidental finding
- GIB
- intestinal obstruction
- peritonitis
- diverticulitis
- appendicitis
- fistulae
- bezoar
49
malrotation
- congenital anomaly of mid gut
- sm intestine on R side of abdomen
- cecum displaced into epigastric region
- ligament of treitz displaced
50
sequelae of malrotation
- fibrous bands form -> obstruction
- narrow base of small intestine -> volvulus
- volvulus -> ischemia -> perf
51
clinical manifestations of malrotation
- asymptomatic
- sx of volvulus or obstruction
- bilious vomiting
- abd pain and distension
- melena and/or mucousy stool
52
diagnosis of malrotation
- clinical suspicion
- surgery
- abd xray- may show obstruction
- UGI series if non-emergent (cork screw appearance of distal duodenum)
- contrast enema
