peds GI Flashcards
when does pyloric stenosis occur
- weeks 3-5
- rare after 12 weeks
clinical manifestations of pyloric stenosis
- post prandial non-bilious projectile vomiting
- hungry after vomiting
- may appear thin or emaciated
- palpable olive in RUQ/ epigastric region
diagnosis of pyloric stenosis
- US
- endoscopy- only if US inconclusive
- labs to assess for dehydration
treatment of pyloric stenosis
- correct hydration status first*
- ranstedt pyloromyotomy
intussusception
- invagination/ telescoping of intestines into itself
- most common cause of obstruction in 6 mo- 3 yrs
pathogenesis of intussusception
- usu near ileocecal junction
- prox bowel segment and messentary telescope into distal segment
- fluid congestion and edema -> possible ischemia -> perf
etiology of intussusception
- mostly idiopathic
clinical manifestations of intussusception
- 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
triad of intussusception
- pain
- palpable mass
- currant jelly stool
- only occurs in 15% of pts
dx of intussusception
- clinical dx or suspcion
- xray: mainly r/o obstruction
- US
US findings for intussusception
- bull’s eye
- coiled spring
- doppler -> poor/ absent perfusion
treatment of intussusception
- non-operative most common
- enema with hydrostatic or pneumatic pressure (risk of perf), usu successful
- surgery if failed non-operative
what should you do if a patient has spontaneous or intermittent intussusception
- refer to surgery
phenylketonuria (PKU)
- def of phenylalanine hydroxylase (PAH) -> inability to bkdn phenylalanine to tyrosine
- autosomal recessive disorder
clinical manifestations of PKU
- intellectual disability*
- epilepsy
- abnormal gait
- blood and urine may smell “mousy”
- pigmentation issues
- eczema
dx of PKU
- routine newborn screening at birth
- dried blood sample from heel
treatment of PKU
- dietary restriction of phenylalanine
- start tx ASAP- within one week of life
- frequent monitoring of phenylalanine
how often do you monitor phenylalanine levels
- weekly for first year
- twice a month for years 1-12
- monthly after 12
appendicitis in kids < 5
- listless, feverish
- diffuse pain
- anorexia, vomiting
- rebound, guarding
- typically present with perf
appendicitis in kids 5-12
- abd pain
- anorexia, vomiting
- +/- migratory pain to RLQ
- much more common than kids < 5
other clinical manifestations of appendicitis
- temp low grade: 100.2- 101
- limp or bend over
- complain of hip pain
- tired or irritable
- NO rectal exam
dx of appendicitis
- 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
tx of non-perfed appendicitis
- fluids
- pain control, anti-pyretics, anti-emetics
- NPO
- pre op abx- usu cefoxitin
- surgery- usu within 6-8 hours
tx of perfed appendicitis
- fluids
- pain control, anti-emetics, anti-pyretics
- NPO
- amp/ gent/ flagyl
- surgery
- surgeon may want 34-48 hours of IV abx before surgery
post-op care for appendicitis
- pain control
- typically d/c post op day 1 if not ruptured
- 3-5 days IV abx if perfed
normal stooling patterns in newborns
- within 36 hours of birth
normal stooling patterns of 0-3 mo old
- 3-4 stools/day
normal stooling patterns of kids < 2 y/o
- 1-2 stools/day
normal stooling patterns by age 4
- 1/day
organic causes of constipation
- anatomic causes
- metabolic causes
- neuropathic
- intestinal nerve or muscle disorders
- food intolerance*
- heavy metal ingestion, meds
functional causes of constipation
- painful defecation
- toilet training issues
- dietary issues*
- trauma
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
encoparesis
- involuntary leakage of stool into underwear
- +/- constipation
- occurs more frequently in males, kids over 4
possible causes of encoparesis
- trauma
- neurologic: peripheral vs central
- psychologic
when does encoparesis typically occur
- time of toilet training
- teasing about stooling
- school onset- poop avoidance
- times of social stress at home/ school
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
tx of encoparesis
- a lot of miralax
- use stool softeners
- scheduled toileting
- parental and pt education
hirschprung’s disease
- congenital genetic abnormality
- incomplete migration of neural cells in myenteric submucosal plexus
- part of colon lacks ganglion cells
where does hirschprung’s disease usually occur
- rectosigmoid
what does the affected colon of hirschprung disease look like
- constricted
- normal proximal segment gets distended
si/sx of hirschprung in a newborn
- failure to have complete stool
si/sx of hirschprung in a child
- swollen belly
- vomiting
- constipation
- diarrhea
- failure to thrive
- fatigue
dx of hirschprung
- biopsy*- gold std
- manometry of anorectum
- barium enema
- xray
treatment of hirschprung
- surgical excision of affected area
- anastamosis of healthy ends
meckel’s diverticulum
- congenitl diverticulum of small intestine
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
treatment of meckel’s diverticulum
- excision
- treat any assoc pathology
clinical presentation of meckel’s
- usu asymtpomatic** incidental finding
- GIB
- intestinal obstruction
- peritonitis
- diverticulitis
- appendicitis
- fistulae
- bezoar
malrotation
- congenital anomaly of mid gut
- sm intestine on R side of abdomen
- cecum displaced into epigastric region
- ligament of treitz displaced
sequelae of malrotation
- fibrous bands form -> obstruction
- narrow base of small intestine -> volvulus
- volvulus -> ischemia -> perf
clinical manifestations of malrotation
- asymptomatic
- sx of volvulus or obstruction
- bilious vomiting
- abd pain and distension
- melena and/or mucousy stool
diagnosis of malrotation
- clinical suspicion
- surgery
- abd xray- may show obstruction
- UGI series if non-emergent (cork screw appearance of distal duodenum)
- contrast enema
