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clin med IV > peds GI > Flashcards

peds GI Flashcards

1
Q

when does pyloric stenosis occur

A
  • weeks 3-5

- rare after 12 weeks

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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
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3
Q

diagnosis of pyloric stenosis

A
  • US
  • endoscopy- only if US inconclusive
  • labs to assess for dehydration
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4
Q

treatment of pyloric stenosis

A
  • correct hydration status first*

- ranstedt pyloromyotomy

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5
Q

intussusception

A
  • invagination/ telescoping of intestines into itself

- most common cause of obstruction in 6 mo- 3 yrs

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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
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7
Q

etiology of intussusception

A
  • mostly idiopathic
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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
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9
Q

triad of intussusception

A
  • pain
  • palpable mass
  • currant jelly stool
  • only occurs in 15% of pts
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10
Q

dx of intussusception

A
  • clinical dx or suspcion
  • xray: mainly r/o obstruction
  • US
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11
Q

US findings for intussusception

A
  • bull’s eye
  • coiled spring
  • doppler -> poor/ absent perfusion
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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
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13
Q

what should you do if a patient has spontaneous or intermittent intussusception

A
  • refer to surgery
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14
Q

phenylketonuria (PKU)

A
  • def of phenylalanine hydroxylase (PAH) -> inability to bkdn phenylalanine to tyrosine
  • autosomal recessive disorder
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15
Q

clinical manifestations of PKU

A
  • intellectual disability*
  • epilepsy
  • abnormal gait
  • blood and urine may smell “mousy”
  • pigmentation issues
  • eczema
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16
Q

dx of PKU

A
  • routine newborn screening at birth

- dried blood sample from heel

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17
Q

treatment of PKU

A
  • dietary restriction of phenylalanine
  • start tx ASAP- within one week of life
  • frequent monitoring of phenylalanine
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18
Q

how often do you monitor phenylalanine levels

A
  • weekly for first year
  • twice a month for years 1-12
  • monthly after 12
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19
Q

appendicitis in kids < 5

A
  • listless, feverish
  • diffuse pain
  • anorexia, vomiting
  • rebound, guarding
  • typically present with perf
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20
Q

appendicitis in kids 5-12

A
  • abd pain
  • anorexia, vomiting
  • +/- migratory pain to RLQ
  • much more common than kids < 5
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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
Q

post-op care for appendicitis

A
  • pain control
  • typically d/c post op day 1 if not ruptured
  • 3-5 days IV abx if perfed
26
Q

normal stooling patterns in newborns

A
  • within 36 hours of birth
27
Q

normal stooling patterns of 0-3 mo old

A
  • 3-4 stools/day
28
Q

normal stooling patterns of kids < 2 y/o

A
  • 1-2 stools/day
29
Q

normal stooling patterns by age 4

A
  • 1/day
30
Q

organic causes of constipation

A
  • anatomic causes
  • metabolic causes
  • neuropathic
  • intestinal nerve or muscle disorders
  • food intolerance*
  • heavy metal ingestion, meds
31
Q

functional causes of constipation

A
  • painful defecation
  • toilet training issues
  • dietary issues*
  • trauma
32
Q

tx for constipation

A
  • 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
Q

encoparesis

A
  • involuntary leakage of stool into underwear
  • +/- constipation
  • occurs more frequently in males, kids over 4
34
Q

possible causes of encoparesis

A
  • trauma
  • neurologic: peripheral vs central
  • psychologic
35
Q

when does encoparesis typically occur

A
  • time of toilet training
  • teasing about stooling
  • school onset- poop avoidance
  • times of social stress at home/ school
36
Q

dx of encoparesis

A
  • 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
Q

tx of encoparesis

A
  • a lot of miralax
  • use stool softeners
  • scheduled toileting
  • parental and pt education
38
Q

hirschprung’s disease

A
  • congenital genetic abnormality
  • incomplete migration of neural cells in myenteric submucosal plexus
  • part of colon lacks ganglion cells
39
Q

where does hirschprung’s disease usually occur

A
  • rectosigmoid
40
Q

what does the affected colon of hirschprung disease look like

A
  • constricted

- normal proximal segment gets distended

41
Q

si/sx of hirschprung in a newborn

A
  • failure to have complete stool
42
Q

si/sx of hirschprung in a child

A
  • swollen belly
  • vomiting
  • constipation
  • diarrhea
  • failure to thrive
  • fatigue
43
Q

dx of hirschprung

A
  • biopsy*- gold std
  • manometry of anorectum
  • barium enema
  • xray
44
Q

treatment of hirschprung

A
  • surgical excision of affected area

- anastamosis of healthy ends

45
Q

meckel’s diverticulum

A
  • congenitl diverticulum of small intestine
46
Q

what is the rule of 2’s

A
  • used for meckels
  • 2% of population
  • 2:1 males to females
  • 2 years old
  • 2 ft proximal to ileocecal valve
  • 2 inches long
47
Q

treatment of meckel’s diverticulum

A
  • excision

- treat any assoc pathology

48
Q

clinical presentation of meckel’s

A
  • usu asymtpomatic** incidental finding
  • GIB
  • intestinal obstruction
  • peritonitis
  • diverticulitis
  • appendicitis
  • fistulae
  • bezoar
49
Q

malrotation

A
  • congenital anomaly of mid gut
  • sm intestine on R side of abdomen
  • cecum displaced into epigastric region
  • ligament of treitz displaced
50
Q

sequelae of malrotation

A
  • fibrous bands form -> obstruction
  • narrow base of small intestine -> volvulus
  • volvulus -> ischemia -> perf
51
Q

clinical manifestations of malrotation

A
  • asymptomatic
  • sx of volvulus or obstruction
  • bilious vomiting
  • abd pain and distension
  • melena and/or mucousy stool
52
Q

diagnosis of malrotation

A
  • clinical suspicion
  • surgery
  • abd xray- may show obstruction
  • UGI series if non-emergent (cork screw appearance of distal duodenum)
  • contrast enema

clin med IV (23 decks)

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