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NURP 502 - Ex 3 > Peds GI > Flashcards

Peds GI Flashcards

1
Q

What are the concerns if there are high pitched bowel sounds?

A

early peritonoits
gastroenteritis
intestinal obstruction

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2
Q

What are the concerns if there are absence of bowel sounds?

A

peritonitis

intestinal obstruction

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3
Q

Which areas should be dull to percussion vs tympany?

A

dull along right costal margin 1-3 cm below margin of liver

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4
Q

What are the 4 peritoneal signs?

A

rebound tenderness
obturator sign - flex hip w/ knee bent, internal hip rotation
psoas- lying on left side flex and extend right leg
Rovsing’s sign- palpation of LLQ causes RLQ pain

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5
Q

What is Dunphy’s sign?

A

Increased abd pain with cough, appendicitis

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6
Q

Markle sign?

A

stand on tip toes and fall onto heels

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7
Q

Murphy’s sign?

A

Have p breathe in and out to check for hepatomegaly, then have them breathe deeply in again, if gallbladder is inflamed they will c/o pain or stop inhaling due to pain of inflamed capsule

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8
Q

What are the pediatric risk factors for dehydration?

A
  1. increased extracellular fluid % and increase in body water compared to adults
  2. increased basal metabolic rate
  3. increased body surface area
  4. immature renal function
  5. increased insensible fluid loss through temp elevation
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9
Q

Cause of isotonic/isonatremic dehydration?

A

simple diarrhea

fluid loss not balanced by intake, sodium and water loss equal

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10
Q

Cause of hypotonic/hyponatremic diarrhea?

A

massive loss of water nad salt in stool, oral replacement with water only
-sodium loss greater than water

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11
Q

Cause of hypertonic/hypernatremic diarrhea?

A

vomiting and diarhea with decreased water intake

-greater water loss than salt loss

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12
Q

What are the steps to calculate daily maintenance fluid requirements?

A
  1. weight in kg
  2. allow 100ml/kg for 1st 10kg
  3. allow 50ml/kg for second 10kg
  4. allow 20ml/kg for remaining body weight
  5. total daily maintenance
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13
Q

What are the rates of rehydration for mild, moderate, and severe?

A

Mild 40-50 ml/kg over 4 hours
Moderate 60-100 ml/kg over 4-6 hours
Severe NS or LR, 20ml/kg bolus

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14
Q

How should you hydrate as out patient for each episode of stool or vomiting?

A

Slowly for vomiting

10ml/kg for each episode

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15
Q

What should you rehydrate with?

A

Breast feed more often and shorter periods
Avoid: plain water, apple juice, soda, milk sports drinks
Give: pedialyte, or recipe for water sugar and salt
-Reintroduce bland solids after 4-6 hours

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16
Q

What is the age of onset for pyloric stenosis? Who is most likely to have?

A

1-18 weeks (average 3 weeks)

-most common in white, first born males

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17
Q

What is the most common cause of intestinal obstruction in infancy?

A

pyloric stenosis

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18
Q

What is the clinical presentation of pyloric stenosis?

A

Non-bilious emesis, 70% becomes projectile

  • still hungry after emesis
  • occurs post feed
  • dehydration, malnutrition, jaundice
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19
Q

What may you be able to palpate in a baby with pyloric stenosis?

A

1-2 cm olive shaped mass along lateral edge of rectus abdominus in RUQ

  • best palpated after baby has vomited and is calm
  • gastric peristaltic waves may be visible prior to vomiting
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20
Q

How do you diagnose pyloric stenosis?

A

U/s (gold standard)

-EGD if diagnosis is unclear

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21
Q

How do you treat pyloric stenosis?

A

electrolyte and fluid replacement

Surgery- pyloromyotomy

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22
Q

What is primary vs secondary peptic ulcer disease?

A

Primary- duodenal

Secondary- gastric

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23
Q

Who is more likely to have PUD?

A 
Boys
12-18 yo
familial predisposition
critical illness
some medications
stress
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24
Q

How is PUD treated?

A
  • Antacids
  • GER meds
  • H. Pylori treatment
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25
Q

What is GER?

A

reflux of gastric content through lower espohageal sphincter WITHOUT irritation or injury to the esophagus

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26
Q

What is Sandifer syndrome?

A

abnormal posturing of head and trunk after feeds. May be caused bu GER, head positioning relieves discomfort

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27
Q

What prokinetic (motility) agents can be used in GER?

A
  • metoclopramide
  • bethanechol
  • erythromycin
  • baclofen
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28
Q

What is the average age of appendicitis?

A

10 years

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29
Q

Clinical presentation of appendicitis?

A

periumbilical pain

  • peaks, subsidel, migrates to RLQ
  • vomiting AFTER pain
  • anorexia (50%)
  • low volume mucousy stools
  • low grade fever
  • After perf: symptoms lessen, fever
30
Q

How do you diagnose appendicitis?

A

A/S (gold standard), thickened noncompressable mass

-CT has highest accuracy

31
Q

What is the leading cause of abd pain in children?

A

constipation

32
Q

At what year does constipation peak in children?

A

2-4

33
Q

At what age is the anal sphincter mature?

A

18 mo

34
Q

How should you manage constipation in toilet training?

A

Nighttime medication and morning “toilet time”

35
Q

What is intussusception?

A

Ileum “telescopes” inside the ascending colon

-causes edema, strangulation, gangrene, sepsis, shock, death

36
Q

How do stools appear with intussusception?

A

Currant jelly stools

37
Q

Clinical presentation of intussusception?

A

paroxysmal episodic abd pain w/ vomiting Q 5-30 min

  • screaming w/ drawing up of legs
  • calm or sleeping in between
38
Q

What is the Dance’s Sign?

A

palpation of “sausage-shaped” mass in RUQ with empty space in RLQ

39
Q

How do you treat intussusception?

A

Air or barium enema

-surgical management may be needed

40
Q

What is the most common malabsorption syndrome?

A

Lactose intolerance

41
Q

Clinical findings of malabsorption?

A

chronic diarrhea (may not be present)

  • gassy
  • abd distention
  • increased appetite
  • growth failure
  • pallor
  • cheilosis
  • glossitis
  • peripheral neuropathy
  • food aversions
  • delayed puberty
42
Q

Management for malabsorption?

A

assess and treat for underlying infection

  • diary of symptoms and food intake
  • exclusion diet- exclude food for 3 weeks at a time
43
Q

What is inflammatory bowel disease (IBD)?

A

Inappropriate and ongoing activation of mucosal immune system driven by normal flora.

44
Q

Which part of the bowel does Crohns affect?

A

small and lower

45
Q

Is Crohns a continuous disease?

A

No, it is segmental

46
Q

What labs are different in Crohns?

A

High ESR,
microcytic anemia
low albumin

47
Q

What changes in the bowel are associated with Crohns?

A

granulomas, abscesses, diarrhea (may be bloody)

48
Q

Which part of the bowel is affected by ulcerative colitis (UC)?

A

Total colon

49
Q

Is UC a continuous disease?

A

Yes, it affects the whole/continupus colon

50
Q

What symptoms are related to UC?

A

Abd pain, bloody diarrhea, urgency, tenesmus

51
Q

What abx do you treat C. diff and Giardia with?

A

metronidazole

52
Q

What abx do you treat cholera with?

A

tetracycline/doxy

-azithro if younger than 8

53
Q

What causes osmotic diarrhea

A

damage to the villous brush border, causing malabsorption of intestinal contents

54
Q

What causes secretory diarrhea?

A

release of toxins that bind to specific enterocyte receptors and cause the release of chloride ions into the intestinal lumen

55
Q 
Name the pathogen!
A. frequent watery diarrhea
B. bloody/mucous
C, Rice water
D. long duration >14 days
A

A. viral
B. bacterial
C. cholera
D. non-infectious/parasitic

56
Q

What abx are most likely to trigger C. diff

A

PCNs, cephalosporins, and clindamycin

57
Q

What are the most common parasites found?

A

Giardia and cryptosporidium

58
Q

What percent of body weight decrease would you see in minimal, moderate, and severe dehydration?

A

Minimal - 3%
Moderate - 3-9%
Severe - 10%

59
Q

What is Zollinger-Ellison syndrome?

A

A rare syndrome involving refractory severe PUD caused by gastric hypersecretion due to the autonomous secretion of gastrin by a neuroendocrine tumor

60
Q

What formula can infants with cow’s-milk allergy have?

A

Extensively hydrolyzed

  • partially hydrolyzed formula is NOT appropriate
  • if SEVERE allergy use amino-acid formula
  • extensively hydrolyzed soy formula if older than 6 mo (younger may cause nutritional deficit
61
Q

Should mothers of infants with cow’s milk allergy and CMPI avoid milk products?

A

yes

62
Q

What are the extraintestinal symptoms of adenomatous polyposis?

A
  • opthalmologic (hypertrophy of retinal pigment
  • dental (supernumerary or unerrupted teeth)
  • osteomas of skull
  • multiple lipomas
63
Q

Name 5 physical findings that may be seen on a pediatric patient with Crohn’s disease?

A 
perianal skin tags
deep anal fissures
perianal fistulas
clubbing of digits
erythema nodosum
64
Q

What does fecal calprotectin measure?

A

The level of inflammation in intestines

-higher level = more inflammation

65
Q

What medications are used for Crohn’s disease?

A

1st line (mild-mod)- corticosteroids (po, IV, per rectum)
Mild- 5-aminosalicylates (balsalazide, sulfasalazine, olsalazine, mesalamine)
Severe- immunomodulators (azathioprine, 6-mercaptopurine, methotrexate, cyclosporine)
Severe/remission- biologics

66
Q

What is the 1st line medication for UC?

A

topical mesalamine

67
Q

What is the steroid taper for UC?

A

oral prednisone 40-60 mg/day for 1-2 weeks (until response is established). Then taper by 5-10 mg/week

68
Q

What diet changes are recommended in UC?

A
  • high protein and carbs
  • normal fat
  • low roughage
  • omega-3
  • avoid lactose
69
Q

What is the expected weight gain for 0-3 mo, 3-6 mo, 6-12 mo, and 12+ mo?

A

0-3: 25-30 g/day
3-6: 15-20 g/day
6-12: 10-15 g/day
12+: 5-10 g/day

70
Q

What are the most common viral pathogens implicated in acute diarrhea?

A

norovirus and rotavirus

NURP 502 - Ex 3 (5 decks)

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