Peds GI

Question 1

Age of a neonate?

Answer 1

0-28 days (Plus days premature if premie)

Question 2

Age of an infant?

Answer 2

1 to 12 months

Question 3

Age of a child?

Answer 3

1 to 12 years

Question 4

1 oz = __mL

Answer 4

30mL

Question 5

How to measure doses?

Answer 5

Syringes - not tablespoon/teaspoon

Question 6

Estimating renal function in a child

Answer 6

Schwartz Equation:
0.413 * (ht in cm/SCr)
or
Urine output
>1mL/kg/hr

Question 7

GER v. GERD

Answer 7

GERD is pathological - GER is normal reflux

Question 8

Regurgitation v. vomiting

Answer 8

Regurgitation is no effort

Vomiting is effort

Question 9

When does GER peak?

Answer 9

4 months

Question 10

What are GERD risk factors?

Answer 10

Genetic predisposition
Esophageal atresia
Obesity
Prematurity
Neurological impairment
Lung disease (CF)

Question 11

GER is caused by ______ of _____

Answer 11

relaxation of lower esophageal sphincter (LES)

Question 12

GI Symptoms of GERD in infants

Answer 12

Regurgitation
Feeding difficults
Hematemesis

Question 13

Extra-intestinal symptoms of GERD in infants

Answer 13

Failure to thrive
Wheezing/Stridor/Cough/Apnea
Irritability
Back arching

Question 14

GI symptoms of GERD in kiddos

Answer 14

Hearturn
feeding difficulties
Hematemessis
Vomiting
Regurgitation
Dysphagia
Chest pain

Question 15

Extra-intestinal symptoms of GERD in kiddos

Answer 15

Cough/wheezing/stridor
Asthma
Recurrent pneumonia
Dental erosions
Anemia
Laryngitis

Question 16

When to refer for infants

Answer 16

Bile/projectile vomiting
GI bleeding/vomiting blood
Failure to thrive
Emesis begins after 6 months old
Difficulty swallowing
Fever
Diarrhea/constipation
Lethargy
Hepatosplenomegaly

Question 17

Non-pharma GERD treatment in kiddos

Answer 17

Feeding changes - thicker, higher caloric density, hypoallergenic, transpyloric (feeding tube)
Positoning - supine position
Lifestyle - diet, weight, smoke/alcohol

Question 18

Pharma GERD treatment in kiddos

Answer 18

H2RAs
PPIs
Prokinetics (2nd line)
Antacids (older patients)

Question 19

How long to trial GERD therapy before reassessing?

Answer 19

8-12 weeks

Question 20

2 main H2RAs?

Answer 20

ranitidine

famotidine

Question 21

Ranitidine pediatric dose for GERD

Answer 21

PO: 4-8mg/kg/day divided BID

max 300

Question 22

Famotidine pediatric dose for GERD

Answer 22

PO: 1mg/kg/day BID

max 40

Question 23

Do H2RAs or PPIs cause tachyphylaxis?

Answer 23

H2RAs

Question 24

Most peds data on PPIs for which PPIs?

Answer 24

Omeprazole

Lansoprazole

Question 25

DFs of lansopraole?

Answer 25

PO, ODT, suspension

Question 26

DFs of omeprazole, pantoprazole, esomeprazole, rabeprozole?

Answer 26

Granules (and pO)

Question 27

Peds dosing of lansoprazole and omeprazole?

Answer 27

1mg/kg/day (not to exceed adult max doses)

Question 28

Risks of chronic use of acid suppressants?

Answer 28

Increased fractures Gastric tumors Increased pneumonia risk Altered gastric flora

Question 29

Prokinetic agents for kiddos

Answer 29

Metoclopramide | Erythromycin

Question 30

Metoclopramide AEs

Answer 30

Neurologic, tardive dyskinesia, lactation/gynecomastia (neonates)

Question 31

Erythromycin ADEs

Answer 31

``` Pyloric stenosis QT prolongation (arrhythmias) Drug interactions ```

Question 32

QT Prolonging medications

Answer 32

``` Antipsychotics (haloperidol) Fluoroquinolones Macrolides azoles methadone Ondansetron antiarrhythmics (sotolol, dofetilide) ```