Peds GI

Question 1

High pitched frequent bowel sounds c/w:

Answer 1

Early peritonitis
Gastroenteritis
Intestinal obstruction

Question 2

Absent bowel sounds for longer than 3 minutes c/w:

Answer 2

Peritonitis

Intestinal obstruction.

Question 3

This is when you flex the hip with knee bent, internal rotation of the hip induced abdominal pain.

Answer 3

Obturator sign

Question 4

This is when patient lies on the left side, flexion and extension of right leg induces abdominal pain.

Answer 4

Psoas sign

Question 5

Palpation of the LLQ causes pain in RLQ.

Answer 5

Rovsing’s sign

Question 6

When patient stands on tip toes and falls to heels:

Answer 6

Markle sign

Question 7

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

Answer 7

Murphy’s sign

Question 8

Nonbilious vomiting is usually caused by:

Answer 8

Infection, inflammation, metabolic, neurological, or psychological problems.

Question 9

Obstructive lesions cause:

Answer 9

Bilious vomiting

Question 10

This is loss of water and extracellular fluid, fluid imbalance with total fluid output exceeding intake.

Answer 10

Dehydration

Question 11

This type of dehydration is called simple diarrhea, it’s fluid loss not balanced by intake; sodium and water losses in proportion.

Answer 11

Isotonic/isonatremic

Question 12

This type of diarrhea is a massive loss of water and salt in stool, oral replacement with water alone that leads to sodium loss greater than water.

Answer 12

Hypotonic/hyponatremic

Question 13

This type of dehydration is vomiting and diarrhea with decreased water intake, greater water than salt loss.

Answer 13

Hypertonic/hypernatremic

Question 14

Formula for daily maintenance fluid requirements in peds:

Answer 14

100ml/kg for first 10kg
50ml/kg for 2nd 10kg
20ml/kg for remaining body weight

Question 15

Rehydration first mild dehydration:

Answer 15

40-50 ml/kg over 4 hours

Question 16

Rehydration for moderate dehydration:

Answer 16

60-100ml/kg over 4-6 hours

Question 17

Rehydration for severe dehydration:

Answer 17

Normal saline or LR bolus

20ml/kg bolus and repeat as needed

Question 18

With dehydration avoid:

Answer 18

Plain water, apple juice, soda, milk, sports drinks

Question 19

This is characterized by recurrent stereotypical spells of vomiting between which the child is completely well.

Answer 19

Cyclical vomiting syndrome

Question 20

Triggers for cyclical vomiting syndrome?

Answer 20

Anxiety, stress, infections, food triggers, exhaustion, hot weather, motion sickness

Question 21

Management for cyclical vomiting syndrome:

Answer 21

Quiet dark room
During pristine- lorazepam, antiemtics, Tylenol, Motrin, Benadryl, h2 blocker or PPi
Triptans May be used
Prophylactic agents between episodes-same as migraine- may be used
Evaluation to r/o other causes

Question 22

This typically occurs around 3 weeks of age and is caused by hypertrophy and hyperplasia of the muscular layers of the pylorus, causing a functional gastric outlet obstruction.

Answer 22

Pyloric stenosis

Question 23

Presentation of pyloric stenosis:

Answer 23

Non-bilious vomiting and regurg (70% become projectile)
Still hungry after vomiting
Vomiting occurs post feed
Dehydration, malnutrition, and jaundice may develop

Question 24

Physical exam of pyloric stenosis:

Answer 24

1-2 cm olive mass in RUQ

Gastric peristaltic waves may be present prior to vomiting

Question 25

How to diagnosis pyloric stenosis?

Answer 25

Ultrasound is gold standard

Question 26

Primary ulcers of PUD?

Answer 26

Duodenal

Question 27

Secondary ulcer in PUD:

Answer 27

Gastric

Question 28

PUD most common in peds in:

Answer 28

Boys and children 12-18

Question 29

Management of PUD?

Answer 29

Antacids GER meds H. pylori treatment

Question 30

This is reflux of gastric content through LES without irritation or injury to the esophagus.

Answer 30

GER

Question 31

This is abnormal behavior and posturing of head and trunk after feeds.

Answer 31

Sandifer syndrome

Question 32

First line meds in GER:

Answer 32

H2 blockers Cimetidine Famotidine Nizatidine

Question 33

This is acute inflammation (can be chronic) that follows obstruction of appendices lumen by a fecalith, lymphoid tissue, tumor, etc. causes peritoneal inflammation.

Answer 33

Appendicitis

Question 34

Presentation of appendicitis:

Answer 34

``` Periumbilical pain that peaks, subsides and radiates to RUQ Vomiting after periumbilical pain Anorexia Low volume mucousy stools Low grade fever Prefers to lie on side with legs flexed Infants- irritable, pain with movement Involuntary guarding Rebound tenderness Maximal pain over McBurney’s point- midway between anterior superior iliac crest and umbilicus to the RLQ ```

Question 35

This is invagination of bowel proximal to the ileocecal valve- proximal segment of the bowel telescopes/invaginates into a more distal segment, causing edema, vascular compromise, and partial/total obstruction.

Answer 35

Intussusception

Question 36

Who and when does intussuception usually occur?

Answer 36

Males greater than females Peak incidence 3-12 months Most common cause of intestinal obstruction under 2 Peaks in summer and midwinter

Question 37

Clinical presentation of intussuseption:

Answer 37

Stools- current jelly Paroxysmal episodic abdominal pain with vomiting every 5-30 minutes In between is calm, sleeping, or lethargic

Question 38

Physical findings of intussusception:

Answer 38

Distended, tender abdomin Dances sign- RUQ sausage shaped mass with RLQ empty spaces Occult blood or visible blood

Question 39

Diagnostic work up for intussusception?

Answer 39

Abdominal US is diagnostic

Question 40

Management of intussusception?

Answer 40

Air or barium enema- dx and treat | Surgery if not corrected

Question 41

This is inappropriate and ongoing activation of mucosal immune system driven by normal flora.

Answer 41

IBD

Question 42

This occurs in the small intestine and lower intestine is possible, is a segmental disease, that causes granulomatous and abscesses.

Answer 42

Crohn’s disease

Question 43

This occurs in the total colon and causes abdominal pain, bloody diarrhea, urgency, and tenesmus.

Answer 43

UC