Peds GI Flashcards
High pitched frequent bowel sounds c/w:
Early peritonitis
Gastroenteritis
Intestinal obstruction
Absent bowel sounds for longer than 3 minutes c/w:
Peritonitis
Intestinal obstruction.
This is when you flex the hip with knee bent, internal rotation of the hip induced abdominal pain.
Obturator sign
This is when patient lies on the left side, flexion and extension of right leg induces abdominal pain.
Psoas sign
Palpation of the LLQ causes pain in RLQ.
Rovsing’s sign
When patient stands on tip toes and falls to heels:
Markle sign
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.
Murphy’s sign
Nonbilious vomiting is usually caused by:
Infection, inflammation, metabolic, neurological, or psychological problems.
Obstructive lesions cause:
Bilious vomiting
This is loss of water and extracellular fluid, fluid imbalance with total fluid output exceeding intake.
Dehydration
This type of dehydration is called simple diarrhea, it’s fluid loss not balanced by intake; sodium and water losses in proportion.
Isotonic/isonatremic
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.
Hypotonic/hyponatremic
This type of dehydration is vomiting and diarrhea with decreased water intake, greater water than salt loss.
Hypertonic/hypernatremic
Formula for daily maintenance fluid requirements in peds:
100ml/kg for first 10kg
50ml/kg for 2nd 10kg
20ml/kg for remaining body weight
Rehydration first mild dehydration:
40-50 ml/kg over 4 hours
Rehydration for moderate dehydration:
60-100ml/kg over 4-6 hours
Rehydration for severe dehydration:
Normal saline or LR bolus
20ml/kg bolus and repeat as needed
With dehydration avoid:
Plain water, apple juice, soda, milk, sports drinks
This is characterized by recurrent stereotypical spells of vomiting between which the child is completely well.
Cyclical vomiting syndrome
Triggers for cyclical vomiting syndrome?
Anxiety, stress, infections, food triggers, exhaustion, hot weather, motion sickness
Management for cyclical vomiting syndrome:
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
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.
Pyloric stenosis
Presentation of pyloric stenosis:
Non-bilious vomiting and regurg (70% become projectile)
Still hungry after vomiting
Vomiting occurs post feed
Dehydration, malnutrition, and jaundice may develop
Physical exam of pyloric stenosis:
1-2 cm olive mass in RUQ
Gastric peristaltic waves may be present prior to vomiting
How to diagnosis pyloric stenosis?
Ultrasound is gold standard
Primary ulcers of PUD?
Duodenal
Secondary ulcer in PUD:
Gastric
PUD most common in peds in:
Boys and children 12-18
Management of PUD?
Antacids
GER meds
H. pylori treatment
This is reflux of gastric content through LES without irritation or injury to the esophagus.
GER
This is abnormal behavior and posturing of head and trunk after feeds.
Sandifer syndrome
First line meds in GER:
H2 blockers
Cimetidine
Famotidine
Nizatidine
This is acute inflammation (can be chronic) that follows obstruction of appendices lumen by a fecalith, lymphoid tissue, tumor, etc. causes peritoneal inflammation.
Appendicitis
Presentation of appendicitis:
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
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.
Intussusception
Who and when does intussuception usually occur?
Males greater than females
Peak incidence 3-12 months
Most common cause of intestinal obstruction under 2
Peaks in summer and midwinter
Clinical presentation of intussuseption:
Stools- current jelly
Paroxysmal episodic abdominal pain with vomiting every 5-30 minutes
In between is calm, sleeping, or lethargic
Physical findings of intussusception:
Distended, tender abdomin
Dances sign- RUQ sausage shaped mass with RLQ empty spaces
Occult blood or visible blood
Diagnostic work up for intussusception?
Abdominal US is diagnostic
Management of intussusception?
Air or barium enema- dx and treat
Surgery if not corrected
This is inappropriate and ongoing activation of mucosal immune system driven by normal flora.
IBD
This occurs in the small intestine and lower intestine is possible, is a segmental disease, that causes granulomatous and abscesses.
Crohn’s disease
This occurs in the total colon and causes abdominal pain, bloody diarrhea, urgency, and tenesmus.
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