Peds GI Disorders Flashcards
Time pattern of functional abdominal pain?
<5 min
Time pattern: upon awakening or bedtime but decreased during activities never awakes
Location of functional abdominal pain?
Closer to umbilicus the more likely functional
Red flag of abdominal pain?
Positive occult blood (+ve)
Urgent condition- pyloric stenosis: s/s?
projectile vomiting immediately after eating
Urgent condition- pyloric stenosis: PE findings?
olive-shaped mass on abdominal palpation.
Urgent condition- pyloric stenosis: diagnostic test?
barium swallow-string sign
Urgent condition- pyloric stenosis: occurs at what age range?
4-6 wks
What is midgut malrotation?
a congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
What is midgut malrotation s/sx?
abdominal pain, weight loss, melena, chronic pancreatitis = failure to thrive
What is volvulus?
bowel twisting on itself
MC location of volvulus?
sigmoid volvulus
Diagnostic finding of volvulus on imaging?
bent inner tube or “coffee bean sign”
Treatment for volvulus?
emergent decompression (sigmoid of colonic placement of rectal tube drainage.
reoccurrence is common-may require elective colectomy.
What is Meckels diverticulum?
remnants of omphalomesenteric duct
What is the rule of 2s for meckles diverticulum?
2% population
2ft proximal to ileocecal valve
2” in length
2 yrs of age
Presentation of Meckels diverticulum?
Painless rectal bleeding - d/t too much acid production
Obstructive signs
Epigastric pain
When is a meckel scan considered positive?
positive when the diverticulum contains associated ectropic gastric mucosa that is capable of uptake of the tracer
What is intussusception?
One segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage)
MC location of intussusception?
Ileocolic
Intussusception usually follows what?
a viral infection
S/Sx of intussusception?
currant jelly stool - intestinal bleeding and edema
intermittent sudden and severe cramping pain alternates with periods of increasing lethargy
vomiting
Diagnostic finding of intussusception?
palpable mass = sausage mass
barium enema
Pathophysiology of appendicitis?
obstructed lumen (fecolith) —> bactria proliferate —> inflammation —> local irritation —> rupture —> peritonitis —> abscess
Appendicitis Triad?
RLQ pain
Fever
Anorexia
Appendicitis PE?
Guarding
Rovsing sign
McBurneys point tenderness
Psoas Sign
Obturator sign
Appendicitis tx?
Nothing PO
IV fluids, pre-op antibiotics, pain control, anti-emetic
Appendectomy
Post-op antibiotics if gangrenous or ruptured (7-10 days)
What is biliary atresia?
Bile flow usually present at birth but the decreases d/t inflammation and fibrosis
Tx: kasai procedure —> liver transplant
S/Sx of biliary atresia?
Appear normal at birth then jaundice, darkened urine, and paling of stool
What is Gastroesophageal reflux?
non-forceful movement of gastric contents to esophagus-mouth-nose.
When does Gastroesophageal reflux resolve for pediatric patients?
9-12 mos
What are some increased risks for GERD in peds pts?
Sandifer syndrome
neurologic impairment
Obesity
Lung disease (CF)
Esophageal atresia
Prematurity
GERD diagnostic study?
24hr esophageal pH monitoring (gold standard)
Barium UGI
GERD management in peds pts?
Increase caloric density
Thickening feeds with rice cereal
Positioning
2wk trial of casein hydrolysate or amino acid formula
GERD management for children/adolescents?
Limit high-fat content, caffeine, spicy foods, chocolate
Avoid tobacco and alcohol
Taking a esophageal biopsy you may see what?
Eosinophils
What causes non-ulcer dyspepsia?
acid-irritation of the stomach mucosa –> dyspepsia (upper abdominal pain) —> bloating, nausea (no vomiting)
Gastric ulcer pain worsens with?
Eating
Duodenal ulcer pain worsens when?
After eating, often at night
Peptic ulcer disease S/Sx?
Weight loss
Bleeding
Perforation
What is peptic ulcer disease?
Imbalance of acid secretion and mucosal defense —> stomach or duodenal mucosal breakdown/ulcer
What are some causes of peptic ulcer disease?
NSAIDs, H. pylori, stress, crohns disase
What is the H. pylori test?
Stool antigen test
MCC of constipation is?
Functional (idiopathic)
Associated sxs of constipation in peds?
Pain
Stool holding
Bleeding
Leakage
What is encopresis?
Involuntary stool leakage around fecal impaction
What is Hirschsprung’s disease?
Ganglion cells fail to migrate into distal colon —> spasm and narrowing of affected section —> proximal dilation
Clinical S/Sx of Hirschsprung’s disease?
delayed stooling as newborn then recurrent constipation.
Diagnosis of Hirschsprung’s disease?
Rectal suction biopsy
Tx of Hirschsprung’s disease?
pull-through procedure (surgery)
Increased risk for celiac disease for children?
Type 1 DM and 1st-degree relative w/ celiac disease
Location of Ulcerative Colitis?
Colon
Location of Crohns Disease?
Anywhere from mouth to anus
Clinical manifestations of UC in peds?
cramping, diarrhea, rectal bleeding, chronic sxs
primary sclerosing cholangitis, uveitis, pyoderma gangrenosum
Clinical manifestations of Crohns disease in peds?
oral aphthous ulcers, arthritis, erythema nodosum, clubbing, episcleritis, gallstones, renal stones
Clinical manifestation IBD?
Toxic megacolon = systemic tox + colitis (massively dilated).
Fever, tachy, hypotension, dehydration, anemia, increased WBC, fecal protein loss- can be life-threatening.
IBD specific antibody tests?
ANCA - more common in UC
ASCA - more common in CD
Acute gastroenteritis MC virus?
Rotavirus
Acute gastroenteritis 3 MC bacteria?
Shigella, salmonella, e.coli
Acute gastroenteritis (AGE) 2 MC Parasites?
Giardia, Entamoeba histolytica
Acute gastroenteritis (AGE) S/Sx?
sever dehydration
lethargic
tachy
sunken eyes
cold extremities
poor skin turgor
Acute gastroenteritis (AGE) inpatient tx?
Admit for IV hydration (bolus, then 2x maintenance) until able to tolerate po
Acute gastroenteritis (AGE) outpatient tx?
Oral rehydration fluids w/ glucose and electrolytes in small amounts
S/Sx of Shigella?
Dysentery (blood, mucus, and foul-smelling diarrhea)
Some strains of Shigella produce?
Shiga toxin
When do you treat non-typhoid Salmonella?
Tx if < 3 mos old or sepsis, bacteremia
Diagnostics for parasites?
Stool antigen test and ova and parasites x3
Tx for parasites?
Metronidazole and albendazole
Chronic diarrhea is defined as how many weeks?
> 2 wks
What are S/Sxs of Ascariasis worm infection?
abdominal pain and possible cough
Tx for Ascariasis worm infection and pinworm infection?
Mebendazole
What are S/Sxs of pinworm infection?
Nighttime perianal itching and restlessness
