Peds GI Disorders Flashcards by Vanessa Amabile

Time pattern of functional abdominal pain?

<5 min

Time pattern: upon awakening or bedtime but decreased during activities never awakes

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Location of functional abdominal pain?

Closer to umbilicus the more likely functional

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Red flag of abdominal pain?

Positive occult blood (+ve)

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Urgent condition- pyloric stenosis: s/s?

projectile vomiting immediately after eating

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Urgent condition- pyloric stenosis: PE findings?

olive-shaped mass on abdominal palpation.

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Urgent condition- pyloric stenosis: diagnostic test?

barium swallow-string sign

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Urgent condition- pyloric stenosis: occurs at what age range?

4-6 wks

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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

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What is midgut malrotation s/sx?

abdominal pain, weight loss, melena, chronic pancreatitis = failure to thrive

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What is volvulus?

bowel twisting on itself

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MC location of volvulus?

sigmoid volvulus

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Diagnostic finding of volvulus on imaging?

bent inner tube or “coffee bean sign”

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Treatment for volvulus?

emergent decompression (sigmoid of colonic placement of rectal tube drainage.

reoccurrence is common-may require elective colectomy.

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What is Meckels diverticulum?

remnants of omphalomesenteric duct

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What is the rule of 2s for meckles diverticulum?

2% population

2ft proximal to ileocecal valve

2” in length

2 yrs of age

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Presentation of Meckels diverticulum?

Painless rectal bleeding - d/t too much acid production

Obstructive signs

Epigastric pain

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When is a meckel scan considered positive?

positive when the diverticulum contains associated ectropic gastric mucosa that is capable of uptake of the tracer

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What is intussusception?

One segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage)

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MC location of intussusception?

Ileocolic

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Intussusception usually follows what?

a viral infection

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S/Sx of intussusception?

currant jelly stool - intestinal bleeding and edema

intermittent sudden and severe cramping pain alternates with periods of increasing lethargy

vomiting

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Diagnostic finding of intussusception?

palpable mass = sausage mass

barium enema

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Pathophysiology of appendicitis?

obstructed lumen (fecolith) —> bactria proliferate —> inflammation —> local irritation —> rupture —> peritonitis —> abscess

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Appendicitis Triad?

RLQ pain
Fever
Anorexia

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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