Peds GI uworld Flashcards
episodic crying, emesis, bloody stool, lethargy in young child think…
intussusception - reducing and recurring
how will abdominal pain manifest in non-verbal child
crying and drawing legs to abdomen
currant jelly stool suggests…
bowel ischemia
dark and sticky loose stool with streaks of blood think…
currant jelly stool
bowel ischemia
diagnosis
treatment
of intussusception
ultrasound-guided air contrast enema
(diagnostic and therapeutic… choice)
some places saline enema
if diagnosis less certain, can just ultrasound first
peds intussusception path pres dx tx
telescoping bowel, periodic, ischemia, infarct
young child episodic crying, emesis, bloody stool (currant jelly), lethargy
ultrasound-guided air contrast enema
(diagnostic and therapeutic)
vs if dx uncertain can US for target sign, sausage sign
why is abdominal CT with contrast not the study of choice for peds intussusception
time-consuming (compared to US)
radiation exposure
us guided air contrast enema is diagnostic and therapeutic
anorectal manometry
what does it analyze
common use in peds
analyses motility and pressure in distal bowel
for Hirschsprung disease
presentation of Hirschsprung disease
neonate with delayed meconium passage or bilious emesis
less commonly enterocolitis in older infant with chronic constipation
risk with enema reduction of telescoped bowel
is the risk high or low
low risk of intestinal perforation
why isn’t barium enema preferred to dx and tx intussusception
current preference
because if rare case of leak/perf barium can cause peritonitis
so air contrast enema preferred now
technetium-99m scan aka... how does it work... used to dx... general presentation of that dx...
aka Meckel scan
identifies ectopic gastric tissue
used to dx Meckel diverticulum
which presents with painless rectal bleeding in child typically
tf
intussusception is a pediatric emergency
T
rapid dx and tx w ultrasound-guided air contrast enema is critical for avoiding ischemia and peritonitis
ddx for neonate with delayed passage of meconium and differentiation according to: associated disorder typical level of obstruction meconium consistency squirt sign
hirschsprung - downs, rectosigmoid obstruction, normal meconium, positive squirt sign
meconium ileus - cystic fibrosis, ileal obstruction, inspissated (thickened/congealed) meconium, negative squirt sign
hirschsprung aka
congenital aganglionic megacolon
what percent of healthy, full-term infants pass stool within 48 hours of birth
what to suspect if this is not happening
99%
suspect hirschprung or meconium ileus if no stool in 48 hours
how to differentiate hirschsprung from meconium ileus
level of obstruction
hirschprung colon, meconium ileus ileum
meconium consistency
hirschsprung normal, meconium ileus inspissated (thickened/congealed)
squirt sign
positive hirschsprung, negative meconium ileus
the earliest life-threatening manifestation of cystic fibrosis
meconium ileus
tf
meconium ileus is virtually diagnostic of CF
T
basic 1-sentence pathophys of CF
mutation in CF transmembrane conductance regulator gene causes abnormal chloride and sodium transport and thick, viscous secretions in multiple organs
pathophys of meconium ileus
CF
thick, inspissated meconium difficult to propel
ileal obstruction
upright abdominal xr in meconium ileus
multiple dilated loops of small bowel with paucity of air in narrow underdeveloped microcolon
baby pt has meconium ileus,
what comorbidity of underlying condition are they most likely to develop?
what likely treatment?
chronic rhinosinusitis
(meconium ileus is virtually diagnostic of CF, and nearly all patients with CF develop sinopulmonary disease)
likely to need surgical debridement of sinuses when sx develop
what is “squirt sign”
what does it suggest in baby?
forceful expulsion of stool after rectal exam
suggests hirschsprungs
hirschsprung
underlying dz assoc
comorbiditis to expect
alzheimer
hypothyroidism
% and pathophys of infertility in CF
men - almost all infertile from congenital absence of vas deferens
women - 20% infertile from secondary amenorrhea from malnutrition and thick cervical mucus obstructing sperm entry
% and pathophys of sensorineural hearing loss in CF
20% sensorineural hearing loss
from frequent treatment with aminoglycosides for gram-negative infections (e.g. pseudomonas aeruginosa)
inspissated means
thick/congealed
manage child who ingested battery
get xr
if in esophagus, likely lodged, so immediate endoscopic removal to prevent esophageal erosion
if in stomach, 90% pass uneventfully so observe to confirm excretion and/or follow with radiographs as necessary
normal CSF cell count
0-5 /mm^3
normal CSF glucose
40-70 mg/dL
normal CSF pressure
70-180 mm H2O
normal CSF protein
v40 mg/dL
normal CSF cell count glucose pressure protein
cell count 0-5 /mm^3
glucose 40-70 mg/dL
pressure 70-180 mm H2O
protein v40 mg/dL
Reye syndrome etiology presentation clinical features (what organs affected) lab findings treatment
aspirin (salicylates) to kid during influenza or varicella infection
vomiting, abnormal behavior… then seizures, lethargy
acute liver failure
encephalopathy
inc AST ALT PT INR PTT NH3
maybe dec glucose from use and depletion
supportive tx
NH3 aka
ammoniA
is acute liver failure and encephalopathy in Reye syndrome rapid or slow onset?
rapid onset
major cause of death in Reye syndrome
encephalopathy — elevated iCP
anticholinergic toxicity
most common drug
presentation
diphenhydramine overdose
dry mouth and skin
blurry vision
hyperthermia
urinary retention
hep A infection
top 3 presenting symptoms
top 3 labs
fever, vomiting, diarrhea
elevated LFTs - AST ALT bilirubin
5 risk factors for celiac
first degree FH celiac down syndrome autoimmune thyroiditis type 1 diabetes selective IgA deficiency
celiac dz symptoms
4 GI
3 not GI
abdominal pain
flatulence/boating
diarrhea (rarely constipation)
nausea/vomiting
short stature / weight loss
iron deficiency anemia
dermatitis herpetiformis
diagnose celiac
inc tissue transglutaminase IgA
inc anti-endomyseial antibodies
inc intraepithelial lymphocytes and flattened villi on Duodenal biopsy
celiac disease path risk factors symptoms diagnosis
immune-mediated hypersensitivity to gluten - imparied nutrient absorption in proximal small intestine
first degree FH celiac, down syndrome, autoimmune thyroiditis, type 1 diabetes, selective IgA deficiency
abdominal pain, flatulence/boating, diarrhea (rarely constipation), nausea/vomiting, short stature / weight loss, iron deficiency anemia, dermatitis herpetiformis
inc tissue transglutaminase IgA, anti-endomyseial antibodies, intraepithelial lymphocytes and flattened villi on Duodenal biopsy
labs consistent with iron deficiency anemia
microcytic anemia (low Hb, low MCV) low ferritin
how does celiac pt get iron deficiency anemia
impaired nutrient absorption from villous atrophy in Proximal Small Intestine aka DUODENUM where iron is absorbed
I’m on faceBook
Do join In
(Iron abdorbed in Duodenum,
B12 absorbed in Ileum?)
dermatitis herpetiformis
describe
food allergy association
pruritic papular or vesicular rash on knees, elbows, forearms, buttocks
celiac disease
fatigue, weight loss, itchy papular/vesicular rash on knees, elbows, forearms, bottocks, iron deficiency anemia…
think…
next step in workup…
and next step if that one is positive…
celiac disease
(allergic duodenal inflammation and villous atrophy, poor iron and other nutrient absorption, dermatitis herpetiformis)
anti-tissue transglutaminase antibody assay
followed by endoscopic duodenal biopsy for confirmation
in general, what kinds of lab findings might make you consider a bone marrow biopsy
abnormal peripheral cell counts
e.g. pancytopenia, leukocytosis
confirm suspicion of iron deficiency
microcytic anemia (low Hb low MCV) low ferritin
when to consider hemoglobin electrophoresis for microcytic anemia
to exclude thalassemia and other hemoglobinopathies after iron deficiency anemia ruled out with a normal or elevated ferritin
what should be followed every 1-2 years in patients with type I diabetes
TSH for autoimmune thyroiditis
fatigue, anemia, hair loss, brittle nails, constipation in type I diabetic…
think…
1st step in workup…
autoimmune hypothyroidism
TSH
