PEDS: Kids and Their Tummy Aches - Hoffman Flashcards
Tummy Aches - associated symtpoms
- weight loss
- decreased appetitie
- nausea
- intestinal gas
- diarrhea
- cough
- wheezing
- horase voice
HEADSS mnemonic
Home
Education
Activities
Drugs
Sexuality
Suicide/Depression
Identify this condition and describe the management:
patient is a 6 year old male with a “tummy ache”
history reveals that all he eats are poptarts and milk and only stools once a week, he doesn’t like going at school
he is otherwise normally active
CONSTIPATION
exam:
- general exam
- abdominal exam (may be able to palpate hard stool)
- rectal exam - visualize external exam, anal wink, digital rectal exam
- neuro exam - lower extremity reflexes, cremasteric reflexes, tip toe/heel walking
diagnostic studies:
- flat plate of abdomen
tx/management:
- adequate clean-out;
- education, maintenance, behavioral and dietary components
Stool guiac test: infants and children with abdominal pain, FTT, diarrhea or FHX of colorectal cancer
Encopresis
lack of voluntary control over defecation
develops as a result of long-standing constipation with enlargement of rectal vault
sensation prompting the urge to defecate is lost
large fecal masses accumulate, allowing only liquid stoll to pass
Treatments for Functional Constipation
GOAL: one soft stool daily, no fecal incontinence
TX: reduce after 6 months of stability, slowly taper dose
Dietary Changes
- increase fiber and fluids
Bowl Evacuation
- manual disimpaction
- enema
- laxatives
- cathartics
- infants: glycerin suppositories
Stool Softeners
- smaller, more frequent stooling
Behavioral Modification
- establish stooling routine soon after meals
- praise successful elimination of stool
GERD Manifestations in Infants
- fussiness
- arching
- feeding refusal or some feed more frequently
- congestion
- wheezing
GERD Manifestations in Preschool
- on/off abdominal pain
- decreased food intake
- discomfort after eating
- cough
- wheezing
GERD Manifestations in Older Children Adolescents
- burning epigastric pain
- regurgitation
- chest pressure
- early satiety
- nausea
- bad taste in mouth (especially in AM)
Identify this condition and describe the management:
pt is a 16 year old female
she reports stomach pain usually after dinner and it wakes her up at night
she also notes that this gets worse before her AP history exams
GERD
other clinical manifestations
- can be triggered by viral illness
- can have dysphagia/odynophagia
- hoarseness and stridor can occur
possible testing based on symptoms and severity
- endoscopy
- esophageal pH monitoring
treatment: acid supression medication
- Ranitidine
- Omeprazole
- Lansoprazole
- treat aggresively
- trial 2 weeks, if it works 1-6 months
Suggested Approach for Common Clinical Scenarios:
Recurrent Vomiting or Regurgitation (older than 18 months)
- upper GI series
- upper endoscopy
- acid supression trial
Suggested Approach for Common Clinical Scenarios:
Heartburn
- treat empirically and do lifestyle changes
- persistnent or recurrent symptoms should prompt referral endoscopy with biopsy
Suggested Approach for Common Clinical Scenarios:
Dysphagia or Odynophagia
- barium esophagram - looking for anatomic abnormailities
- NO empiric treatment
- upper endoscopy is necessary
Suggested Approach for Common Clinical Scenarios:
Recurrent Pnemonia
- insufficient research - trial empiric treatment
- video fluoroscopy?
Identify this condition and describe the management:
patient is a 8 year old, he complains of umbilical pain that has been going on for over a year
he has soft stools each day
he just is bullied at school, but otherwise enjoys his classes
Irritable Bowel Syndrome/Functional Abdominal Pain
nonorganic abdominal pain, associated with stress
often diagnosed by GI specialists after organic causes are ruled out
can be a cry for help - consider abuse
TX:
- Eliminate Secondary Gain
- Treat underlying negative stress
- Relaxation techniques
Abdominal Alarm Findings
- involuntary weight loss
- deceleration of linear growth
- GI blood loss
- significant vomiting
- chronic severe diarrhea
- persistent RUQ or RLQ pain or tenderness
- unexplained fever
- family history of IBD
- localized fullness or mass effect
- Hepatomegaly or Splenomegaly
- Costovertebral angle tenderness
- Tenderness over the spine
- Perianal abnormalities
- Abnormal or unexplained physical findings
Diarrhea
Signs of Volume Depletion
- thirst
- tachycardia
- lethargy
- orthostasis
- oliguria
- tachypnea
- dry mucous membranes
- weight loss
- decreased tear production
- decreased skin turgor
Diarrhea
Etiologic Risk Factors
- recent travel to an underdeveloped area
- other family members affected
- daycare attendance or employment
- pets in home (turtles, snakes)
- visiting farm or petting zoo
- recent or regular medications
- occupation as food handler or caregiver
- sexual contact
- underlying medical conditions
Diarrhea
Diagnostic Studies & Microscopic Exam
Diagnostic Studies
- gross or occult blood
- undigested vegetable matter
- mucus present
- color
Microscopic Exam
- Leukocytes - bacterial or inflammation
- Lymphocytes - inflammatory
- Eosinophils - food sensitivities
- Fat - malabsorption or pancreatic enzyme insufficiency
- O&P - ova and parasites
Labs:
- CBC, BMP, BUN, creatinine, and UA
- stool studies
- rapid rotovirus test
Identify this condition and describe the management:
patient is a 1 year old reporting on Friday Jan. 30
he vomited on Monday and has had a temp of 99 and watery, foul-smelling diarrhea, no blood is present
Acute Diarrhea: Viral Gastroenteritis
Rotovirus is most common
- peaks in winter
- can live outside body longer
Norwalk Virus (norovirus)
Adenovirus
fecal-oral route
self limited; tx administer oral rehydration solution
Identify this condition and describe the management:
patient was on a camping trip last weekend
he reports abdominal pain, increased flatulence, and diarrhea
stool analysis reveals cysts
Acute Diarrhea: Parasitic Gastroenteritis
Giardia Lamblia
fecal-oral transmission
other symptoms: malabsorption, failure to thrive
at risk groups: IgA deficient, CF patients
tx: Flurazolidone, Metronidazole
Identify this condition and describe the management:
patient has loose, bloody, mucoid stools
abdominal exam revealed hepatic abscess
Acute Diarrhea: Infectious Gastroenteritis
Entamoeba Histolytica
diagnosed via: stool examination and immunoassays
tx: Furazolidone, Albendazole, Metronidazole
Acute Diarrhea: Infectious Gastroenteritis
Cryptosporidum
frequent, watery stools
common in day cares
self-limited in healthy kids
can become chronic in the immunocompromised
no effective therapy
Acute Diarrhea: Infectious Gastroenteritis
Isospora Belli
protozoan infection cuasing diarrhea in AIDS patients
treated with TMP-SMZ
Identify this condition and describe the management:
patient ate a cream-filled donut that was leftover from yesterday for breakfast
at lunch time patient reports: nausea, vomiting, abdominal cramping
Acute Diarrhea: Infectious Gastroenteritis
Staphylococcus Aureus
symptoms resolve spontaneously within 24 hours
