Week 4.1 - GI Disorders Flashcards
Why are pediatric patients more susceptible to dehydration?
–> Larger body water content
–> Developmental communication barriers
–> Higher metabolic rates
–> Babies are unable to concentrate urine and are more prone to be affected by losses
What might tachycardia be compensating for?
Lack of stroke volume - low blood volume
Why might tachypnea occur with GI disorders?
To ensure adequate perfusion or compensate for metabolic acidosis
What is a late sign of decompensation seen in children?
hypotension - often seen in state of shock when compensation is no longer possible
What are some red flags with vitals for GI disorders?
Tachycardia and low BP
What might be concerning in a child’s appearance with a GI disorder?
Pallor, lethargy, signs of poor perfusion (delayed cap refill, mottling, weak pulses)
What are some red flags seen in children’s emesis?
Bilious (colour)
Hematemesis
Projectile
What are some red flags in intake and output of children for GI disorders?
Weight loss (never normal)
Decreased output
What might pale stool indicate in a peds patient?
biliary atresia
What is a primary concern when a child has diarrhea?
Dehydration
What four things are assessed in a modified Gorelick scale?
Cap refill more than 2 seconds
Absent tears
Dry mucous membranes
Ill general appearance
1 point each, assesses pediatric dehydration. 3+ points indicates fluid deficit of 5%.
What is ORT?
Oral rehydration therapy - electrolyte solution
When is ORT indicated?
Mild to moderate dehydration
How much fluid should be given with ORT?
15 mL/kg/hr
(different than prof’s slides)
What kind of fluid is given for IV bolus to children? Over what time period? At what rate?
RL or NS
–> 20 ml/kilo/hr
What is the number one medical reason peds patients are in the hospital?
Acute gastroenteritis
–> Rotavirus, norovirus
What is diarrhea?
3+ loose/liquid stools for 24 hours
–> Associated with cramping
What is considered an acute case of diarrhea?
Lasting less than 14 days
What history do we want to assess in a child with acute gastroenteritis?
Hx of recent travel, contact with source of infection
What could bilious emesis indicate?
Volvulus - emergency
What is biliary atresia? What are the S/S?
A rare newborn condition wherein bile cannot get from the liver to stool cause acholic stool
–> Results in buildup of bile in the liver, causing damage and failure.
Newborns will have jaundice and hepatomegaly
What are causes of biliary atresia?
Congenital or environmental (inflammation)
How is congenital biliary atresia treated?
Surgically
What is acholic stool?
Pale stool
What is the difference between GERD vs GER?
Presence of breath holding spells (BRUE- Brief resolved unexplained event), poor weight gain, and feeding issues.
How does the presentation of IBD differ in children and adults?
Children generally have more significant disease involvement
ABD pain, diarrhea, rectal bleeding, weight loss, fatigue and pallor are all associated with what disease?
IBD
What might cause IBD?
Cause not known
May be genetic predisposition, gut microbiome, immune system, environmental exposures.
How is IBD treated pharmacologically?
Immune modulators (infliximab)
Corticosteroids
Enteral nutrition
Methotrexate
What are the two kinds of hematemesis and their potential causes?
Frank Red
–> Maternal blood from nipple laceration
–> Small intestine - ligament of Treitz birth defect resulting in malrotation
Coffee Ground: Upper GI (stomach, GI)
What is hematochezia?
Frank red blood in stool, suggestive of bleeding in colon
What is a concern when an exclusively breastfed baby is spitting up red blood?
Whether is it maternal from breastmilk or from the baby
When is the peak age of occurrence for appendicitis?
10-17
What is the first symptom of appendicitis? How does it progress?
peri-umbilical pain that migrates to the RLQ.
Accompanied by anorexia, N&V, low grade fever, rebound tenderness, guarding
How is appendicitis managed?
IV bolus
Analgesia
NG tube if peritonitis or obstruction
Antibiotics
NPO
Surgical consult
What antibiotics are used for appendicitis?
Ampicillin, tobramycin, flagyl
What is pyloric stenosis? What is a sign of it? What are more clinical manifestations?
Narrowing of the outlet from stomach to small intestine that occurs in infants
Non bilious, non projectile vomiting in babies under 2-8 weeks who demonstrate hunger but cannot tolerate eating.
Dehydration, and weight loss.
Will also present with diminished or absent bowel sounds and visible gastric peristalsis left-right following feeding
What is intussusception?
When a loop of bowel slips into another section (telescoping) - reduces blood flow, obstruction, tissue damage
What age group and sex is most effected by intussusception?
Peaks ages 5-9 months (up to 3 years)
–> More common in males, can be fatal
What is the classic presentation of intussusception?
Vomiting
Bloody-mucoid stools
Intermittent colicky abdominal pain
What treatment is available for intussusception?
Air enema might be attempted, if not effective an emergency surgery is necessary
What is a volvulus? What kind is most common in infants and toddlers? What complications will be seen?
Malrotation of bowel results in small bowel obstruction - mid gut most common in infants and toddlers. Results in bilious emesis.
Medical emergency
–> Dehydration, electrolyte imbalance, prolonged vomiting can lead to shock
What are signs of splenic injury?
LUQ pain and referred pain to left shoulder
What kind of IBS is characterized by affecting only the superficial mucosa, beginning with the rectum and limited to the colon?
UC
What kind of IBD is characterized by transmural inflammation that affects any part of the GI tract?
Crohn’s
What is the ligament of Treitz?
A ligament that anchors the duodenum - birth defect can results in intestinal torsion.
What is the most common solid organ injury in children?
Splenic injury
Why should we opt for conservative treatment of splenic injury?
The spleen filters blood and removed old/damaged cells
Destroys pneumococcal bacteria - considered immunocompromised without it
Stores platelets
What is the pathophyiosology of acute gastroenteritis?
Irritation of mucosa by toxins results in excretion of water and electrolytes –> Metabolic acidosis, dehydration, electrolyte imbalance
Inflammation + destruction of mucosal lining + increased motility = decreased absorption
Peritonitis is a possible complication of appendicitis. What are the S&S?
Sudden relief of pain indicates rupture
–> Peritonitis can lead to fever, abd rigidity/distention, ischemic bowel, sepsis, shock
What demographic is most affected by pyloric stenosis/when does it become apparent?
Caucasians, Males
–> 2-8 weeks of age
What is meant by a “pyloric olive”?
Palpable stenotic pyloric sphincter
What are some complications of intussusception?
Necrotic bowel
Perforation of Bowel
Shock
Sepsis
Recurrent intussussception
When is splenic injury suspected?
Anyone with blunt abd trauma
How is splenic injury confirmed? Managed?
Admit for observation of VS + CBC + obtain T&C
–> Mange with IV boluses, analgesia
