Week 5 - GI Flashcards
Dehydration
loss of water and extracellular fluid
Levels of dehydration
‣ Mild <3% weight loss children <5% infants
‣ Moderate 6% in children, 10% in infants
‣ Severe 9%+ in children, 15%+ in infants
Most frequent cause of dehydration
Viral. Often accompanied by diarrhea
Three types of dehydration
‣ Isotonatremic – simple diarrhea, body able to maintain salt balance
‣ Hyponatremic – large amount of diarrhea, water and salt is lost
‣ Hypernatremic – vomiting and diarrhea results in water loss and decreased intake
Clinical findings for dehydration
‣ Hypotension
‣ Nuchal rigidity
‣ Decreased level of consciousness
‣ Irritability
‣ Lethargy
‣ Tachypnic (most helpful)
‣ Skin turgor (most helpful)
‣ Increased capillary refill time (*most helpful)
Parameters used for assessing dehydration
‣ general appearance
‣ eyes (sunken or not)
‣ moistness of mucous membranes
‣ presence of tears.
Labs for dehydration
‣ CBC with differential
‣ Blood culture
‣ Electrolytes
‣ BUN, creatinine
‣ Glucose
‣ LFTs
‣ Sodium level
‣ CRP/ESR
‣ Lactate
‣ UA & culture
‣ Stool for culture
‣ Toxicology screen
Imaging for dehydration
‣ Abdominal xray (mass or obstruction)
‣ Chest xray (pneumonia)
‣ US (abscess, mass, stenosis, cysts, pyloric stenosis)
‣ CT or MRI – masses, inflammation, herniation, perforation, obstruction
Management of dehydration
‣ Determine degree of dehydration
‣ Minimal, mild, moderate
oral rehydration soluation
‣ Severe
immediate IV fluids
‣ Pediatric SQ rehydration with human hyaluronidase
‣ Initial rehydration, maintenance of fluids, replacement of ongoing fluid losses
‣ Frequent small fluids (less than 5ml), give larger amounts as tolerated
‣ Antiemetics
‣ Treat fever over 38.2
Colic
Crying for no apparent reason that lasts for 3 hours or more per day and occurs 3 days or more per week in an otherwise healthy infant younger than 3 months of age
S/S of Colic
‣ Difficult to soothe crying
‣ Frowning and grimacing.
‣ Reddening of the face.
‣ The baby may pull up its legs, suggesting stomach pains.
‣ Loud and long screaming fits.
‣ Loud tummy rumblings.
‣ The baby cannot be consoled.
‣ The crying lasts for three hours or more.
Treatment for colic
‣ Reassure the parents and address how difficult colic is
‣ Use white noise to help calm infant
‣ Ceiling fan
‣ Lactobacillus probiotic
Appendicitis
inflammation of the appendix that leads to distention and ischemia that can result in necrosis, perforation, and peritonitis or abscess formation
Time management for appendicitis
36- to 72-hour maximum window from the onset of pain to the rupture of the gangrenous appendix.
S/S of appendicitis
‣ Periumbilical pain shifting to RLQ becoming more intense and localized
‣ Anorexia
‣ Low volume stool with mucous
‣ Fever
‣ Irritability
‣ Crying from pain or silent due to pain when crying
‣ RLQ rebound tenderness
‣ Maximal pain over mcburneys point
‣ Positive psoas or obturator sign
‣ Rovsing’s sign
Psoas sign
Having the patient lie supine and placing your hand just above the knee. Ask the patient to lift the straight right leg up against resistance of your hand
Obturator sign
Pain on passive internal rotation of the hip when the right knee is flexed
Rovsing’s sign
pain elicited in the right lower quadrant with palpation pressure in the left lower quadrant
Scoring for appendicitis (less than 4 then less likely appendicitis)
‣ Nausea/emesis (1 point)
‣ Anorexia (1 point)
‣ Migration of pain to RLQ (1 point)
‣ Low-grade fever (1 point)
‣ RLQ tenderness on light palpation (2 points)
‣ Cough/percussion/heel tapping tenderness at RLQ (2 points)
‣ Leukocytosis (>10,000/mm3) (1 point)
‣ Left shift (>75% neutrophilia) (1 point)
Diagnostics for appendicitis
‣ CBC with differential
‣ Amylase, lipase, LFTs
‣ UA
‣ Abdominal x-ray may show fecalith or rupture
‣ US – enlargement of the appendix wall
‣ CT with contrast
Management for appendicitis
‣ Surgical consultation
‣ Narcotics for pain
‣ Lap appy with f/u in 2-4 weeks
S/S of Abdominal Foreign Body Ingestion
‣ cramps
‣ abdominal pain
‣ bloating
‣ streaks of bloody sputum or in stool
‣ edema of the hypopharynx
Treatment for abdominal foreign body
‣ Most ingested objects that reach the stomach pass through the remainder of the GI tract without difficulty. Items greater than 5 cm in diameter or 2 cm in thickness tend to lodge in the stomach and need to be retrieved.
‣ leave to pass through the system (button batteries included).
‣ Have parents check stool for 2-3 days, f/u if not passed during this time.
Esophageal foreign body ingestion S/S
‣ initial episode of choking, gagging, and coughing
‣ Excessive salivation
‣ Dysphagia
‣ food refusal
‣ emesis/hematemesis
‣ pain in the neck, throat, or sternal notch
‣ Respiratory symptoms such as stridor, wheezing, cyanosis, or dyspnea may occur if the esophageal body impinges on the larynx or tracheal wall.
‣ Cervical swelling, erythema, or subcutaneous crepitations may indicate perforation of the oropharynx or proximal esophagus
Diagnostics for esophageal foreign body ingestion
‣ xray of chest, neck, abdomen - both front and lateral views
Management of esophageal foreign body
‣ If in the esophagus consider object impacted, removal through UGI or removal by experienced GI doc with xray before and after removal.
Intussusception
section of intestine being pulled antegrade into adjacent intestine with the proximal bowel trapped in the distal segment
S/S of Intussusception
‣ intermittent colicky (crampy) abdominal pain
‣ vomiting
‣ bloody mucous stool
‣ history of URI
‣ Lethargy
‣ Fever
‣ sausage like mass in the abdomen on palpation
‣ bloody or guiac positive stools
Diagnostics for intussusception
‣ Abdominal ultrasound
‣ Abdominal xray
‣ Air contrast enema (diagnostic and treatment)
Treatment for intussusception
‣ Air contrast enema under fluorosopy is gold standard
‣ IV antibiotics and surgery for perforation
