week 6 peds abdominal Flashcards
4 week gestation
pancreas, gallbladder, and liver begin to form
intestine already exists as single tube
infant GI tract
elasticity, musculature, and control mechanisms develop until 2-3 years old
liver
creates blood cells by week 6
glycogen by week 9
bile by week 12
pancreas
islets by week 12 -> insulin production
spleen
active in blood formation until 1st year of life then moves to destruction of blood cells
kidney
produces urine by week 12
infant hx
gestation age birth weight passage of 1st meconium stool within 24 hours jaundice vomiting diarrhea colic failure to gain wt steatorrhea enlarged abdomen
Children hx
constipation
dietary habits
abdominal pain
psychosocial stressors
intussusception patho
prolapse, or telescoping, of one segment of intestine into another -> intestinal obstruction
- common between 3-12mo
intussusception subjective
acute intermittent abd. pain abd. distention vomiting - can be dramatic onset legs and knees flexed up to abd. stools nml in beginning, then may be mixed with blood and mucus with a red currant jelly appearance.
intussusception objective
sausage shaped mass may be palpated in the R or LUQ
lower quadrants feel empty
abdominal distention and guarding
pyloric stenosis patho
hypertrophy of the circular muscle of the pylorus leading to obstruction of the pyloric sphincter
pyloric stenosis subjective
s/s develop after several weeks
- regurgitation -> projectile vomiting
feeding eagerly
failure to gain weight
pyloric stenosis objective
epigastric distention
possible visible wave of peristalsis in epigastric
small, rounded olive-shaped mass sometimes palpable in RUQ
Meconium ileus patho
distal intestinal obstruction caused by thick inspissated impacted meconium in the lower intestine of newborn
meconium ileus subjective
failure to pass meconium in the first 24 hours after birth
vomiting
abdominal distention
meconium ileus objective
abdominal distention
complicated -> shock s/s:
- tachycardia, hypotension
biliary atresia patho
congenital obstruction or absence of some or all of the bile duct system
- > bile flow obstruction
- postnatal or embryonic onset
biliary atresia subjective
s/s of neonatal cholestasis develop in the first several weeks
- jaundice, light clay-colored stools, dark urine
possible failure to gain wt
biliary atresia objective
jaundice in the first 2 months
hepatomegaly- may be firm to palpation
splenomegaly may occur
embryonic type: pt may have heart murmurs as well
meckel diverticulum patho
outpouching of the ileum that varies in size from a small appendiceal process to a segment of bowel several inches long
often in proximity of the ileocecal valve
- incomplete obliteration of the vitelline duct resulting in a blind-ending pouch
meckel diverticulum subjective
most asymptomatic
can have rectal bleeding
possible abdominal pain
meckel diverticulum objective
painless rectal bleeding
some present with intestinal obstruction
- abd. tenderness, guarding, rebound tenderness
necrotizing enterocolitis patho
inflammatory disease of the GI mucosa associated with prematurity and gut immaturity
necrotizing enterocolitis subjective
may be subtle inability to tolerate feedings (oral or nasogastric) abd. distention vomiting blood stools
necrotizing enterocolitis objective
temperature instability subtle signs of distress lethargy abdominal distension apnea respiratory distress Xray: air in the bowel wall (pneumatosis intestinalis)
neuroblastoma patho
solid malignancy of embryonal origin in the peripheral sympathetic nervous system
- commonly arising form the adrenal medulla, may occur anywhere along the craniospinal axis though
neuroblastoma subjective
asymptomatic abdominal mass in a young child s/s could be - malaise - loss of appetite - weight loss - protrusion of one or both eyes
neuroblastoma objective
firm, fixed, nontender, irregular, and nodular abdominal mass that crosses the midline
metastases to periorbital region
-> proptosis and infraorbital eccymoses
horner syndrome, ataxia, opsomyoclonus “dancing eyes and dancing feet”
wilms tumor (nephroblastoma) patho
most common intraabdominal tumor of childhood
usually appears at 2-3 y/o
small percent genetic: chromosome 11
wilms tumor subjective
painless enlargement of the abdomen or an abdominal mass
some may have abdominal pain, vomiting, hematuria
wilms tumor objective
may be felt on abdominal examination
- firm, nontender mass deep within the flank, only slightly moveable, not crossing the midline, sometimes bilateral
HTN may be present
hirschsprung disease patho
primary absence of parasympathetic ganglion cells in a segment of the colon
- > interrupts intestinal motility, absence of peristalsis
- > accumulation of stool proximal to the defect
hirschsprung disease subjective
s/s begin with failure to pass meconium in the first 24-48 hours
- failure to thrive, constipation, abd. distention, episodes of bilious vomiting and diarrhea
- small ribbon stools
hirschsprung disease objective
severe constipation
abdominal distention
stool palpated in the LLQ
hemolytic uremic syndrome (HUS) patho
triad of microangiopathic hemolytic anemia, thrombocytopenia, and uremia
- most commonly caused by shiga-like toxin produced by E. coli
hemolytic uremic syndrome subjective
preceding URI or gastroenteritis with fever, abd. pain, and vomiting
diarrhea becomes bloody
may lead to acute abd. or perforation
some w/ sudden onset pallor, weakness, lethargy, and dec. urine output
hemolytic uremic syndrome objective
dehydration edema petechiae hepatosplenomegaly severe GI disease: abd. distention, guarding, rebound tenderness
umbilical hernia
common
60% of black babies born with this
pinworms
caused by nemotoad parasite
