Williams- PEDS GI of Upper Tract Flashcards
passage of esophageal contents into esophagus that happens in 2/3 healthy infants
gastric esophageal reflux (GER)
painful passage of gastric contents into esophagus + complications such as projectile emesis and hematemesis
GERD
children should double their weight by _____ months
3 months
children should triple their weight by _____ months
12 months
____ is normal
GER
____ in infants is not a problem of excessive acid production
GER
the ____ has the same pressure in infants as it does in adults (10-30 mmHg)
LES
how to test for reflux
observation
pH testing
what to not do when testing for reflux
do not do upper GI study
what does this show
swallowing (pH doesnt drop)
what does this show
acidic reflux event (pH drops)
drop in pH
acid reflux episode
no pH drop
nonacid reflux episode
upper GI study is _______ justified to diagnose GER or GERD in infants
NOT
______ imaging is useful in the evaluation of vomiting (due to obstruction)
upper GI
how do H2 receptor antagonists work
inhibit acid secretion from H/K ATPase by blocking histamine
histamine
gastrin
Ach
all cause acid production (H/K ATPase stimulation)
these drugs physically attach to and block H/K ATPase
PPIs
_____ blocks gastrin, histamine
somatostatin
does not block vagal stimulation
somatostatin
2 main H2 blockers used in peds
Famotidine
Nizatidine
this suppresses acid production from 12-24 hours
PPIs
PPI that can be given in first few weeks/months of life
Omeprazole
this drug has no benefit in reducing crying or fussing and can be tied to increase risk for infection (due to decrease in acid production)
PPIs
SE of this drug: necrotizing enterocolitis in preterm infants
PPIs
this drug is a coating agent that is good if used short term
Sucralfate
SE of this drug is bezoar formation
Sucralfate
best position for babies to sleep in
supine
FPIAP is aka
milk protein allergy/intolerance
milk allergy
explain FPIAP (milk protein allergy)
GI tract has allergic response (IgA mediated) to milk proteins and antibodies created against specific protein and attacks; inflames GI mucosa—–> mucosal injury
sx’s of this include:
hematochezia
fussiness
mucus in loose stools
milk protein allergy (FPIAP)
blood in stool
hematochezia
how to manage milk protein allergy
change diet (exclude cow milk from mothers diet if breast feeding or use formula that is hydrolyzed)
formula that does not have protein intact any longer
elemental formula (AA based)
gastric emptying faster for ____ than for ______
human milk than formula
if you are to use formula, what kind speeds up gastric emptying
hydrolyzed/elemental
trachealization seen in eosinophilic esophagitis
eosinophilic esophagitis
pt has a food allergy and also dysphagia or odynophagia
eosinophilic esophagitis
eosinophilic esophagitis is ______mediated
IgA-mediated
to Rx eosinophilic esophagitis
food elimination diets
PPIs
Dupixent
IL-4, IL-13 blocker used to treat eosinophilic esophagitis
Dupixent
to dx eosinophilic esophagitis
EGD
responsible for 90% of cases of peptic ulcer formation
H. pylori
triple therapy Rx of H. pylori
PPIs
Clarithromycin
Amoxicillin
quadruple therapy of H. pylori
PPIs
tetracycline
metronidazole
bismuth
congenital hypertrophy of pylorus muscle
pyloric stenosis
palpable mass or “olive” noted on exam
pyloric stenosis
infants will have PROJECTILE vomiting that will shoot across the room
pyloric stenosis
to dx pyloric stenosis
ultrasound
to Rx pyloric stenosis
surgery to cut hypertrophied muscle and open canal
what makes up gluten
Gliadin + Glutanin (protein combo)
gluten is found in
wheat, rye, barley
explain celiac disease
body makes Ab’s that attack gluten and injure the villi in small intestine
patient experiences sx’s to gluten but has negative lab findings
non-gluten celiac sensitivity
pt has elevated specific Ab’s for this and dermatitis herpetiformis
pathognomonic for celiac disease
to dx this:
upper endoscopy w/ atleast 6 biopsies in duodenum and atleast 2 from the bulb
celiac disease
what must you always get when checking celiac specific antibodies
total IgA
alleles that confer an increased risk for celiac disease
DQ2/DQ8
to Rx celiac disease
gluten free diet
intraepithelial lymphocytes in duodenum and damage to villi (think what)
celiac disease