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32 Cards in this Set
- Front
- Back
Duodenal atresia
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Bilous emesis (bile - green)
Double-bubble sign on x-ray. Lumen does not recanalize. Associated with prematurity and Down's |
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Tx of duodenal atresia
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NG tube, surgery, support (can't feed them)
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Biliary atresia
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Pale/clay stools (acholic), jaundice, dark urine, failure to thrive, hepatomegaly, elev liver enzymes.
Conj bili raised and unconj can be normal (very bad to have it this way) Fetus can't drain bile from liver to intestine. |
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Biliary atresia - more often extrahepatic or intrahepatic ducts?
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Extrahepatic
More often in girls and asians. |
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Dx of biliary atresia
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US, liver biopsy, ERCP, MRCP, HIDA scan, exploratory lap
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Tx of biliary atresia
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Kasai procedure - hepatoportoenterostomy.
Liver transplantation with unsuccessful kasai procedure or dev of cirrhosis, portal HTN, ascites, cholestasis (flow from liver is blocked) Better to do the surgery early. |
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Tracheoesophageal fistula
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Polydramnios (can't swallow amn fluid), salivation and drooling, choking, coughing, cyanosis with feeding, aspiration, resp distress.
Most often there is a distal fistula that connects to the trachea but food could obv not get in there.. |
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Associated anomalies with TE fistula
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CV defects, imperforate anus, intestinal malrotation/volvulus, duodenal anomalies
Down's syndrome! |
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Dx of TE fistula
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Pass radiopaque NG or OG and CXR.
Pulm sx more often seen. |
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Tx of TE fistula
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Primary surg repair. There are complications.
Abnormal LES leads to stricture formation at times leading to pneumonia. |
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Malrotation and volvulus
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Anomaly of intestinal rotation from failure of midgut to approp reenter fetal abdomen.
SI suspended by a stalk containing superior mesenteric artery. Leads to midgut ischemia and infarction. |
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Sx of malrotation with volvulus
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abdom distention, bilious vomiting - suggests obstruction.
volvulus can lead to perforation and bloody stools. THIS IS A SURGICAL EMERGENCY!!! |
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Gastroesophageal reflux
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not a disease.
emesis occurs as a result. no tx usually. due to the LES still developing. less pressure, poor relaxation, delayed gastric emptying, poor contractions of LES and gastric distention. |
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Pyloric stenosis
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nobilious vomiting. emesis increases and becomes projectile.
hypokalemic metabolic alkalosis results with dehydration and paradoxic aciduria. "palpable olive" - where outlet of stomach is and peristalsis can be seen grossly. |
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Dx and tx of pyloric stenosis
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This si the end of the stomach - surgical pyloromyotomy (reduce the amt of muscle)
correct electrolyte imbalance and dehydration. US is teh dx. |
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Infant nutrition
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Vit D is the only thing not in breast milk.
Contraind breast milk with contag TB and HIV in the US Solids at 4 months (cereal on spoon, then veggies [new ones every 4 days], fruit. meat and water around 9 months. |
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Colic
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unexplained crying that will eventually resolve. need to reassure parents.
more than 3 hours a day, 3 days a week and more than 3 weeks in a health well-fed infant. |
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cows milk
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start at one year. and whole milk until age 2 (fat for brain)
too soon --> anemia. |
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juice?
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no!
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toddler feeding
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they adjust over the course of days.
don't give too much milk. |
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Failure to thrive
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Asymm - weight goes first, then length, then head circum.
nonorganic is due to a lack of calories coming in - by far the most common reason. almost every condition can cause failure to thrive. |
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DDx of failure to thrive
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Psychosocial
CNS pathology, poor suck.. Maldigestion/ Malabsorption (CF) Inborn Errors of Metabolism Incr Metabolic rate (heart) Regurgitation Chromosomal/Genetic HIV |
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Hypernutrition
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leads to earlier growth plate closure and thus short and fat adults.
reduce "screen time" to less than 2 hours a day. |
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Constipation definition
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delay or diff in defecation for over 2 weeks and causes signif stress.
note there is a large variation in normal stool patterns. |
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Most constipation is...
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functional - due to painful defecation cycle, diet, illness, stress, too busy playing, travel/attending school
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red flags with constipation
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failure to thrive, abdom distention or abnormality, empty rectum and palpable fecal mass, liq stool with withdrawal finger, heme occult, absent anal wink, decreased LE tone or strength (neuro disorder)
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fecal witholding
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kid had a painful stool so he is holding in which will only make it worse...
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Encopresis
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result of long standing constipation. rectum gets dilated and can't contract as well. then water leaks around it so the child spoils underwear and has many other issues.
more often in boys. tough to potty train these kids. |
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Developmentally delayed with potty training when...
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not trained by age 5.
most do it by age 3. most constipation occurs during potty training. |
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Tx of constipation
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Disimpact with meds -Miralax or rectals - or manually.
Maintenance - many months req for bowel diameter and sensation to be restored. |
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Tx of...something stimilar to constipation. maybe with potty training?
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Educate
Meds are same as for adults. MiraLax is my personal favorite Enemas: watch electrolytes… Diet very important Common offenders: milk, (apple juice) Push Practice – sit on potty for 5 minutes and try to push with feet on ground. Psyche is important. |
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Enemas to rx to kids
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5 year old needs "adult" ones and baby needs "child" ones.
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