Kaplan Pediatrics: Chapter 18 Gastroenterology

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Presents with watery diarrhea, which can last for up to 7-10 days. It can be accompanied by 3-4 days of vomiting. Fever may be present

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Rotavirus

Front 3

Causes a mild diarrhea in immunocompetent infants, but causes severe diarrhea in AIDS pts

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Cryptosporidium

Front 4

When is treatment of Salmonella diarrhea indicated?

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-only for < 3 mo of age
-toxic patient
-disseminated dz
-or if its S. typhi

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What is the treatment for Shigella diarrhea?

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Tri/Sulfa = Bactrim

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What is Entamoeba treated with?

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Metronidazole

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Obstipation = ?

Back 7

absence of bowel movements

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Constipation = ?

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infrequent passage of hard, dry stools

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Front 10

What is the most common cause of constipation outside of infance?

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Functional constipation = voluntary withholding

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What should constipation in the neonate be considered until proven otherwise?

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Hirschprung

Front 12

What is the treatment for functional constipation?

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Initial cleaning out, & may involve dietary manipulation, stool softeners, & counseling

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Front 14

A newborn presents with bilious vomiting with every feed. Abdominal film reveals a double bubble

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Duodenal Atresia

Front 15

What is the association with Duodenal Atresia?

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Trisomy 21

Front 16

When does Duodenal Atresia usually present?

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usually in the first day of life
-there may be a history of Polyhydramnios

Front 17

A 4 month-old is admitted w/ episodes of apnea occurring 20-30 minutes after feeds. The mother states the baby has been spitting up since birth. She is at the 5th% for weight

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GER = occurs when the lower esophageal sphincter pressure is reduced

Front 18

What associated conditions is GER more common in?

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pts with Developmental Delay & Cerebral Palsy

Front 19

Patients presents with GER & opisthotonus ( condition, caused by a tetanic spasm of the back muscles, in which the trunk is arched forward while the head and lower limbs are bent backward)

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Sandifer syndrome

Front 20

How would you diagnose GER?

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pH probe is the standard

Other imaging studies include technetium scanning & barium swallow

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What is the treatment for GER?

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Antireflux measures such as elevating the head of the bed & thickening of feeds.

Medical management = antacids, prokinetics, H2-receptor blockers, PPI's

Failure of medical management results in surgical correction w/ a Nissen Fundoplication

Front 22

A 4 week old boy has nonbilious projectile vomiting. Exam is remarkable for a small mass palpated in the abdomen

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Pyloric Stenosis

Front 23

What is the gender ratio for Pyloric Stenosis?

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Boys 4:1

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What is the presentation of Pyloric Stenosis?

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1. nonbilious projectile vomiting
2. usually AFTER 3 WEEKS of age
3. baby remains hungry after vomiting
4. olive may be palpated
5. peristaltic wave may be seen

Front 25

What does the BMP show in Pyloric Stenosis?

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Hypokalemic, Hypochloremic Metabolic Alkalosis

Front 26

A 15 month-old child is seen for cramping, colicky abdominal pain of 12 h duration. He has had 2 episodes of vomiting & a fever. Exam is remarkable for a lethargic child; abdomen is tender to palpation. Leukocysotis is present. During examination, the patient passes a bloody stool with mucus

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Intussusception

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When do most intussusceptions occur?

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6-24 months of age

Front 28

What vaccine was associated with Intussusception?

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Rotavirus vaccine

Front 29

Acute onset of cramping, colicky abdominal pain. Pts may have vomiting. Pt may develop fever & become lethargic. Sausage-shaped mass may be palpated

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Intussusception

Front 30

What is the diagnostic test for Intussusception?

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Barium enema or Air Enema

Front 31

A 2 year old boy presents with a 1 wk history of painless rectal bleeding. Exam is unremarkable. Abdomen is soft & nontender. Rectal examination is unremarkable

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Meckel Diverticulum

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Most frequent congenital anomaly of the GI tract

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Meckel Diverticulum

Front 33

What are the rules of 2 with Meckel Diverticulum?

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1. presents in about 2% of infants
2. peak incidence is by 2 years of age
3. contains 2 types of tissue
4. 2 cm in size
5. located 2 feet from ileocecal valve

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Painless rectal bleeding

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Meckel Diverticulum

Front 35

What can be a complication of Meckel Diverticulum?

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Intussusception

Inflammation mimicking appendicitis

Can perforate & cause peritonitis

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What is the diagnostic test for Meckel Diverticulum?

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Technetium scan for gastric mucosa in the bowel

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An 8 year old is seen in the emergency department w/ persistent vomiting & mental status changes. On exam he is combative & has a seizure, becomes apneic, & requires intubation. Lab tests are remarkable for hypoglycemia & elevated ammonia. The pt had recently recovered from a viral URI

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Reye Syndrome

Front 38

Define Reye Syndrome

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Encephalopathy with fatty degredaton of the liver

Front 39

What is the etiology of Reye Syndrome?

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Recent viral URI or Varicella with concomitant use of Aspirin

Front 40

What is the presentation of Reye Syndrome?

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-hx of recent viral URI
-after 5-7 days they then present w/ abrupt onset of protracted vomiting
-delerium, combative behavior, & stupor quickly ensue. can progress to seizures, coma, & death
-focal neurologic signs are absent

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What are the lab tests like in Reye Syndrome?

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Ammonia, Transaminases, CK, & LDH are markedly elevated

Hypoglycemia