Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
89 Cards in this Set
- Front
- Back
|
prevalence of uncomplicated GER in infancy:
1st 3 mo @4mo 10-12mo |
50% in 1st 3mo
67% of 4mo only 5% 10-12 mo |
|
|
Etiology of GER in peds
|
1. transient relaxation of LES
2. inadeq adaptation to increased abdominal pressure (cry, cough, etc) 3. anatomic problem with GE junction (hiatial hernia) |
|
|
When is a clinical diagnosis of GER acceptable in Peds (what criteria)?
|
<6mo
thriving |
|
|
What differentiates GERD from GER in peds
|
GERD is or can be a/w
poor wt gain or weight loss recurrent emesis in older children apnea or ALTE asthma/recurrent pna chronic cough esophagitis, anemia from blood loss irritability dysphagia, back arching, food refusal, abnormal neck posture |
|
|
If there's blood in the spit up, is it GER?
|
No, it's GERD
|
|
|
what is sandifer syndrome and when do you see it?
|
abnormal neck posturing - the head turns one way and the hips/legs the other way & back arches
a/w feeding a/w either GERD or HIATAL HERNIA infancy to early childhood (18-36mo) |
|
|
PE signs of GER
|
possible epigastric tenderness &/or foul breath
|
|
|
what are the characteristics of emesis in GER in infants
|
can be a few cc--> several oz.
NONbloody NON bilious effortless to mildly forceful happy spitters a/w feeds or a little while after |
|
|
What are some symptoms of GER in older kids
|
Pain - chest or substernal or epigastric
Regurg Night awakenings bad taste in mough food gets "stuck" related to diet/meals chronic cough hoarseness sore throat |
|
|
what are some differentials for persistent vomiting in babies
|
anatomic obstruction
hydrocephalus inborn metabolic errors infection (UTI, sepsis, etc) |
|
|
what are some differentials for GER/D
|
eosinophillic esophagitis
food allergies/intolerance rumination achalasia cyclic vomiting |
|
|
What disorders in kids are a/w GER
|
esophageal atresia & repair & other congenital anomalies of GI tract
hiatal hernia neuroimpairment & delay bronchopulm dysplasia asthma CF & any disease with chronic cough. |
|
|
diagnostic studies for GER diagnosis (if not clinical dx)
|
1. pH probe study
2. EGD 3. scintigraphy & multiple intraluminal electrical imedance measures are not generally used in kids (lack of standardized measures) |
|
|
pH probe study - what is it and benefits?
|
measures amount of acid in 24hrs - detects episodes of reflux and its association with symptoms
able to rule out anatomic cause determines effectiveness of esophageal clearance & med effectiveness |
|
|
what is the downside of pH probe
|
cannot detect NON acid reflux or GER complications a/w normal GER
not able to determine apnea |
|
|
benefit of EGD for dx of GER
|
visualization and biopsy of esophageal epithelium - able to determine presence of other problems
reflux vs. non reflux |
|
|
prob w/ EGD for dx of GER in kids
|
not standardized for kids
requires sedation cannot tell the extent of GER |
|
|
what TLC recommendations would you make for INFANT with GER
|
small frequent feeds and frequent burping
thicken formula - 1 tsp rice cereal/oz position - left side, not in infant seat after eating hypoallergenic formula - consider on tight diapers/waistbands no tobacco smoke |
|
|
what TLC recommendations would you make for OLDER KIDS with GER
|
sleep on left
increase HOB no lying supine after eating no acidic foods - limit chocolate, caffeine, mints, high fat foods smaller, more frequent meals no tight clothing no NSAIDS |
|
|
med classes for GER
|
antacids
H2RA PPI prokinetics |
|
|
when to use H2RA vs PPI
|
H2RA for kids <1yo, PPI OK >1yo
can use either, otherwise PPI can be dissolved (comes as solution or open caps) |
|
|
What are the H2RA's most used in kids
|
ranitidine (Zantac)
famotidine (Pepcid) |
|
|
What is the dose of Zantac?
|
5-10mg/kg/day divided BID or TID
|
|
|
What are the PPIs used in peds
|
omeprazole (Prilosec)
lansoprazole (Prevacid) |
|
|
How much omeprazole
|
0.6-1mg/kg/day
|
|
|
when to give PPI
|
30 min before meals.
|
|
|
what prokinetics are used in GER
|
erythromycin
reglan |
|
|
when is surgery appropriate for GERD
|
FTT
esophagitis/strictures apneic spells |
|
|
what are the characteristics of complicated GERD
|
poor wt gain
excessive crying/irritabiltiy feeding problems respiratory issues: wheezing, stridor, recurrent pneumonia |
|
|
criteria for defining functional constipation
|
2+ symptoms for 2+ mo
|
|
|
criteria/def of functional constipation
|
<3BM/week
>1 encopresis/wk impaction large stool retentive posturing/withholding pain with defecation |
|
|
prevalence of functional constipation in kids
|
1-2% primary school kids
|
|
|
what should you suspect in a 3yo that is grunting, straining, reddening w/ bowel movements?
|
this is NORMAL in a 3mo - not a sign of constipation
|
|
|
what are the risk fc for functional constipation?
|
painful defecation
skeletal dysfunction / weakness psych issues (control / authority) modesty meds |
|
|
what is the onset of hirsprungs disease vs. constipation?
presence of abdominal distension? normal nutrition & growth? |
onset:
Hirshprungs: @ birth Constipation: 2-3yo abdominal distension is present in Hirshprungs, but not in constipation nutrition and growth are poor in Hirshprungs, but normal in constipation |
|
|
what are non pharm mgt options for constipation (dietary, behavior, and educational)
|
Diet: increase fluids, decrease milk, increase fiber
Behavior: scheduled toileting - sit on toilet x20min after meals, use foot leverage, diary, positive reinforcement Education: Assurance that it's OK, describe importance of regularBM (explain dilation), importance of maintaining treatment regimen x3mo |
|
|
what is used to relieve constipation if there is impaction
|
soap suds enema
|
|
|
what Rx measures can be used for constipation
|
barley malt extract: 1-2 tsp per feeding BID or TID (safe in small infants)
Miralax - daily, can increase to more often Senna - for short periods it's OK |
|
|
what are the criteria for functional abdominal pain
|
3+ occassions over 3 mo
persists >3mo affects normal activity there is no discernable organic cause >5yo (consider organic cause if less than 5yo) |
|
|
what family history is common in children with functional abdominal pain
|
IBS
ulcers migraine HA |
|
|
what is the common clinical presentation of functional abd pain
|
episodic abdominal pain (periumbilical, vague localization)
self-limited (30min-3hr) Not a/w meals/activities may start with N/V or autonomic arrousal interferes w/ ADl Generally no signs |
|
|
what is the differential dx of functional abd pain
|
constipation
recurrent UTI IBS lactose intol or food allergy PUD lead poisoning eosinophillic esophagitis GER IBD Giardia Abdominal Migraine Uteropelvic junction obstruction GYN conditions muscular abuse |
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests would you do if you suspected IBD |
ESR
serum protein albumin guiac |
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests would you do if you suspected celiac (FTT) |
tissue transglutinase
|
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what test should you always do? |
LEAD
Pregnancy test in female |
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests would you do if there was marked diarrhea, nonbloody, and you suspect pathogen |
stool O&P
Giardia probably also test for Celiac (tissue transflut) and IBD (ESR, serum protein, serum albumin, guiac) |
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests would you do if you suspected lactose intol |
trial a lactose free diet
|
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests would you do if you suspected constipation |
abdominal x-ray
|
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what tests might you consider just in general? |
CBC
macroscopic UA Stool blood test |
|
|
what is the management of functional abdominal pain?
|
assurance & behavioral approach - CBT is also helpful for getting through it and getting the plan down
peppermint oil diary of foods / pain high fiber sometimes? decrease carbs? decrease milk products? shift attn to childs accomplishments and other parts of life. |
|
|
In a child with recurrent abdominal pain with suspected functional etiology:
what are the RED FLAGS that it might be an organic cause |
weight loss
nocturnal pain recurrent emesis abnormal PE findigns abnormal lab values or +guiac decreased albumin, increased ESR, anemia, increased amylase/lipase |
|
|
what is the definition of celiac disease?
|
intestinal sensitivity to the glandin fractions of gluten in wheat/rye/barley/ and sometimes oats
|
|
|
when does celiac disease generally present and what's the prevalence in the US
|
1st 2yrs of life - about 6-12 mo after intro of gluten to the diet
1:300 |
|
|
what are some risk fc for celiac disease
|
Family hist
type 1 DM IgA deficiency Downs |
|
|
what are the clinical signs of Celiac disease in a crisis
|
dehydration
can have shock and acidosis |
|
|
what are other clinical signs and symptoms of celiac disease?
|
diarrhea: intermittent and becomes continuous, pale, bulky, frothy, greasy, foul smelling
constipation (from dehydration) emesis abdominal pain FTT with onset of diarrhea and distended abdomen from gas anemia, FTT, vitamin deficiencies in later stages |
|
|
whatare the diagnostic criteria for celiac??
what is the definitive dx of celiac disease? what other tests can be done? |
1. small bowel microscopic changes
2. clinical improvement on gluten free diet ***biopsy of small bowel*** 3-day stool collection impaired oral glucose tol test tissue transgluinase (will be false pos in IgA defic) |
|
|
what is the treatment for celiacs dis
|
gluten free for life
assure high enough calories and fat intake in the acute phase: decrease milk and increase vitamins and supplements, test oats after recovery corticosteroids only when very ill and profound anorexia --> will speed recovery |
|
|
what hx questions/PE/dx tests are most important in a child with emesis or regurg
|
pain
consider BMP for electrolyte abnormalities consider upper GI to r/o anatomic cause in young infants think of increased ICP |
|
|
what is achalasia?
|
failure of the LES to relax that is a/w abnormal nonperistaltic activity of the esophagus and vomitting/regurg
|
|
|
at what age does achalasia generally present
|
over 5yo
|
|
|
what is the clinical presentation of achalasia
|
retrosternal pain, sensation of food impaction
dysphagia relieved with forceful swallowing and drink a lot with meals chronic cough/wheeze, may have recurrent aspiration anemia poor wt gain |
|
|
how is achalasia diagnosed
|
on a barium esophagram: there is a "beak" shaped dilated esophagus at the GE junction
|
|
|
what is the treatment of achalasia
|
pneumatic dilation of LES
botulinum toxin surgical - heller myotomy - divides the LES |
|
|
what should be suspected if emesis is BILIOUS and what should eb done?
|
suspect intestinal obstruction
IMMEDIATE referral |
|
|
clinical presentation of pyloric stenosis
|
vomitting, rapidly becomes projectile and after each feeding
emesis may be bloody emesis is rarely bilious hungry, ravenous constipation dehydration wt loss, fretfullness olive shaped mass at RUQ, especialy after vomiting |
|
|
at what age is pyloric stenosis most common
|
2-4wk old
sometmes at birth |
|
|
how is pyloric stenosis diagnosed
|
upper GI or US
|
|
|
what is the treatmetn for pyloric stenosis
|
pyloromyotomy
**treat dehydration and electrolyte imbalance before surgery** |
|
|
what are the differntials for vomiting
|
GER/GERD
Eosinophilic Esophagitis Achalasia Food Allergies/Intol Cyclic Vomiting Rumination UTI Gastritis Gastric outlet obstruction CNS masses otitis or sinusitis metabolic disease that causes acidosis psychogenic vomitting |
|
|
what is the age of presentation of food allergies
|
generally childhood allergies present early, like at 1yo
|
|
|
what are the symptoms of food allergies?
what are the signs |
vomitting, diarrhea, cough/congestion/breathing probs.
mild to fatal reactions hives, angioedema, eczema, shock anaphylaxis, hypotension diarrhea, often bloody (with milk) |
|
|
what is the best diagnosis of food allergies
|
Oral challenges/elimination diet
RASTs and skin tests have high flase positives |
|
|
define cyclic vomiting
|
recurrent episodes of intense vomiting, hrs to days
|
|
|
what's the cause of cyclic vomiting
|
unknown
|
|
|
what is the clin presentation of cyclic vomiting
|
intense vomiting interspersed with periods of being fine
may be abdominal pain |
|
|
what's a risk fc for cyclic vomiting
|
family hx of migraines
|
|
|
how is cyclic vomiting diagnosed?
|
rule out other possibilities
|
|
|
what is the treatment for cyclic vomiting
|
prevent vomiting
rehydration |
|
|
what is the prognosis for cyclic vomiting
|
migraines in adolescence
|
|
|
what is rumination
|
chronic regurg of partially digested foods
assumed psych basis |
|
|
what is the clinical presentation of rumination
|
halitosis / bad taste
chronic regurg that is either expelled or reswallowed generally seen in child who is institutionalized or understimulated. |
|
|
how is rumination diagnosed
|
rule out other disorders and do a psych eval
|
|
|
treatment for rumination
|
behavioral therapy
|
|
|
what is eosinophilic esophagitis
|
eosinophilic infiltrate of esophageal mucosa r/t food allergy that leads to chronic inflammation
|
|
|
who/when do kids get eosinophilic esophagitis
|
peaks in childhood and adolescence
suspect in kids known to have food allergies |
|
|
what is the clinical presentation of eosinophilic esophagitis?
|
abdominal pain
emesis or reflux diarrhea sensation of food getting stuck may see weight loss and FTT |
|
|
what is the diagnosis of eosinophilic esophagitis
|
no improvemnt with meds for regurg
EGD - will show classic signs will improve with food avoidance |
|
|
what is the treatment for eosinophilic esophagitis
|
avoidance diet
may need corticosteroids (inh or po) |
