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30 Cards in this Set
- Front
- Back
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What is the initial treatment for pediatric GI bleeding?
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Gastric lavage
Acid suppression Supportive care |
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What is the difference between functional and pathological GER in children?
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Pathological is caused by relaxation of the LES, associated with more severe symptoms.
Functional is associated with mild regurgitation that improves with time. |
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What are symptoms of pathological GER in children?
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Forceful emesis after meals.
Irritability Respiratory problems Laryngeal symptoms Food averson Sandifer's syndroe |
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What is Sandifer's syndrome? How does it relate to GER?
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Spasmodic torsional dystonia with arching of the back. Occurs because arching helps lengthen the esophagus, increase LES pressure and prevents aspiration.
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How is pathologic GER treated? (feeding habits, drugs, surgery)
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Hold infant upright 30 min after feeding.
Thicken feedings. Hypoallergenic formula H2 blocker, PPI, prokinetics, cholinergic agonist. Surgical- Nissen fundoplication |
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What are future complications of pathologic GER?
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Esophageal strictures
Barrett's esophagus Poor weight gain Failure to thrive |
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What are the three growth curve abnormalities that can indicate failure to thrive?
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Drop off in height, weight, or head circumference.
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Why is hospitalization used for failure to thrive children?
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Feeding to supplement.
Observe parent-child interactions Monitor complications Investigations- CBC, lead, UA |
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What pediatric populations most often have chronic abdominal pain? What is the pathophysiology?
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Girls age 9-10
Visceral abdominal pain associated with c-type pain fibers. |
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What are typical symptoms of chronic abdominal pain in children? HOw does Apley's law apply?
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Central nonradiating pain
Nausea, anorexia The further the pain from the umbilicus, the more likely to have pathology. |
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How is chronic abdominal pain treated in children?
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PPI or H2 blocker
Stool softeners Reduced lactose diet Regular follow up visits |
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How is enterobiasis transmitted? How does it present? How is it diagnosed and treated?
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Fecal-oral autoinnoculation in children 5-10 year old.
Presents as perianal pruritis Diagnosed by presence of eggs on scotch tape test. Treated with mebendazole. |
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What are the four types of congenital diaphragmatic hernias?
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Bochdalek- posterolateral
Morgagni- anterior Central Hiatal |
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Why is it important not to bag infants with a diophragmatic hernia?
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Intubate, instead of bagging, because air can enter the esophagus and into the abdomen.
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What are risk factors for necrotizing enterocolitis?
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Prematurity
Presence of patent ductus arteriosus |
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What factors contribute to necrotiing enterocolitis?
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Abnormal intestinal flora
Intestinal ischemia/ reperfusion Intestinal mucosa immaturity/ dysfunction |
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What are radiologic findings of necrotizing enterocolitis?
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Pneumotosis intestinalis- gas within the submucosa
Pneumoperitoneum Dilated loops of small bowel |
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How is necrotizing enterocolitis prevented?
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Breast milk
Avoid broad-spec antibiotics Increase enteral feeds Probiotics |
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What are symptoms of short bowel syndrome involving the jejunum? Ileum?
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Jejunum- nutrient malabsorption
Ileum- loss of water and electrolytes, B12 and bile salt loss. Diarrhea |
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How is short bowel syndrome treated acutely and managed?
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Acute- nutritional support, correct fluid/electrolyte losses.
Adaptation- increase amounts PO and decrease parenteral feeds. Maintenance- manage nutrient deficiencies, fiber, antidiarrheals. |
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When does pyloric stenosis present? How does it present? What lab abnormality is found?
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Presents at 2-4 weeks.
Projectile emesis after feeding, palpable "olive", visible peristalsis Hypokalemic hypochloremic alkalosis present due to loss of gastric secretions. |
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What is duodenal atresia? What is the presentation? What sign is seen on xray?
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Failure to recanalize lumen during development.
Presents as bilious vomiting, distended abdomen, maternal polyhydramnios, jaundice. Double bubble sign seen on xray |
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What are Ladd's bands? How are they involved with malrotation?
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Malrotation- failure to fully rotate in development.
Ladd's bands are obstructing bands of peritoneum left across the duodenum |
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How does malrotation present in infants? What sign is seen on xray? How is it treated?
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Bilious emesis, acute obstruction
Recurrent abdominal pain Diagnosed with double bubble or corkscrew sign of KUB. Treat with removal of the volvulus. |
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What syndromes are associated with intussusception? What can cause it?
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Cystic fibrosis
Henoch Schoenlein purpura Polyposis syndrome Can be caused by Peyer's patches, Meckel's, polyps, etc. |
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What are symptoms of intussusception?
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Severe, colicky pain.
Vomiting Currant jelly stool Sausage shaped mass often in RLQ Abdominal distension |
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What are the typical xray findings for insussusception? How is it treated?
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Coiled spring sign
Treated with gastrograffin/barium/ air enema |
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What are symptoms of Hirschsprung disease? How is it diagnosed?
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Failure to pass meconium, abdominal distension, no rectal tone.
Xray: dilated proximal colon and microcolon distally. Rectal biopsy: hypoganglionic area |
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What is the classic presentation of appendicitis? How does it change with perforation?
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Malaise, anorexia, colicky RLQ pain, nausea, vomiting.
After perforation, transient relief of pain followed by diarrhea, dehydration, sepsis, SBO symptoms |
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What are physical exam findings for appendicitis?
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Rebound tenderness
Guarding over McBurney's point Rovsing's sign- pain in RLQ on palpation of LLQ Obturator sign- pain on rotation of R. hip Iliopsoas sign- pain on extansion of R. hip |
