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247 Cards in this Set

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What is the tell-tale sign of GI mechanical obstruction?
Green vomit
What is the most important portion of the history for a child presenting with abdominal issues?
NEEDS
What is the initial presentation of an appendicitis?
periumbilical pain but localizes to the RLQ within 2 hours of onset
Where are the ovaries at birth?
in the abdomen
Why is a proper genital exam vital in conducting a problem abdominal exam work-up?
If the child does not have a vaginal opening they may have an obstruction that causes pain
Why is the abdominal history for GI difficult to obtain?
because it is parent vs the child
ToF: the further the pain is from the umbilicus, the less likely it is to pathological?
FALSE: more likely! if it is at the umbilicus it is likely psychosocial pain
What is the correct method in assessing symptoms of abdominal disorders?
PQRST
The __ and __ predominantly lie in the LUQ
pancreas and spleen
the RUQ houses the ___ & ___
gallbladder and liver
The colon, intestine and L orvary are likely found in which quadrant?
LLQ
What is found in the RLQ?
intestine, appendix, R ovary
What is the first step in the abdominal assessment?
INSPECTION!!!
What is the scratch test used for?
Non-invasive technique to assess the size and location of the liver and the spleen
Why must children with SCD have a scratch test done at every visit?
They may have splenic sequestration under 3 years of age which will cause enlargement. the sickled cells will get trapped in the spleen
Why must a rectal exam be conducted for an abdominal assessment?
-Crohn's disease will present with lesions in this area
After you inspect the abdomen, what is the proper order of assessment for the remainder?
-non-touching manuevers
-auscultation: scratch test considered non-touching test
-palpation
-exam of non-abdominal areas
-rectal and genitalia
when should the abdomen not be palpated during the abdominal exam? Where are the important areas to palpate?
when there is extreme splenomegaly.

must palpate the sides of the abodomen because wilm's tumor moves to the inside
ToF: the liver is not palpable in the newborn periord>?
FALSE!!! must palpate it! 1-3 cm below the costal margin
when does the liver move under the costal margin?
in preschool
ToF: kidneys are rarely palpable?
True
Describe the proper way to assess the kidney.
 Place left hand posteriorly just below the right 12th rib. Lift upwards trying to displace the right kidney anteriorly
 Palpate deeply with right hand on anterior abdominal wall.
 Have the patient take a deep breath.
 Feel for lower pole of kidney as it descends and try to
 Have the patient release breath. Slowly release the kidney and feel it slide back into place.
Describe the method for conducting CVA tenderness.
 With patient seated upright, place palm of
left hand over each costovertebral angle.
 Strike back of left hand with ulnar surface of right fist.
What does tenderness in the CVA test indicate?
kidney infection; pyelonephritis or perinephric abscess
What is an Inflammation of kidney substance and pelvis.
pyelonephritis
What is a perinephric abscess>?
Abscess formation in the peritoneal membrane surrounding the kidney
What are the red flags during an abdominal exam?
-guarding
-point tenderness
-assymetry
-no bowel sounds
-palpable mass
-nutritional status
-extra intestinal features
-abdominal distention
-visible bowel loops
-high pitched bowel sounds
What is a likely cause to high pitched bowel sounds?
obstruction
What is the red flag sign associated with intussusception and obsturction?
visible bowel loops
ToF: peritonitis and obstruction do not cause abdominal distention?
False, they do
What are the red flags associated with nutritional status?
-weight loss
-height loss
-edema
-anemia
what are the possible diagnoses with no bowel sounds?
-peritonitis
-infarcted bowel sounds
What is an acute abdomen?
illness in which the symptoms and signs are focused on the abdomen or one of its organs
What are the characteristics of acute abdominal pain?
 Slow or rapid onset of pain in the abdomen
 Usually steadily builds
 Patient may relate it to an event
 Other physiological disturbances: vomiting, diarrhea, fever,
anorexia
 Guarding is usually present
What are the characteristics of a subacute abdominal pain
 Onset more difficult to remember
 May have other physiological disturbances as well
 Not acutely ill
 Allows examination of the abdomen
 May be vague in location and tenderness
 Difficult to localize
true or F: subacute pain localizes well with 1 finger.
False@ it does not localize well
___ __ is a winter disease associated with lactase deficiency and periumbilical pain.
streptocococal pharyngitis
What are the characteristics of chronic abdominal pain?
 Onset may be associated with an event that the child does not want-test, gym, recess
 Cannot be localized
 Does not waken the child
 Resolves spontaneously when the child has something to do that
he likes
 Pain is out of proportion to physical exam findings
 Laboratory findings are normal
What is the number one cause of abdominal pain in children?
constipation
What is mittelschmerz and where on the abdomen is it felt?
pain in the middle of the menstrual cycle when the egg is released and often occurs in the RLQ
What are the major classes of non-abdominal causes of abdominal pain?
-pneumonia
-streptococcal pharyngitis
-reproductive tract disease
-diabetic ketoacidosis
-sickle cell disease
why can pneumonia cause abdominal pain?
visceral innervation, pain can feel as though it was in the abdomen
List the reproductive tract disorders that can cause abdominal pain?
-STD
-ovarian cyst
-ovarian or testicular torsion
-ectopic pregnancy
What is the classic sign of PID?
the shuffle: bent forward while walking
What are achalic stools? are they alarming?
they are white/pale stools. Yes they are a bad sign
If a child has belly pain that wakes them in the night, is this alarming?>
YES!
What are examples of alarming features of abdominal pain?
 GI blood loss
 Perirectal disease
 Dysphagia
 Involuntary weight loss
 Persistent vomiting
 Deceleration of linear growth
 Delayed puberty n Achalic stools
 Unexplained fever n Persistent right upper or
right lower quadrant pain
 Pain that wakes the child from sleep
 Nocturnal diarrhea
 Arthritis
 Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease
What findings of a pain history would red flags for an abdominal exam?
-Focal
-Nocturnal
-Severity
-duration
What are the NON-worrisome characteristics of a GI history?
 Undigested food in stool
 Green stool
 Child sleeps through the night
 Pain occurs in am and disappears with passing of school bus and tends not to occur on the weekend
Is vomiting involved with an appendicitis?
Yes, they usually vomit once
What are the general symptoms and assessment of severity of ?
 Does the patient look ill?
 Is the child bouncing around the room
 Any signs of trauma
 Any tenderness with percussion or rebound tenderness
 Any signs of dehydration?
 Is the apical rate normal?
True or False: children with an appendicitis will be able to jump up and down when told?
false!
Why can pain be referred in an appendicitis?
Because there are various positions that the appendix can move about the cecum
What are the common malformations of the cecum?
 Non rotation and therefor cecum is found in the left part of
the abdominal cavity
 Malrotation and the cecum remains below the pylorus
 Subhepatic cecum and therefore the cecum is below the liver
 Mobile cecum: not fixed to the retroperitoneum
 Hyperrotation in which the cecum lie directly at the left colic flexure
The ___ ___ is the most important information to obtain with a possible appendicitis?
Clinical history
What are the pertinent clinical history findings for an appendicitis?
-pain that precedes the vomiting
-nausea or vomiting
-tenderness of McBurney's point
-fever
-leukocytosis
What are the common causes of obstruction of the appendix?
 Usually cause fecalith
 Vegetable or fruit seeds
 Intestinal worms
 Inspissated barium
 Hypertrophy of lymphoid tissue following infection/dehydration
Describe the pathophysiology of an appendicitis.
 Increased intraluminal pressure within the appendix stimulated visceral pain fibers and leads to dull, diffuse pain
 Once obstructed, there is inflammation ischemia, necrosis and due to bacterial overgrowth gangrene can occurs
 Increasing pressures leads to occlusion of the capillaries venules causing distention leading to nausea and vomiting
 As the inflammatory process continues, the serosa of the appendix and parietal peritoneum shifts the pain to the right lower quadrant
What are the 3 findings that must be charted to protect against lawsuit of a missed appendicits?
-No rebound pain
-ability to jump
-no obturator sign
What age group has the highest incidenc of appendicitis?
10-19 years
What are the clinical presentations of appendicits in toddlers?
 Fever and vomiting
 Pain may be intermittent and referred to right hip with lip  Abdominal pain may be localized or generalized
List the clinical presentations of a school-aged child coming in with appendicitis.
 Abdominal pain and vomiting are common
 Pain with walking or movement is very specific
 Fever is common
 Abdominal wall tenderness that tends to be focal to right lower
quadrant (unless the appendix is displaced)
 Involuntary guarding is present and is quite sensitive
What does MANTREL stand for?
presentation of an appendicitis

M: Migration of pain
A: Anorexia
N: Nausea and vomiting
T: Tenderness on the right lower quadrant
R: rebound tenderness
E: elevated tenderness
L: leukocytosis
List the factors that suggest an acute abdomen.
-Bilous vomiting
-abdominal tenderness
-distension
-abdominal mass
-obstipation
-feeding intolerance
-edema of abdominal wall
-crying
-irritability
-bloody stool
-fever
-hypothermia
-omphalitis
-severe pain
What is Psoas sign and how do you elicit it?
Test for an appendicitis
-Have the child in supine position
-place hand above right knee
-direct child to raise leg against pressure
-or have child drop right leg over exam table

These will elicit pain
What is the obturator sign?
 Pain in internal and external rotation
of the flexed thigh
 Flex child's right thigh at the hip with the knee bend
 Rotate leg internally at the hi
What is the Faber Test?
Abduction of the hip with a flexed knee to find pain indicative of an appendicitis
Pain found in the right lower quadrant with left sided pressure is called ___ sign.
Rovsing's
The ___ ___ ___ test is the official name of having a child jump up and down as a sign for an appendicitis
Markle Jar heel
ToF: a rebound test should be conducted on young children to assess for appendicitis.
FALSE: do other tests
Descirbe the technique of the rebound test.
Firmly and slowly push in, then quickly withdraw. Pain will occur when you withdraw
What is a positive Murphy sign? what is the likely diagnosis with this test>?
-Temporary inspiratory arrest with palpation of right sbucostal margin
-Indicates cholescystitis
The most common cause of a pancreatitis is ___
Trauma
Pancreatitis causes a raise in the levels of ___ first, followed by a raise in ___ enzyme.
Lipase; amylase
Other than an increase in lipase and amylase, an increase in ___ may also be seen in pancreatitis.
calcium
Pancreatitis can occur as a side effect to what 5 factors?
-HIV meds
-alcohol
-congenital anomalies of biliary tree
-IBD
-pancreatic duct malformations
Describe the pain and physical symptoms of pancreatitis.
Upper abdominal pain or periumbilical pain with radiation to the back.

-Ileus, distension and ascites
What are the risk factors to NASH and NAFLD?
-Obese
-Hispanic
-Male
What are the characteristics of NASH?
Nonalcoholic steatohepatitis

-Fat in the liver, along with inflammation and damage
-leads to cirrhosis
-elevation of ALT and AST with RUQ pain
ToF: nonalcoholic fatty liver disease (NAFLD) is associated with inflammation and fat in the liver.
FALSE: no inflammation!
The most common cause of vomiting in school aged children is ___
viral
What are the 3 common infectious agents that cause vomiting in school age children in order of prevelance?
1. Viral
2. Bacterial
3. Parasites
Where do children often get parasitic infections leading to vomiting?
National parks: Giardia
ToF: vomiting may be a sign of asthma?
TRUE
what is achalasia?>
The esophagus cannot move leading to vomiting
What are the common viral infections that lead to vomiting?
-coxsackie
-adenovirus
List the general causes of vomiting in school aged children
-infection
-cough
-ICP
-Food allergy
-Achalasia
-GERD
-Poisoning Medications
-Psychogenic metabolic disorder
-Cyclic vomiting
-Eosinophilic esophagitis
WHat is eosinophilic esophagitis?
THe esophagus fills with eosinophils and leads to vomiting
Why can asthma cause vomiting?
air trapping and flattened diaphragm that pushed on the stomach.
What is a common cause of vomiting in the morning?
increase ICP
A child with coffee ground colored emesis may have __, ___ or __.
-Esophagitis
-gastritis
-gastric ulcers
a small volume of bright red blood colored vomit may indicate ___ or __
esophagitis or gastritis
What are 4 possible cuases of copious amounts of bright red colored vomit?
-esophageal tear (Mallory Weis tear)
-gastic ulcer
-duodenal ulcer
-esophageal varices
what is a mallory weis tear?
tear in the lower part of the esophagus where the antrum meets the stomach
What is the first sign of dehydration in children?
tachycardia
What are the assessment factors of hydration in children?
-especially important with complaints of diarrhea, vomiting or deceased oral intake
-must be aware of voiding pattern
-level of activity
-heart rate
What is a sign of high sodium levels in children?
doughy skin turgor
what is the preferred treatment for eosinophilic esophagitis?
steroids
What disorder is characteristized as chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation?
Eosinophilic esophagitis
If a child has infectious gastroenteritis, what might their emesis look like?
food or gastric contents
If vomit has a fecal appearance what may be the diagnosis?
obstruction
TofF: vomiting associated with EoE usually occurs in association with eating?
FALSE
What symptoms do children with EoE complain of in association with eating?
-intense feeling of discomfort as a swallowed food bolus slowly moves down the esophagus
-patients try to drink liquids with food
-heart burn, cough, chest pain, or epigastric pain, which does not responds to anti-reflux therapy
ToF: the symptoms of EoE are usually only short duration and pass quickly?
FALSE: can be short or more prolonged and severe, and occasionally result in food becoming stuck in the esophagus: resulting in food impaction
ToF: EoE has genetic links?>
true
WHat is the only reliable diagnostic test for EoE>
endoscopy with biopsy
If a child recently on multiple series of antibiotics presents with diarrhea, what is the likely diagnosis>
C diff
A watery stool is indicative of which problems?
-Infection: viral, bacterial, parasitic
-appendicitis with perirectal abscess
Can mucus containing stool be normal?
Yes, but usually caused by colitis
A child with Jelly stool likely has ___
intussesception
What are the causes of melena stool?
-gastric or duodenal ulcer
Patients with biliary or hepatic disease will most likely have ___ colored stool.
acholic
What is the mandatory criteria for children to be diagnosed with Functional abdominal pain?
-Must include all of the following criteria at least once a week for at least two months prior to diagnosis
Outcome FGID QOL
Symptoms Medication Disability Healthcare
1. Continuous or episodic abdominal pain
2. Insufficient criteria for other functional GI disorders
3. No evidence of an inflammatory anatomic, metabolic, or neoplastic process that explains the subject’s symptoms
What are the major risk factors for functional abdominal pain?
-Genetics
-Child temperament: behavioral inhibition
-socioeconomic/cultural
-situation
-parental behavior
What are the situational factors that can increase a child's risk for having functional abdominal pain?
-Family move
-Parent separation
-Divorce
-Death of family members
-New school
Describe the socioeconomic/cultural factors that have been linked to functional abdominal pain.
-limited exposure to non-family caregivers
-limited participation in activities outside the family
What is the diagnostic criteria for irritable bowel syndrome?
 Must include both of the following criteria, fulfilled at least once per week for two months prior to diagnosis
--Abdominal discomfort or pain associated with two or
more of the following at least 25% of the time
--Improvement with defecation
--Onset associated with a change in frequency of stool
--Onset associated with change in form of the stool
 No evidence of any inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms
If a child presents with Persistent or recurrent pain or discomfort centered in the upper abdomen
Not relieved by defecation or associated with the onset of a change in stool frequency or stool form. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain symptoms, what is the likely diagnosis?
Functional dyspepsia
Which disorder is found in 50% of the world's population and can survive in acidic environment of the stomach due to high urease activity?
heliobacter pylori
H pylor is a gram ___bacteria
negative
Individuals in __ socioeconomic groups have a higher risk of H pylori?
lower
What is the transmission method of H pylori?
fecal oral and oral oral route
what are the symptoms of obstruction in infancy?
-feeing problems with transient episodes of bilious vomiting
-failure to thrive with feeding intolerances
-malforation with volvulus
The school aged child who has had a previous abdominal surgery may acquire an ___ due to adhesions
obstruction
ToF: pyloric stenosis runs in families?
true
THe male to female ratio of pyloric stenosis is __ to __
5:1
What antibiotic used to treat clamydia of the eye in infants was banned due to its causing pyloric stenosis?
erythromycin
What is the hallmark sign of pyloric stenosis?
Projectile vomiting
The test of choice for pyloric stenosis is a ___ ___
pyloric ultrasound
What is the age range that presents with pyloric stenosis?
3- 7 weeks

usually around 6 weeks
What major homeostatic problem can occur as a result of pyloric stenosis?
Hypocholermic metabolic alkalosis as a result of excessive vomiting
What is infant dyschesia?
The infant presents with grunting and groaning when trying to have a bowel movement.

Child has loose stool: not constipated
What causes infant dyschesia?
failure to coordinate relaxation of pelvic floor and external sphincter.
The most frequent cause of mechanical obstruction in infants and toddlers is ____
intussesception
___ is an invagination or telecsoping of one portion of the bowel into itself.
intussesception
WHat does intussesception produce?>
obstruction and vascular compromise
50% of children with intussusception are under ___ years old.
one
Fewer than 10% of children with intussusception are over __ years old.
5
WHat is the male to female ratio for intussusception?
2:1
the peak age for intussusception is ___ to ___ months
5-10
What is a key symptoms of children with intussesception?
intermittent crying and calming: calming is caused by a large release of endorphins to act as a sedative to deal with the severe pain
What are the 3 classic signs of intussusception?
 Current jelly stool
 Vomiting
 Intermittent abdominal pain
with palpable sausage shaped mass
Intussusception is often associated with a __ infection
viral
only __ % of the children with Intussusception have the classic triad?
21
What is Dance's sign?
concavity in the right lower quadrant due to absence of underlying bowel in Intussusception.
the palpable mass of Intussusception is most commonly seen in the __ __ quadrant.
right upper
THe most common type of Intussusception is ___
ileocolic
What is the diagnostic test for Intussusception?
barium enema
ToF: Intussusception is a one time occurance?
FALSE: recurrence rate is 8-12%
What are the treatments for Intussusception?
 Pneumatic reduction has less sedation, less pain, decreased morbidity 80-90% success
 Hydrostatic reduction effective in 60-80%
 Operative reduction if all else fails
ToF: Hirschsprung’s Disease is a common finding?
FALSE
A child that has a history of constipation from birth will likely have ___
Hirschsprung’s Disease
Describe the rectal anatomy of aganglionic megacolon.
Anterior placement of the rectum or it is lie against the scrotum: have a large ampulla
-will not have a normal anal wink
-when the finger is removed following a rectal exam the child may have projectile bowel movement
IF a child has delayed passage of meconium after the first 48 hours of life what are the possible diagnoses?>
Hirschsprung’s Disease
Cystic Fibrosis
Stool that appears pellet like with a pungent smell in infants is often associated with ___.
Hirschsprung’s Disease
which disorder will have an abnormal anal wink on rectal exam?
Hirschsprung’s Disease
what will be found during a physical exam of Hirschsprung’s Disease?
 Newborn: well constipated with distended soft abdomen with normal or hyperactive bowel sounds
 Rectal exam slight pressure on examining finger with no stenosis or obstruction
 Ampulla is empty: on removal explosive evacuation of stool or gas
Describe how a newborn with Hirschsprung’s Disease will present during the physical exam.
 Ill newborn:
 More distended without peritoneal signs unless perforation
 React minimally to examiner
 Can be lethargic
 Fever
 Tachycardia
 Ominous hypotension
Why might infants with Hirschsprung’s Disease present lethargic?
may have an endorphin release do to severe pain and thus creates a sedative effect
How might an older infant or child present with Hirschsprung’s Disease?
 Chronically distended, nontender
abdomen with large fecal masses on the left side
 Rectal exam: ampulla is empty
 Anal tone is normal
 Explosive stool will also occur after
examining finger is withdrawn.
A child who presents with abnormal linear growth and constipation may have ___
hypothyroidism
Describe melena stool.
 dark or black tarry stools when the bleeding
is from upper tract
What is hematochezia?
maroon stools which indicated distal GI
source or short transit time from briskly bleeding proximal source
List the culprits that mimic GI bleeds.
-Red candies, juices, red dy in foods, beets
-black stool
WHat are some non-pathologic causes of black stool?
 Peptobismol
 Iron
 Spinach
 Blueberries
 Licorice
Describe the methods of determining if a bleed is upper vs lower GI involvement?
-NG tube placement
-Presentation:
--hematemesis: is blood mixed in with stool or around it
--melena: dark tarry stools
--hematochezia: marron stools
What is the Apt Test?
If a test to see if hematemesis in a newborn is a result of swallowing maternal blood or is from the infant.
---Mix emesis with 1% sodium hydroxide/ fetal hemoglobin remain pink or bright red, maternal hemoglobin turns brown
Other than swallowing maternal blood, what might cause hematemesis in a newborn>?
esophagitis secondary to reflux
List the possible causes of Upper GI bleeds.
 Stress
 Vascular malformation
 Gastric/esophageal duplication
 Hemorrhagic gastritis
 Esophagitis
 Varices from portal hypertension
 Vascular malformations
 Bleeding diathesis from such hemorrhagic disease of the newborn
ToF: juvenile polyps are a common cause of lower GI bleeding in infants?
FALSE! not common in infants
ToF: juvenile polyps, when passed cause pain, but are rarely large.
FALSE: they are painless and rarely massive
What is gardner's syndrome?
familial GI polyps that have malignant potential
If an anal fissure if found in older children, what must be considered?
Crohn's disease
Where do juvenile polyps usually occur
proximal to transverse colon
THe most common source of significant lower GI bleeding in children is ___ ____.
Meckel diverticuli
The bleeding from ___ ___ results from peptic ulceration of the ileal mucosa from HCL secreted from ectopic gastric mucosa within the diverticulum.
Meckel diverticuli
Children in the ___ age are the most common group to present with meckel diverticuli.
preschool
ToF: meckel diverticuli are painless and massive.
TRUE!
What is the name of an abnormal fixation of the bowel mesentery with twisting around the mesenteric artery? What does this cause?
Malroation with volvulus

-causes painful distended abdomen, bilious vomiting, blood in stool, abdominal pain
What are the history findings for children with malrotation with volvulus?
-feeding problems with transient episodes of bilious vomiting
-failure to thrive with feeding intolerance
___ ___ IS MECHANICAL OBSTRUCTION UNTIL PROVEN OTHERWISE!!!!!
BILIOUS EMESIS!
A ___ ___ is noticed most easily when the child cries and screams?
inguinal hernia
What is the preferred method to see an inguinal hernia come down in older children?
have them jump up and down
ToF: inguinal hernias are very common in infants?
true
When is an inguinal hernia not-benign?
when it is incarcerated and causes ischemia
The swelling of an inguinal hernia usually resolves when the baby ___
sleeps
Boys are effected __ times more often with inguinal hernias.
6
Incarcerated hernias occur __ to __ % of the time
5 to 31
The rate of inguinal hernias is highest in the __ year of life.
first
Which group of infants has the highest rate of inguinal hernias?
Premature infants
What are the common symptoms associated with a strangulated hernia?
-abdominal distension
-bilious emesis
-edema
-erythema over mass
ToF: the scrotum of a boy with an incarcerated inguinal hernia will be swollen.
FALSE: it may or may not be
What are the differential diagnosis of inguinal hernias?
-hydrocele
-abscess
-testicular torsion
Which IBD can occur anywhere in the GI tract?
Crohn's disease
where is the most common location for ulcers in crohn's disease?
int he terminal ILEUM proximal colon and ileocecal junction
A child with edema and shallow ulceration and small pseudoplps in the rectum or descending color as the ileocecal juncture, what might they have?
Ulcerative colitis
ToF: ulcerations of ulcerative colitis are diffuse, continuous and superficial.
TRUE
Most cases of UC are diagnosis between __ and __ years
15-30
what are the history findings of UC?
-acute bloody diarrhea
-cramping
-tenesmus
-pallor
-growth retardation
What is tenesmus?
Severe cramping of the GI tract and they are not able to hold their stool. Associated with UC
What are the common symptoms associated with a strangulated hernia?
-abdominal distension
-bilious emesis
-edema
-erythema over mass
ToF: the scrotum of a boy with an incarcerated inguinal hernia will be swollen.
FALSE: it may or may not be
What are the differential diagnosis of inguinal hernias?
-hydrocele
-abscess
-testicular torsion
Which IBD can occur anywhere in the GI tract?
Crohn's disease
where is the most common location for ulcers in crohn's disease?
int he terminal ILEUM proximal colon and ileocecal junction
A child with edema and shallow ulceration and small pseudoplps in the rectum or descending color as the ileocecal juncture, what might they have?
Ulcerative colitis
ToF: ulcerations of ulcerative colitis are diffuse, continuous and superficial.
TRUE
Most cases of UC are diagnosis between __ and __ years
15-30
what are the history findings of UC?
-acute bloody diarrhea
-cramping
-tenesmus
-pallor
-growth retardation
What is tenesmus?
Severe cramping of the GI tract and they are not able to hold their stool. Associated with UC
What are the extraintestinal manifestations of UC?
-Arthralgia (25% involving the knees, ankle and wrist)
-oral aphithous ulcers
-Uveitis: Episcleritis (ciliary injection in the eye)
-Growth retardation
-liver disease in 15% caused by fatty infiltration or sclerosing cholangitis
What test must be done for a child that presents with oral aphithous ulcers, weight loss and failure to thrive?
Sed rate to find IBD
children with UC often require a __ __ later in life.
liver transplant
What is the name of the skin manifestation of UC that looks like mosquito bites?
erythema nodosum
WHat is pyoderma granulosum?
Non-healing ulcer on the leg asscoiated with UC
What location on the abdomen is the most common for pain with Crohns?
RLQ: due to inflamed edematous terminal ileum: 70%
Weight loss with crohn's disease occur in __% of patients.
90
An anal skin tag is assciated with __ __
crohns disease
What diagnosis is often confused with crohns disease?
appendicitis
The most common tumor found in children under 1 year old is a ___
neuroblastoma
Neuroblastomas are often found in stage __ or __
3 or 4
The most common location for neuroblastomas is on the ___
adrenal glands
20% of neuroblastomas occur in the ___ ___
posterior mediastinum
1/3 of neuroblastomas occur in the ___ ___ ___
sympathetic paraspinous ganglia
Only 5% of neuroblastomas are found in the __ and ___
head and neck
What is opsoclonus-myoclonus? what is it associated with?
Dancing eyes with myoclonic jerks with or without cerebellar ataxia.

associated with neuroblastoma
Children who present with flushing, tachycardia, headache and hypertension are displaying ___ excess associated with ___
catecholamine; neuroblastoma
descirbe the bowel movements of children with neuroblastoma.
watery diarrhea with abdominal distention and electrolyte imbalance
Periorbital ecchymosis, aka __ __ , is associate with ___ that occurs on the head and neck.
raccoon eyes; neuroblastoma
What occurs if a nueroblastoma in the thoracic region has a dumb bell extension into the spine?
have neurological abnormalities, cough and SOB
What is Horner's syndrome? What is it associated with?
-pstosis
-meiosis
-anhydrosis
associated with neuroblastoma
What type of abdominal mass crosses the midline?
neuroblastoma
Describe an eye abnormality that occurs with neuroblastoma.
Heterochromia iridis: 2 different colored eyes
The most common hereditary tumors of childhood are ___ and ___
retinoblastoma and Wilm's
When does Wilm's tumor often occur?
in young age (mean: 30 months) and bilateral
ToF: a child with neuroblastoma will present well, while a child with WIlm's will appear sick.
FALSE: other way around
Describe how abdominal tumors will feel?
Hard, fixed with firm irregular borders
ToF: abdominal tumors will present with symptoms only when they are large?
true
What is the number one rule for HCP that believe that a child has wilm's tumor?
DO NOT TOUCH THE BELLY!! The tumor spreads that way!
What are the S/S of WIlm's tumor?
Firm flank, nontender, does not usually cross the midline
Why must the HCP do the side maneuver when attempting to palpate the kidney?
they will not catch a Wilm's tumor any other way
ToF: the Wilm's tumor crosses the midline
FALSE: only neuroblastoma
THe most common abdominal malignancy is the ___ ___
Wilm's tumor
When is pain associated with a WIlm's tumor?
when it is necrotic
A child with hypertension and micro-hematuria may have __ __
wilm's tumor
___ in a boy with left sided tumor indicates __ vein occlusion
varicocele; renal
What are they physical exam findings for a wilm's tumor?
-Large firm mass
-non tender
-minimal mobility of the tumor
-varicocele in a boy with left sided tumor indicate renal vein occlusion