Gi - 3-4 - Pediatric Gi

Front 1

Duodenal atresia

Back 1

Bilous emesis (bile - green)

Double-bubble sign on x-ray.

Lumen does not recanalize. Associated with prematurity and Down's

Front 2

Tx of duodenal atresia

Back 2

NG tube, surgery, support (can't feed them)

Front 3

Biliary atresia

Back 3

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.

Front 4

Biliary atresia - more often extrahepatic or intrahepatic ducts?

Back 4

Extrahepatic

More often in girls and asians.

Front 5

Dx of biliary atresia

Back 5

US, liver biopsy, ERCP, MRCP, HIDA scan, exploratory lap

Front 6

Tx of biliary atresia

Back 6

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.

Front 7

Tracheoesophageal fistula

Back 7

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..

Front 8

Associated anomalies with TE fistula

Back 8

CV defects, imperforate anus, intestinal malrotation/volvulus, duodenal anomalies

Down's syndrome!

Front 9

Dx of TE fistula

Back 9

Pass radiopaque NG or OG and CXR.

Pulm sx more often seen.

Front 10

Tx of TE fistula

Back 10

Primary surg repair. There are complications.

Abnormal LES leads to stricture formation at times leading to pneumonia.

Front 11

Malrotation and volvulus

Back 11

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.

Front 12

Sx of malrotation with volvulus

Back 12

abdom distention, bilious vomiting - suggests obstruction.

volvulus can lead to perforation and bloody stools.

THIS IS A SURGICAL EMERGENCY!!!

Front 13

Gastroesophageal reflux

Back 13

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.

Front 14

Pyloric stenosis

Back 14

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.

Front 15

Dx and tx of pyloric stenosis

Back 15

This si the end of the stomach - surgical pyloromyotomy (reduce the amt of muscle)

correct electrolyte imbalance and dehydration.

US is teh dx.

Front 16

Infant nutrition

Back 16

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.

Front 17

Colic

Back 17

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.

Front 18

cows milk

Back 18

start at one year. and whole milk until age 2 (fat for brain)

too soon --> anemia.

Front 19

juice?

Back 19

no!

Front 20

toddler feeding

Back 20

they adjust over the course of days.

don't give too much milk.

Front 21

Failure to thrive

Back 21

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.

Front 22

DDx of failure to thrive

Back 22

Psychosocial
CNS pathology, poor suck..
Maldigestion/
Malabsorption (CF)
Inborn Errors of Metabolism
Incr Metabolic rate (heart)
Regurgitation
Chromosomal/Genetic
HIV

Front 23

Hypernutrition

Back 23

leads to earlier growth plate closure and thus short and fat adults.

reduce "screen time" to less than 2 hours a day.

Front 24

Constipation definition

Back 24

delay or diff in defecation for over 2 weeks and causes signif stress.

note there is a large variation in normal stool patterns.

Front 25

Most constipation is...

Back 25

functional - due to painful defecation cycle, diet, illness, stress, too busy playing, travel/attending school

Front 26

red flags with constipation

Back 26

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)

Front 27

fecal witholding

Back 27

kid had a painful stool so he is holding in which will only make it worse...

Front 28

Encopresis

Back 28

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.

Front 29

Developmentally delayed with potty training when...

Back 29

not trained by age 5.

most do it by age 3.

most constipation occurs during potty training.

Front 30

Tx of constipation

Back 30

Disimpact with meds -Miralax or rectals - or manually.

Maintenance - many months req for bowel diameter and sensation to be restored.

Front 31

Tx of...something stimilar to constipation. maybe with potty training?

Back 31

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.

Front 32

Enemas to rx to kids

Back 32

5 year old needs "adult" ones and baby needs "child" ones.