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143 Cards in this Set
- Front
- Back
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GE Reflux
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Normal – gastric contents in esophagus
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GERD
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Symptomatic reflux in esophagus
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GERD Complications
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Failure to thrive, esophagitis, pulm
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GERD Symptoms
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Irritability, poor feeding, pneumonia
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GERD DX
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Esophageal manometry, pH probe, upper GI
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GERD Epidemiology
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↑ premies, newborns- gone by 18 months
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GERD Tx- conservative
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↑burping, thicken feeding, elev. Head
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GERD Tx- meds
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Reglan, PPI, H2 blocker
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GERD Tx - severe
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Surgery
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“Happy Spitters”
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Infants - normal GE Reflux
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Pyloric Stenosis
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Gastric outlet obstruction at pyloric valve
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Pyloric Stenosis – Epidemiology.
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Males > females, first-born male, 3 – 6 weeks’ old
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Pyloric Stenosis – Dx
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“olive” sign, UTZ, barium swallow
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Pyloric Stenosis- Sx
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Non- bilious vomit, soon after feeding, “hungry” vomitter
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Pyloric Stenosis – Tx
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Surgery- pyloromyotomy
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Why infants are not given macrolide Abx
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↑ risk of pyloric stenosis
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Congenital Atresia
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Complete or partial obstruction of bowel lumen
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Congenital Atresia – Epi
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Most common – ileum, jejunum, 30% of duodenal have Trisomy 21
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Congenital Atresia – Sx
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GI distension, vomiting, +/- bilious
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“Double Bubble” sign
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Duodenal atresia
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Congenital atresia Tx
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Stabilize surgery
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Neonatal Cholestasis
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↑Conjugated bilirubin = liver disease
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Neonatal Cholestasis – S/Sx
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Jaundice, enlarged liver, dark urine, poor growth
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Congenital Atresia
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Closure or absence of normal organ
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Biliary Atresia
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Obliteration of the extrahepatic biliary tree
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Biliary Atresia – Sx
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↑ing jaundice – birth to 8 weeks, acholic stools, dark urine
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Biliary Atresia – Dx
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↑ conjugated bilirubin and ↑ liver enzymes, UTZ
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Biliary Atresia – Tx
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Kasai procedure, liver transplant
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Byproduct of RBC breakdown
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Bilirubin and iron
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Incidence of jaundice in newborns
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60 – 80% of all newborns
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Unconjugated bilirubin
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Toxic, fat-soluble, pre-liver, not excreted
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Conjugated bilirubin
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Water soluble, metab. in liver, excreted in bile
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Physiologic jaundice
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Unconjugated bili > 24 hrs after birth self- resolves by 2 weeks
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Neonatal ↑ bilirubin always pathologic
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Conjugated hyperbilirubinemia
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↑ bilirubin seen with hemolysis
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Unconjugated – ABO/Rh incompatibility etc.
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Cephalohematoma, ↑RBC’s, sepsis
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Causes of non-hemolytic jaundice
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Acholic stool
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Pale stool without bile
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Malrotation
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Arrested normal rotation of embryonic gut
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Malrotation – Sx
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Asymptomatic to life-threatening volvulus
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Volvulus
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Life-threatening complication of malrotation
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Volvulus – Epidemiology
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50% of malrotation present before 1 month of age
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Volvulus – Cause
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Small bowel twists around mesenteric artery = ischemia / necrosis
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Volvulus – Sx
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Vomiting, abdominal pain, sepsis, shock
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Volvulus – Dx
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Upper GI best- “corkscrew” with contrast
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Volvulus – Tx
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Surgery to resect necrotic bowel and “un-rotate”
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Meckel Diverticulum
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Vestigial remnant of omphalomesenteric duct
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Most common congenital anomaly of GI tract
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Meckel Diverticulum
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Meckel Diverticulum – Sx
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Painless lower GI bleed
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Anal Fissure
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Most common cause – rectal bleeding < 12 month
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Stool streaked with bright red blood
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How anal fissures present
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Ulceration of Meckel Diverticulum
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Due to acid secretion by ectopic gastric cells
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Meckel Diverticulum – Dx
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Meckel’s scan, mesenteric arteriography, capsule endoscopy
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Meckel Diverticulum – Tx
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Surgical resection of diverticula
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2 yo, 2% of population, 2 cm long, 2 ft from ileocecal valve, 2 types of tissue
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Meckel’s Rule of Two’s
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Hirschsprung Disease
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motor disorder of gut - Functional obstruction
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Hirschsprung Dz – Cause
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Aganglionic segment of colon - failure of embryo neural crest cell migration
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Hirschsprung Dz – Sx
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Distal obstruction- bilious emesis, abdominal distension, failure or delayed meconium
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Squirt or Blast Sign
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Explosive reaction to DRE in Hirschsprung Dz
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Hirschsprung Dz – Dx
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Rectal Bx- Gold Standard, x-ray, contrast enema
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Hirschsprung Dz – Tx
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Surgical resection of aganglionic colon
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Necrotizing Enterocolitis
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Ischemic necrosis of intestinal mucosa seen in premies
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Necrotizing Enterocolitis – Signs
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Ischemia of intestinal mucosa, inflammation, gas in portal vein and muscularis
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Necrotizing Enterocolitis – Sx
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Poor feeding, distension, vomiting, diarrhea, GI bleed, apnea, temp instability
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Necrotizing Enterocolitis – Dx
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Clinical + x-ray, UTZ, full labs
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Necrotizing Enterocolitis – Tx
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Bowel rest, TPN, fluids, monitor => surgery
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Short Bowel Syndrome
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Malabsorptive state due to bowel resection
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Small Intestine Length in Short Bowel
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< 75 cm of small intestine
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Intestinal Failure
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GI function inadequate for nutrition +/- hydration
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Short Bowel Syndrome – Tx
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Parenteral nutrition until able to resume oral nutrition
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Inability to resume oral nutrition with short bowel
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Up to 40% mortality – most due to liver failure
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Omphalocele
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Defect of abdominal wall at umbilical insertion- external sac with abdominal contents
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Most common fetal abdominal wall defect
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Omphalocele/ gastroschisis
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Gastroschisis
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Defect of abdominal wall – apart from umbilicus, may contain bowel
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Omphalocele/Gastroschisis – Dx
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Most diagnosed on prenatal UTZ
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80% of defects include liver- no liver = aneuploidy
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Omphalocele/Gastroschisis
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Omphalocele/Gastroschisis – Tx
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Primary or staged secondary surgical closure after normal delivery
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Intussusception
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Invagination of intestine into itself-
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Intussusception – S/Sx
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Acute, intermittent colicky abdominal pain- currant jelly stool
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Most common area - intussusception
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Junction of colon and ileum
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Intussusception – Dx/Tx
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Contrast enema will ID and treat
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Intussusception – surgery
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Not reduce with enema, or if perforation, peritonitis or shock
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Most common abdominal emergency in children < 2 yo
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Intussusception
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Umbilical Hernia
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Defect < 2cm close spontaneously by 18 months of age
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Umbilical Hernia – Surgery
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Large defects, supra-umbilical or proboscoid defects
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Most common helminthic infection in US
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Pinworm
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Pinworm
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Severe perianal itching, especially at night
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Pinworm - Dx
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Perianal addle test = microscope- ID of eggs
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Pinworm Tx
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Anti-parasitic for whole family, treat again in 2 weeks
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Abdominal Pain
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Most common peds GI complaint
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Abdominal Pain Classification
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Visceral, somatic, referred
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Vomiting
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Forceful oral ejection of gastric contents
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Bilious Vomiting in newborns
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Considered an emergency
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Food Protein-Induced Proctocolitis
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Cow’s and soy milk most common cause
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Food Protein-Induced Proctocolitis- Symptom
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Healthy infant with rectal bleeding
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Food Protein-Induced Proctocolitis – Tx
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Remove causative protein from diet- hydrolyzed formula
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Reintroduce cow or soy protein- 12 moa
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Food Protein-Induced Proctocolitis
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Inflammation of distal colon due to food protein
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Food Protein-Induced Proctocolitis - Sign
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Chronic Abdominal Pain
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3 or more episodes of pain in 3-month period – effects ADL’s
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Appendicitis- cause
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Obstruction of lumen with inflammation and bacterial overgrowth
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Appendicitis – Sx
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Periumbilical pain (early), RLQ pain- anorexia, N/V, fever. tenderness
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Appendicitis – Dx
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Physical signs, ↑ WBC’s, ↑ neutrophils & bands- MRI, CT, UTZ
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Appendicitis – Signs
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Involuntary guarding; Rovsign, obturator, iliopsoas signs
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Appendicitis – Tx
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Abx, surgical removal of appendix
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Vomiting – Tx
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Treat underlying cause
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Acute Gastroenteritis- US
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Primarily viral etiology
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Acute Gastroenteritis
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↑ stool frequency – loose/watery stools, +/- vomiting
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Acute Gastroenteritis – complications
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Dehydration, hypovolemia, electrolyte imbalance
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Acute Gastroenteritis – Tx mild
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Supportive with fluids and unrestricted diet
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Acute Gastroenteritis – Dx mild
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H & PE- if viral, no studies indicated
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Acute Gastroenteritis – Tx Mod – severe
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Fluid & electrolyte replacement
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Acute Gastroenteritis – S/Sx – mod/severe
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↓ capillary refill, ↓ urine output, ↑ HR, dry mucous membranes
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Juvenile Polyps
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85% benign tumors – common 2 – 10 years
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Pedunculated tumor
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Most common form of juvenile polyp
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Juvenile Polyps – Sx
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Painless rectal bleeding- may be painful with traction on tumor
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Colonoscopy for Dx and Tx- every 2 – 3 years with > 10 or family hx
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Treatment of Juvenile Polyps
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Cow's milk composition |
↑ protein, ↓ carbohydrates |
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Breastmilk composition |
↓ protein, ↑ carbohydrates |
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Breastmilk advantages |
↑ immunity, hormones, growth factor, enzymes |
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Safe to start solids in diet |
4 to 6 months of age |
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Prevents rickets in breastfed babies |
400 IU vitamin D3 |
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Hematochezia |
Bright red blood in stool |
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Melena |
Dark, coffee ground stool |
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Occult blood |
Blood in stool not visible |
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Visceral pain |
Organ |
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Somatic pain |
Skin +/- deep tissue |
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Abdominal pain |
Most common GI complaint |
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Most common ER condition peds==> abdominal surgery |
Appendicitis |
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Fever in appendicitis |
More common in kids < 5 yoa |
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Best to assess perfusion in kids |
Capillary refill |
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Mild dehydration |
HR -RRR, tacky MM, ↓ urine output, thirsty |
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Moderate dehydration |
Tachycardia, dry MM, sunken fontanel/eyes, ↓↓ UO |
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Severe dehydration |
Weak pulse, parched MM, cool extremities, anuria |
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Most common cause of death < 5 yoa |
Dehydration |
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Rotavirus |
Vaccine preventable diarrhea |
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Rotavirus - Dx |
Stool ELISA / PCR |
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Hemolytic anemia, ↓ Plts, renal failure |
Hemolytic Uremic Syndrome triad |
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Hemolytic Uremic Syndrome - etiology |
Invasive toxin producing e. coli |
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Kids have seizures with this infection |
Shigellosis |
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Constipation- common timing |
Intro to solids, toilet training, school entry |
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Acute constipation |
↓ freq. of stool, painful defication, straining |
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Constipation - tx |
↑ fiber / fluids, lactulose, miralax |
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Involuntary or voluntary stooling ≥ 4 yoa |
Encopresis |
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Encopresis - Tx |
Counseling, disimpaction, prolonged laxatives |
