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Pediatrics > GI/GU > Flashcards

GI/GU Flashcards

1
Q

Phimosis Definition

A

Inability to retract the foreskin. Physiologic adhesions usually disappear by 7-10 yo. Pathologic is truly non-retractable due to scarring/fibrosis.

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2
Q

Phimosis presentation

A

Painful erection, irritation, bleeding, dysuria, recurrent infections. Secondary non-retractability after having full retractability.

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3
Q

Phimosis treatment

A

Stretching exercises with moisturizer, topical corticosteroids, circumcision (definitive).

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4
Q

Phimosis patient education

A

Don’t retract when less than 6 mo. Clean with mild soap and water. Always return foreskin to natural position.

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5
Q

Paraphimosis definition

A

Retracted foreskin that can not be returned to the natural position. Entrapment, impaired venous outflow, engorgement, arterial compromise.

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6
Q

Paraphimosis Causes

A

Forcible retraction of phimotic skin, infection/inflammation, GU procedures (catheterization), sexual activity, trauma.

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7
Q

Paraphimosis presentation

A

Swelling, pain, irritability, tenderness, swelling of the retracted foreskin, flaccid/unaffected shaft, color change (ischemia).

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8
Q

Paraphimosis Treatment

A

EMERGENCY! Manual reduction. Urology consult for surgery/circumcision.

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9
Q

Circumcision recommendation

A

Not enough benefits to recommend routine circumcision. Based on family’s religious preferences etc.

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10
Q

Chordee Definition

A

Abnormal penile curvature. Often presents with hypospadias.

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11
Q

Hypospadias Definition

A

Congenital anomaly that results in the abnormal ventral displacement of the urethra with an intact foreskin only on the dorsal side.

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12
Q

Hypospadias Presentation

A

Abnormal foreskin, chordee, second but false opening. Look for positive FH, penile length, palpable testes and disorders of sexual development.

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13
Q

Hypospadias Treatment

A

Urology consult. Do NOT circumsize. Surgery around 6 mo.

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14
Q

Cryptorchidism Definition

A

Testis that is not within the scrotum and does not descend by 4 mo. More common in premies.

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15
Q

Cryptorchidism Risks

A

Testicular torsion, subfertility, testicular cancer.

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16
Q

Retractile Cryptorchidism

A

Overactive cremasteric reflex.

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17
Q

Cryptorchidism Presentation

A

Absent testicle with under developed scrotum. May be palpable in the canal. If bilateral be concerned about sexual development dysfunction.

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18
Q

Cryptorchidism Treatment

A

Watchful waiting until 6 mo. Then surgery to bring the testicle down and attach it to the scrotum.

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19
Q

When to refer Cryptorchidism

A

Congenital undescended testes, ascending testes (was there now isn’t), atrophic palpable tissue, difficulty differentiating.

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20
Q

Testicular Torsion Definition

A

Twisting of the spermatic cord due to a poorly anchored testicle (usually attached to the tunica vaginalis) that can result in vascular compromise.

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21
Q

Testicular Torsion incidence

A

less than 25 yo. Peaks during neonatal period and at puberty. Can be due to physical activity. Neonatal Testicular Torsion can lead to an atrophic testicle.

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22
Q

Testicular Torsion presentation

A

Constant and severe testicular/scrotal pain that radiates, nausea and vomiting. Swollen, indurated, erythematous scrotum that is tender and elevated. Testicle may not be in usual orientation. Absent cremasteric reflex. Negative prehn’s sign.

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23
Q

Prehn’s sign

A

Relief when the scrotum is elevated.

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24
Q

Testicular Torsion Diagnosis

A

Doppler ultrasound.

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25
Q

Testicular Torsion Treatment

A

EMERGENCY! Time is tissue. Immediate urology consult for surgical detorsion and fixation of both testes.

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26
Q

Urinary Tract Infection Etiology

A

E. coli, Klebsiella proteus, Enterococcus, S. aureus.

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27
Q

Urinary Tract Infection Risk Factors

A

Female, UT anomalies, bowel/bladder dysfunction, VUR, sexual activity, catheterization.

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28
Q

Urinary Tract Infection Presentation in younger kids

A

Non-specific. Fever, vomiting, irritability, poor appetite.

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29
Q

Urinary Tract Infection Presentation in older kids

A

Dysuria, frequency, abdominal/back pain, new-onset of urinary incontinence.

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30
Q

Urinary Tract Infection Predisposition

A

History of UTI, temp higher than 39 degrees C, fever with no other apparent source, ill appearance, suprapubic tenderness, fever for longer than 24 hours, non-black race

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31
Q

When to obtain a UA

A

Girls/uncircumcised boys less than 2 yo with 1 predisposing factor, Circumcised boys less than 2 yo with 2 predisposing factors, Girls/uncircumcised boys older than 2 yo with urinary/abdominal symptoms, Circumcised boys older than 2 yo with multiple symptoms. Any febrile infant/child with urinary tract abnormalities or FH of abnormalities.

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32
Q

Urinary Tract Infection Diagnosis

A

UA with catheterization. Positive leukocyte esterase and nitrite. Culture will show more than 50,000 (cath) or 100,000 (clean catch) CFU and will direct treatment. Neonates need full septic workup.

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33
Q

Urinary Tract Infection Treatment

A

Begin with empiric therapy of amoxicillin, augmentin, cephalosporin or bactrim then adjust based on sensitivity results. Treat for 7-10 days.

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34
Q

Urinary Tract Infection Ultrasound indications

A

First febrile UTI in kids less than 2 yo, recurrent UTI, FH of renal/urologic disease or HTN and those who don’t respond to appropriate treatment.

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35
Q

Urinary Tract Infection VCUG indications

A

Abnormalities on the ultrasound

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36
Q

Vesicoureteral reflux (VUR) Definition

A

Retrograde flow of urine from the bladder into the upper urinary tract usually due to a problem at the ureteral vesicular junction. Occurs in 30-45% of the children presenting with UTI.

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37
Q

Vesicoureteral reflux (VUR) Presentation

A

Hydronephrosis (on prenatal US), febrile UTI and recurrent UTIs.

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38
Q

Vesicoureteral reflux (VUR) diagnosis

A

VCUG

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39
Q

Vesicoureteral reflux (VUR) Treatment

A

May spontaneously resolve by 5-6yo. Low dose prophylactic antibiotics (bactrim) with aggressive UA screening if symptoms of a UTI. There are surgical options.

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40
Q

Enuresis Definition

A

Accidents occurring after successful potty training.

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41
Q

Diurnal Enuresis Etiology

A

Neurogenic (spina bifida), anatomic (meatal stenosis or labial adhesions), functional (constipation).

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42
Q

Diurnal Enuresis Definition

A

Abnormal after 4 yo

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43
Q

Enuresis Diagnostics

A

UA with specific gravity and KUB (constipation)

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44
Q

Diurnal Enuresis Treatment

A

Urology referral

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45
Q

Nocturnal Enuresis Definition

A

Abnormal for girls older than 5 and boys older than 6

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46
Q

Nocturnal Enuresis Etiology

A

Genetic, Maturational delay, deep sleeper, organic cause (VUR)

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47
Q

Nocturnal Enuresis Treatment

A

Bladder training, ensure proper hydration, constipation management. DDAVP (synthetic ADH) or imipramine (older than 6yo) but only for occasional use. Refer to urology.

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48
Q

Routine UA screening indications

A

HSP, DM, glomerulonephritis, acute renal injury/failure, sickle cell, FH of renal disease.

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49
Q

Hematuria Differential

A

Foods (beets), medications (pyridium), metabolites (porphyria), free Hgb or Mgb. UTI, meatal/perineal irritation, trauma, glomerular disease, SLE, Sickle cell, menses.

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50
Q

Glomerular Disease Presentation

A

Gross hematuria, increased serum creatinine, edema (periorbital), HTN, Dark urine, microscopy with RBC casts and TNTC.

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51
Q

Post-Infectious Glomerulonephritis Etiology

A

Usually follows a Strep group A infection 7-14 days after.

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52
Q

Post-Infectious Glomerulonephritis Presentation

A

Acute, cola-colored urine, renal insufficiency, recent strep infection, positive ASA and depressed complement levels.

53
Q

Henoch-Scholnlein Purpura (HSP) Etiology

A

IgA autoimmune response to an infectious process usually after a URI.

54
Q

Henoch-Scholnlein Purpura (HSP) Presentation

A

Abdominal pain, +/- bloody diarrhea, maculopapular purpuric rash on buttocks, posterior legs and feet. Microhematuria. Can lead to renal failure.

55
Q

Hemolytic-Uremic Syndrome (HUS) Etiology

A

Most common cause of acute renal failure in kids. Glomerular vascular disease that is associated with E. Coli.

56
Q

Hemolytic-Uremic Syndrome (HUS) Presentation

A

Bloody diarrhea. Leads to renal failure and neurological problems (electrolyte imbalance).

57
Q

Alport Syndrome Etiology

A

Hereditary glomerulonephritis. Autosomal dominant X-linked.

58
Q

Alport Syndrome presentation

A

microhematuria, proteinuria, HTN, deafness, visual distrubances.

59
Q

Proteinuria definition

A

Greater than 1,000mg in 24 hours

60
Q

Proteinuria differential

A

Benign, HTN, DM, glomerulonephritis, nephrotic syndrome.

61
Q

Nephrotic Syndrome Definition

A

Renal disease (intrinsic or post-infectious) that causes massive protein loss which exceeds the liver’s capacity to produce albumin.

62
Q

Nephrotic Syndrome Presentation

A

Nephrotic proteinuria, hypoalbuniemia, edema, hyperlipidemia. Protein/creatinine ratio greater than 0.20.

63
Q

Nephrotic syndrome treatment

A

Refer to nephrology

64
Q

Gastroesophageal reflux (GERD) Presentation

A

Common in infants younger than 6 mo. “unhappy spitter”. FTT, fussy, irritable, dystonic neck positioning, feeding refusal, respiratory complications, occult stool.

65
Q

GERD treatment

A

Positional therapy, elimination diet, thickened feeds, smaller more frequent feeding. H2 blockers (ranitidine) and or a PPI (iansoprazole if over 1yo). Symptoms usually resolve by 9-12 mo.

66
Q

Pyloric Stenosis presentation

A

Common in the first 3-12 weeks, males and first born. Projectile vomiting after feeding that is non-billous. “hungry vomiter.” FTT, dehydration, distended upper abdomen, peristaltic waves from left to right, olive sized mass in the RUQ.

67
Q

Pyloric Stenosis Diagnostics

A

Ultrasound will show elongation and thickening of the pylorus. If the ultrasound isn’t diagnostic a UGI (barium swallow) will show a “string sign”

68
Q

Pyloric Stenosis Treatment

A

Supportive. Pylormyotomy.

69
Q

Gastroenteritis Etiology

A

Viral

70
Q

Gastroenteritis presentation

A

Diarrhea, vomiting, fever, anorexia, HA, cramping. Usually lasts 3-7 days.

71
Q

Congenital Atresia Definition

A

One or more segments of the bowel may be absent and/or obstructed at birth.

72
Q

Duodenal Congenital Atresia

A

Associated with trisomy 21. Events occur at 8-10 weeks gestation.

73
Q

Jejunoilial Congenital Atresia

A

Associated with cystic fibrosis. Due to uterovascular accident later in gestation (after 12 weeks).

74
Q

Colonic Congenital Atresia

A

Least common. Due to uterovascular accident later in gestation (after 12 weeks).

75
Q

Congenital Atresia Presentation

A

Bile-stained vomiting within the first 24-48 hours of life. Mild abdominal distension. Failure to pass meconium.

76
Q

Duodenal Congenital Atresia Diagnosis

A

KUB shows a “double bubble” sign due to gas and dilation of the stomach and duodenum.

77
Q

Jejunoileal Congenital Atresia Diagnosis

A

Dilated loops of bowel and air/fluid levels.

78
Q

Congenital Atresia UGI (contrast enema)

A

Microcolon. Confirms diagnosis and identifies the area of obstruction.

79
Q

Congenital Atresia Pre-natal Diagnosis

A

Polyhydramnios, double bubble sign, dilated bowel loops, ascites and hyperechoic bowel.

80
Q

Congenital Atresia Treatment

A

Supprotive (may need TPN). Antibiotics. Surgical intervention.

81
Q

Midgut Malrotation Definition

A

Incomplete rotation of the midgut during embryonic development. Shortening of the mesenteric root increases small bowel mobility which can lead to a volvulus.

82
Q

Volvulus definition

A

small intestine twists around the SMA causing vascular compromise.

83
Q

Midgut Malrotation Presentation

A

Usually less than 1 mo. Bilious vomiting, abdominal pain, +/- hematochezia, abdominal distension, tenderness, visual peristalsis.

84
Q

Midgut Malrotation Diagnosis

A

UGI will show displacement of the duodenojejunal junction (R instead of L). Corkscrew appearance of the proximal jejunum spiraling down the right or mid-upper abdomen. If non conclusive a barium enema will show the cecum in the RUQ.

85
Q

Midgut Malrotation Treatment

A

Surgical EMERGENCY.

86
Q

Intussusception Definition

A

Invagination of one portion of the intestine into another (often near ileocecal junction. Most common cause of obstruction in children under 2 (rare in neonates). More common in males.

87
Q

Intussusception etiology

A

Idiopathic. Often stem from a lead point like tumor, polyp, hematoma, lesion. Crohn’s disease, celiacs, cystic fibrosis, bacterial enteritis, viral illness, rotavirus vaccine.

88
Q

Intussusception Presentation

A

Intermittent but severe cramps and abdominal pain (draws legs to chest). Vomiting, poor feeding, currant jelly stools with blood and mucous. Palpable sausage in upper mid-abdomen. Distended/tender abdomen.

89
Q

Intussusception Diagnosis

A

Abdominal ultrasound

90
Q

Intussusception Treatment

A

Surgical consult. Ultrasound guided air enema has 74% success rate and lower risk of perforation. If not successful then surgical intervention.

91
Q

Meckel’s Diverticulum Definition

A

Embryonic remnant of the vitelline ducct forms a pouch made of intestinal and gastric epithelium. Usually located two feet from the ileocecal valve. (2% of the pop, 2:1/M;F, 2% become symptomatic).

92
Q

Meckel’s Diverticulum Presentation

A

Painless rectal bleeding, obstruction, diverticulitis that can mimic appendicitis.

93
Q

Meckel’s Diverticulum Diagnosis

A

Technetium-99 scan (meckle’s scan) for ectopic gastric mucosa.

94
Q

Meckel’s Diverticulum treatment

A

surgical resection of the diverticulum

95
Q

Appendicitis Definition

A

Obstruction of the appendiceal lumen leading to inflammation. Most common pediatric surgical emergency. Most common in the second decade, rare less than 5 yo.

96
Q

Appendicitis Presentation

A

Anorexia, vomiting, fever, migrating abdominal pain (periumbilical to RLQ). Guarding, rebound tenderness, positive rovsing’s sign, obturator sign and ileopsoas sign.

97
Q

Appendicitis Diagnosis

A

Ultrasound or low dose CT. WBC is usually greater than 10,000.

98
Q

Appendicitis treatment

A

appendectomy

99
Q

Hirschsprung’s Disease definition

A

Absence of ganglion cells in the mucosal and muscular layers of the colon. Peristaltic waves can’t extend beyond the portion of de innervation so the bowel becomes obstructed. Usually begins in the distal bowel (rectosigmoid). Most common lower bowel obstruction in neonates usually present within first 6 w. More common in males. associated with downs syndrome.

100
Q

Hirschsprung’s Disease Presentation

A

Failure to pass meconium within 48-72 hours. Bilious vomiting, distension, reluctance to feed, irritability, grunting, chronic constipation, FTT. Rectal exam shows a narrow anal canal that is devoid of fecal matter, explosive “squirt” or “blast” of gas/stool when finger is removed.

101
Q

Hirschsprung’s Disease Diagnosis

A

Rectal biopsy is the gold standard to confirm the absence of ganglion cells.

102
Q

Hirschsprung’s Disease Treatment

A

Resection of aganglionic segment with a colostomy then correct it with a colorectal anastomosis.

103
Q

Inflammatory Bowel Disease Definition

A

Includes Crohn’s and ulcerative colitis. Usually presents before 20 yo. Smoking increases risk. white more than black more than hispanic.

104
Q

Inflammatory Bowel Disease Presentation

A

Colitis: Diarrhea, abdominal pain, +/- hematochezia, weight loss, FTT. Extraintestinal: Erythema nodosum, arthritis, sacroileitis, uveitis, anemia.

105
Q

Crohn’s Disease Definition

A

Transmural inflammation anywhere in the GI tract, usually in the ileum. Fistulas, abscesses and strictures.

106
Q

Crohn’s Disease Diagnosis

A

Colonoscopy with skip lesions and cobblestone appearance.

107
Q

Ulcerative Colitis Definition

A

Inflammation of the mucosal layer in the rectum and large colon. Starts at the rectum and extends proximally. High risk for colon cancer.

108
Q

Ulcerative Colitis Diagnosis

A

Colonoscopy shows erythematous and friable mucosa with small erosions.

109
Q

Inflammatory Bowel Disease Treatment

A

5-ASA, immunomodulators/biologics. Steriods for flare ups or budesonide for those older than 6.

110
Q

Diarrhea Definition

A

More than 3 loose/watery stools a day.

111
Q

Diarrhea Red Flags

A

Fever, severe abdominal pain, hematochezia, vomiting, dehydration, leukocytosis, persistent symptoms, FTT.

112
Q

Diarrhea Treatment

A

Hydration always, antibiotics sometimes, anti-motility agents never.

113
Q

Constipation Definition

A

Regular passage of firm/hard stools or the infrequent passage of stool. Most common at 5-6 yo and during times of change.

114
Q

Functional Constipation Definition

A

Voluntary withholding of stool due to a negative experience or pain. Associated with stool incontinence (encopresis). Commonly occurs when introduced to solid food, potty training and the start of school.

115
Q

Organic Constipation Definition

A

Abnormal bowel movement after birth, FTT, obstructive symptoms, lumbosacral problems, anterior placed anus, occult blood, neurological abnormalities.

116
Q

Constipation Presentation

A

Encopresis, abdominal pain. Decreased bowel sounds, distension (obstruction?). Palpable stool mass in LLQ. Rectal exam can shoe anal fissures, fecal impaction and the anatomic placement of the anus.

117
Q

Constipation Red Flags

A

FTT, vomiting, acute onset.

118
Q

Constipation work up

A

CBC/CMP, TSH, sweat test (CF), KUB (impaction), MRI (neuro disorder), Rectal biopsy (hirchsprung’s).

119
Q

Constipation Treatment

A

Decrease dairy intake, relieve any impactions with polyethylene glycol. Laxative therapy: miralax, lactulose. GI referral if no improvement.

120
Q

Clinical Jaundice

A

More than 3mg/dl of indirect bilirubin.

121
Q

Fatal Jaundice

A

More than 20mg/dl of indirect bilirubin. Neurotoxic.

122
Q

Breast Milk Jaundice

A

Appears within the first week of life but is harmless and spontaneously resolves.

123
Q

Pathologic Jaundice Definition

A

Jaundice appearing in the first 24 hours or after 14 days.

124
Q

Causes of Jaundice in the first 24 hours of life

A

Hemolysis: ABO incompatibility, Rh iso-immunisation, sepsis, G6PD deficiency, spherocytosis. Hepatitis.

125
Q

Pathologic Jaundice Treatment

A

Monitor bilirubin levels, treat with phototherapy. If not successful refer to a neonatologist.

126
Q

Post Hepatic Jaundice

A

Biliary atresia. Disease destroys the bile duct resulting in obstruction to bile flow which damages the liver.

127
Q

Post Hepatic Jaundice Presentation

A

Jaundice, Dark urine, light stools

128
Q

Post Hepatic Jaundice Treatment

A

Liver Transplant

Pediatrics (8 decks)

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