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Pediatric Emergencies Exam 2 > Abdominal Emergencies 2 > Flashcards

Abdominal Emergencies 2 Flashcards

1
Q

Common Sources of GI Bleeding: Anal Fissures in First Two Years of Life (3)

A

a. Superficial tear of squamous lining
b. Large constipation stool
c. Child learns to hold back

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2
Q

Common Sources of GI Bleeding: Cow’s Milk Protein Intolerance (6)

A

a. Cow’s milk and soy are most often responsible
b. Appear health and normal weight gain
c. Allergic eosinophilic gastroenteritis RARE
d. Infiltration of GI tract with eosinophils May have iron deficiency anemia, FTT
e. Watery diarrhea
f. Postprandial vomiting

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3
Q

Common Sources of GI Bleeding: Polyps (3)

A

a. Beyond two years of age, polyps are most common cause of painless lower GT Bleeding
b. Poly will outgrow its blood supply and slough off of its stalk
c. Usually left sided and solitary; Usually painless

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4
Q

Common Sources of GI Bleeding: Genetic Syndromes Associated with Multiple Polpys (3)

A
  1. Familial polyposis
  2. Peutz Jegher syndrome
    * Will have freckles all over their face and body
    * Freckles around the lips
    * HALLMARK: Freckles
    * Look for family history of colon cancer
  3. Gardner’s syndrome
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5
Q

Lower GI bleed: Neonatal Period (11)

A
  1. Cow’s milk protein allergy
  2. Midgut volvulus
  3. Hirschsprungs
  4. DIC
  5. Intussusception
  6. Vascular malformation
  7. Anal fissures
  8. Swallowed maternal blood
  9. Infectious diarrhea
  10. Duplication
  11. Hemorrhagic disease of newborn
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6
Q

Lower GI bleed: 30 days to 2 years old (10)

A

a. Anorectal lesion
b. Infectious diarrhea
c. Intussusception
d. Meckel’s
e. Midgut volvulus
f. Vascular malformation
g. Duplication
h. Hemolytic uremic syndrome
i. IBD
j. Acquired thrombocytopenia

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7
Q

Lower GI bleed: 2-5 years old (11)

A
  1. Anal Fissure
  2. Infectious diarrhea
  3. Juvenile Polyp
  4. Intussusception
  5. Henoch-Schonlein purpura
  6. Meckels
  7. HUS
  8. IBD
  9. Ulcer
  10. Vasculitis
  11. Nodular lymphoid Hyperplasia
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8
Q

Lower GI bleed: 5-15 years old (12)

A
  1. Infectious diarrhea
  2. HUS
  3. Polyp
  4. IBD
  5. Hemorrhoids
  6. Anal fissure
  7. Meckel’s
  8. Intussusception
  9. HSP
  10. Vasculitis
  11. IBD-Ulcer Colitis
  12. Nodular lymphoid Hyperplasia
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9
Q

Lower GI bleed: History (6)

A
  1. Weight loss, anorexia, arthralgia, red eyes
  2. Dietary history: Milk
  3. Exposure to infection
  4. Family history bleeding polyps
  5. Drug history: NSAID, salicylates, iron
  6. Constipation
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10
Q

Lower GI bleed: Physical Exam (2)

A

a. Abdominal tension Mass

b. Anus, rectal; skin tags, polyps, fissure

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11
Q

Lower GI bleed: Labs to obtain (4)

A

a. CBC
b. Stool C and S
c. Stool O and P
d. Stool for WBC

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12
Q

Lower GI bleed: Diagnostics (5)

A

a. Gastric aspirate
b. Acute abdominal series
c. Ultrasound
d. CT of abdomen
e. Air contract enema

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13
Q

Lower GI bleed PE: Possible Dx for fever

A

Points to infection

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14
Q

Lower GI bleed PE: Possible Dx for petechiae, ecchymosis

A

Coagulopathy, thrombocytopenia –> Henoch Schonlen purpura

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15
Q

Lower GI bleed PE: Possible Dx for cutaneous perioral and oral pigmentation

A

Peutz Jegher syndrome

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16
Q

Lower GI bleed PE: Possible Dx for digital clubbing, palmar erythema, gynecomastia and hepatosplenomegaly

A

cirrhosis of the liver

17
Q

Pancreatitis overview (3)

A

a. Inflammation within the parenchyma of the pancreas
b. Reversible
c. Acute inflammation

18
Q

Pancreatitis causes (8)

A
  1. Blunt Trauma: accounts for 10% to 40% of the cases
    i. Amylase may be elevated due to intestinal perforation
  2. Systemic disease
    i. Sepsis, hemolytic uremic syndrome, SLE
  3. Structure/biliary disease
    i. Pancreas divisum with presence of a dorsal and ventral pancreas Gallbladder sludge
  4. Medications
  5. Infections—mumps, hepatitis A, rotavirus, hepatitis E, varicella and host of virus
  6. Metabolic
  7. Hereditary: CF, Abnormalities of the cationic trypsinogen gene(PRSS1)
  8. Idiopathic
19
Q

Pancreatitis symptoms (6)

A
  1. Abdominal pain
  2. Epigastric region in 62% to 89% of cases
  3. Can also be diffuse and in lower abdominal area
  4. Younger children fever and irritability
  5. Nausea or vomiting
  6. Fever and jaundice
20
Q

Pancreatitis physical exam (7)

A
  1. Uncomfortable with movement*****
  2. Quiet bowel sounds
  3. Abdominal tenderness
  4. Dyspnea
  5. Epigastric mass (pseudo cyst formation)
  6. Hemorrhagic pancreatitis with bluish flanks (Grey Turner sign)*****
  7. Bluish area surround the umbilicus (Cullen Sign)
21
Q

Pancreatitis diagnostics (10)

A
  1. Ultrasound initial test
    i. Pancreas is difficult to visualize but this is first test
  2. CT with contrast can help evaluate severity
  3. MRI limited data in children
  4. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic ultrasound
  5. Elevation of serum amylase and lipase
  6. Sensitivity in amylase is 50 to 90%
  7. Lipase remains elevated longer and correlates with severity
  8. Elevation of both sensitivity of 94% CBC
  9. Elevation of WBC and Hematocrit due to hemoconcentration and volume depletion
  10. Hypocalcemia and hyperglycemia in acute pancreatitis
22
Q

Pancreatitis treatment (3)

A

a. Pain control
b. Fluid restriction
c. Nutrition; Jejunal feedings

Pediatric Emergencies Exam 2 (9 decks)

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