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Disciplines II, Final Exam > Peds GI Disorders > Flashcards

Peds GI Disorders Flashcards

1
Q

What is Esophagreal atresia?

A

blind esophageal pouch w/ or w/o a fistulous connection between the proximal or distal esophagus & trachea

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2
Q

Clinical Presentation of Esophagreal Atreasia

A

Polyhydramnios (excess amniotic fluid)infants in the 1st few hrs of life w/ copious secretions, choking, cyanosis & respiratory distress

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3
Q

What imaging test is best used for Congenital Tracheoesophageal Fistulas and Esophageal Atresia

A

U/S followed by MRI

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4
Q

How does TE fistulas present on X-ray vs EA?

A

TE fistula distal to the esophagus = gas PRESENT in bowel

EA WITHOUT TE fistula = NO gas seen in bowel

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5
Q

Treatment of Congenital Tracheoesophageal Fistulas and Esophageal Atresia

A

NG tube in proximal pouch on low intermittent suction elevate head of bed to prevent reflux
IV glucose & fluids
O2
Surgery

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6
Q

What is the most common FB ingested? How do these present on CXR if in the esophagus or trachea?

A

CoinsSee slide 9

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7
Q

Treatment for button battery ingestion?

A

Requires endoscopic retrieval if lodged in the esophagusIf in stomach,

watch for 24-48 hours to see if it passes if not, must be removed endoscopically

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8
Q

What happens in magnets are ingested in a child and how is it treated?

A

multiple magnets can lead to fistula formation w/in bowel wall… these need surgical intervention!

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9
Q

Difference between GER vs GERD

A

GER: Reflux of gastric contents into the esophagus

GERD: present when reflux causes secondary sx or complications

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10
Q

What situations cause GER?

A

Occurs during relaxation of of LE sphincter small stomach capacity
large volume feedings
short esophageal length
supine positioning

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11
Q

Treatment for GER?

A

Usually benign expected to resolve by 12-18mo of life

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12
Q

What GER symptoms are concerning

A 
When infants develop sx like FTT, 
food refusal, 
pain, 
GI bleeding, 
upper or lower airway sx, etc. 
GER becomes GERD
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13
Q

What Symptoms are seen with GERD in older children?

A

Older children = heartburn, dysphagia

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14
Q

What are complications seen with GERD?

A

esophagitits recurrent pneumonia, recurrent cough dental erosions

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15
Q

How is GERD treated?

A

Reflux usually resolves 85% of time in infants by 12 mo
Can use thickened foods with oat cereal
Milk free and soy free diet
PPI medicines have shown better improvements

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16
Q

What risk is associated with given a PPI with infants?

A

risk for infection

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17
Q

What are the 2 most common complications of Eosinophillic Esophagitits (EoE)

A
  1. esophageal food impactions

2. esophageal stricture

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18
Q

How is EoE diagnosed?

A

Endoscopy

esophageal mucosa w/ thickening, mucosal fissures, strictures & ringsesophagus sprinkled w/ pinpoint white exudates (resembles candida)white spots composed of eosinophils

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19
Q

How is Eosinophilic Esophagitits treated?

A

elimination of food allergens

swallowed topical steroids (MDI)2 puffs of Fluticasone BID

Do NOT rinse mouth (unlike w/ asthma) & avoid eating for 30min to improve effectiveness

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20
Q

What is Pica?

A

Persistent eating of nonnutritive substances Animal feces, Clay, Dirt, Hairballs, Ice, Paint, SandAt least 1 month

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21
Q

What labs should be order to determine PICA?

What is the treatment?

A

CBC
Zinc levels
Lead levels

Tx: Address nutrient deficiency or lead poisoning
Behavioral therapy and family education

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22
Q

What is Rumination?

A

Repeated regurgitation and re-chewing of food At least 1 month

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23
Q

complications of Rumination?

A 
Associated with depression and eating disorders
Malnutrition
Failure to thrive
Weight loss
Bad breath
Tooth caries
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24
Q

Malabsorpion

A

slide 22

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25
Q

Malabsorption

A

slie 23

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26
Q

What is the Most common inborn error of amino acid metabolism

How is this caused?

A

Phenylketonuria (PKU)

Decreased activity of phenylalanine hydroxylase (enzyme that converts phenylalanine to tyrosine)

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27
Q

Clinical Presentation of PKU

Which is the MC finding?

A

Intellectual disability (the most common finding overall)

Fair skin and hair (impairment of melanin synthesis)
Atopic dermatitis
hyperactivity seizures
Musty or mousy odor to body & urine 
Epilepsy (50%)
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28
Q

How can PKU be managed

How much phenylalanine should be consumed ideally?

A

Dietary restriction of phenylalanine and aspartame Goal is <6mg/dL phenylalanine a day

Tyrosine supplementation
Elimination of all high-protein foods (meat, dairy, nuts, legumes)Restrict starches

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29
Q

MC food allergy in peds?

A

Cow’s milk (12%)

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30
Q

What is the MC presentation of a Food allergy?

A

Skin: Urticaria and angioedema (most common)

31
Q

How are Food allergies diagnosed?

A

In vivo IgE against a specific food (skin testing)
In vitro for specific IgE
- RAST (radioallergosorbent testing )
-FEIA (fluorescent-enzyme immunoassay)
Removal and re-challenge
Clinical reactivity vs IgE antibodies

32
Q

Treatment for Food allergies?

A

Avoidance and re-introduction annuallyEpinephrineH1 blockers

33
Q

What is Celiac disease?

What are signs and symptoms?

A

Immune mediated enteropathy triggered by glutenabdominal pain, diarrhea, vomitingabdominal bloating or distention sometimes constipation

34
Q

What are GI complications that occur with Celiac disease?

A

chronic diarrhea, abdominal distention, irritability, anorexia, vomiting, poor weight gain

35
Q

What are non-GI complications that occur with Celiac disease?

A

delayed puberty or short staturedelayed menarche think CD w/ unexplained Fe def anemia

36
Q

How is Celiac’s Diagnosed?

How can it be treated?

A

Diagnosis: serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes)

Tx: gluten restriction for life (wheat, rye & barley)

37
Q

Essentially what is Omphalocele and Gastroschisis

A

Abdominal wall defects

38
Q

What is Omphalocele?

A

Membrane covered herniation of the abdominal contents into the base of the umbilical cord

39
Q

What is an GastroschisisWhat is the reason for incrased incidence of these?

A

Uncovered (no sac) intestine through small abdominal wall defect to the right of the umbilical cord Why?illicit drugs like meth & cocaine possible link w/ aspirin & ibuprofen use during pregnancy young maternal age

40
Q

How does someone with Diaphramtatic Hernia present?

A 
Respiratory distress - intestines poking through to the lungs
Retractions, cyanosis, 
grunting respirations 
Scaphoid abdomen,
barrel-shaped chest
41
Q

How does someone with Diaphragmatic hernia present on CXR

A

bowel loops seen in chest w/ mediastinal shift to opposite side on CXR

42
Q

How is a Diaphragmatic hernia treated?

A

intubation, mechanical ventilation & decompression of the GI tract w/ OG tube

43
Q

What are Indirect hernia?
Who are they most common in?
What side is it most common?

A

Passes LATERAL to the deep epigastric vessels
Follows tract THROUGH the inguinal canal (goes “IN” the “Inguinal canal”)

Mostly male (9:1)

More common than direct & most common in childrenMC on the right side

44
Q

What is a Direct hernia? Where are these located?

A

Passes MEDIAL & INFERIOR to the deep epigastric vessels
Does NOT go through the inguinal canal
Hesselbach triangle
RARE in children

45
Q

What are Femoral hernias?
Where are they located?
Who are these most common?

A

Follows the tract below the inguinal ligament through the femoral canalMedial to the femoral vein and lateral to the lacunar ligamentMost common in females

46
Q

Who are umbilical Hernias most common?

A

More common in full term, African American infants

47
Q

What is Pyloric Stenosis?

A

Postnatal muscular hypertrophy of the pylorus

Progressive gastric outlet obstruction

48
Q

What is the MC presenting symptom of Pyloric Stenosis?

A

projectile postprandial vomiting

49
Q

What is a Hallmark sign on physical exam that indicates Pyloric Stenosis?

A

Hallmark sign: olive mass “stenosis” (mass in RUQ esp. after vomiting)

50
Q

What imaging is best used to diagnose Pyloric Stenosis?

A

Ultrasound

51
Q

What would be seen on Barium upper GI for pyloric Stenosis?

A

String sign- indicating the elongated narrowed pyloric canal

52
Q

What is a genetic cause of Duodenal atresia?

A

Associated with Trisomy 21 (30%)

53
Q

What findings will see on CXR with Duodenal atresia?

A

“Duodenal-Double bubble”Double-bubble sign (on abdominal xray) Dilated stomach & proximal duodenum

54
Q

What is a sign that is seen right after birth in an infant with duodenal atresia?

A

Bilious vomiting hours after birth

55
Q

What is Short Bowel syndrome?

A

A condition resulting from reduced intestinal absorptive surface

56
Q

What is Intussusception?

A

Telescoping of one segment of the intestine into another segment

57
Q

What are signs of Intussusception?

A

Passage of rectal blood and mucous“Red current jelly”- pathognomonicPalpable right-sided sausage-shaped massAbsent right-sided and cecal gas shadow on abdominal x-ray

58
Q

What is seen on abdominal x-ray with Intussusception?What imagining test is most sensitive for Intuussusception?

A

“target sign” (2 concentric radiolucent circles superimposed)Ultrasound

59
Q

What is the best therapeutic approach with Intussusception?

A

Air enema is the BEST therapeutic approach in the stable pt

60
Q

What is Meckels Diverticulum?

A

Outpouching or bulge lower part of the small intestineLeftover umbilical cord

61
Q

What is MC congenital anomaly of the GI?

A

Most common congenital anomaly of the GI tract

62
Q

How do you treat Jaundice?

A

Treatment by exposure to bright lights – phototherapy

63
Q

What affect does CF have on the pancrease?Intestine affects?

A

fat soluble vitamin deficiency intussception, rectal prolapse, carb intolerance

64
Q

Cystic Fibrosis

A

Oral supplementation of pancreatic enzymes improves digestion

65
Q

What is Pilonidial Cysts

A

Infection of the skin or subcutaneous tissue at or near the upper part of the natal cleft of the buttock

66
Q

Treatment for Pilonidial cysts?

A

Soaking in warm water ease pain of pilonidal cystsSurgical opening and draining of the infected sinus

67
Q

What signs and symptoms of Pinworms?

A

Worms in the stool or eggs on perianal skinintense anal pruritus - kids will scratch at the butt and contaminate fingers

68
Q

Diagnosis for for Pinworms?Treatment for pinworms? What instructions need to be followed?

A

Scotch tape testOTC: Pyrantel pamoate Instructions: treat all household members at the same time to prevent reinfections repeat therapy after 2 weeks

69
Q

What is Encopresis?

A

Repeated passage of feces into inappropriate places due to children not fully developing bowel control

70
Q

How is Encopresis treated?

A

Behavioral-educational treatment of encopresis:1) Educating both child and parents about the disorder and its relation to regular bowel action2) Designing a feasible program of consistent toilet use3) Positive reinforcements for successful use of the toiletScheduled toileting shortly after meals- gastrocolic reflux

71
Q

What pharmacotherapy can be used to treat Encopresis?

A

Initially – suppositories and enemasMiralax usually better

72
Q

HOw is Constipation defined?

A

Chronic constipation is defined as 2 or more of the following characteristics for 2 months:1) < 3 BMs per wk2) > 1 episode of encopresis per wk3) impaction of the rectum w/ stool4) passage of stool so large it obstructs the toilet5) retentive posturing & fecal witholding6) pain w/ defecation

73
Q

How is constipation treated?

A

diet changes “P” fruitsMedications:Miralax (polyethylene glycol) 0.8-1g/kg/dLactulose 1-2g/kg/dMilk of Magnesia

Disciplines II, Final Exam (4 decks)

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