Pediatric GI

Question 1

what is the definition of GER?

Answer 1

the passage of gastric contents into the esophagus

“the happy spitter”

Question 2

what is the definition of GERD?

Answer 2

when symptoms and/or complications are present as a result of GER

ex: unable to gain weight, difficulty eating, failure to thrive

Question 3

how do you distinguish GER vs GERD?

Answer 3

based on history of presenting illness

Question 4

what is the treatment for GERD?

Answer 4

kids should sleep on their back
hypoallergenic formula
smaller feeds more frequently
upright position during and after feeding for 30 minutes
medications: H2 antagonists or PPI
surgery: fundoplication

Question 5

what is intussusception?

Answer 5

telescoping of one part of the intesting (most commonly ileocecal) resulting in impaired venous return, bowel ischemia, edema, necrosis or perforation

Question 6

what is the clinical presentation of intussusception?

Answer 6

episodes of irritability, colicky pain and emesis

currant jelly stools

palpable tubular mass in RUQ

coiled spring apperance on air enema

Question 7

what is the treatment for intussusception?

Answer 7

fluid resuscitation

hydrostatic reduction with contrast enema OR pneumatic reduction with an air enema

open reduction is needed if it won’t reduce with enema or if reoccurance

Question 8

what is pyloric stenosis?

Answer 8

gastric outlet obstruction due to hypertrophied pyloric junction

M > F

usually presents in the first 2-3 months of life

Question 9

what is the clinical presentation of pyloric stenosis?

Answer 9

projectile vomiting
dehydration (decresed urine output)
poor weight gain

Question 10

what is the classic metabolic picture of pyloric stenosis?

Answer 10

hypochloremic
hypokalemic
metabolic alkalosis

Question 11

what PE findings are associated with pyloric stenosis?

Answer 11

olive sized, muscular, mobile, nontender mass in the epigastrium

peristaltic waves

“string sign” on upper GI

thickened, elongated pylorus on US

Question 12

what is the treatment for pyloric stenosis?

Answer 12

pyloromyotomy

Question 13

what is hirschsprung dz?

Answer 13

failure of the ganglion cells of the myenteric plexus to migrate into the developing colon

tonically contracted colon

Question 14

what is the clinical presentation of Hirschsprung dz?

Answer 14

infant fails to pass meconium within first 24-48 hours of life OR infant who requires repeat rectal stimulation to induce BM

poor feeding

bilious vomiting

abdominal distention

Question 15

what are PE findings associated with hirschsprung dz?

Answer 15

palpable stool throughout the abdomen
empty rectal vault
never having unassisted stool

Question 16

what PE findings would be associated with a short segment affected by hirschsprung dz?

Answer 16

failure to grow
intermittent bouts of intestinal obstruction
bloody diarrhea
occasional bowel perforations

*may be undetected until later in childhood

Question 17

what will the XR show for Hirschsprung dz?

Answer 17

distention of the proximal bowel

no gas or feces in the rectum

Question 18

what is the treatment for Hirschsprung dz?

Answer 18

first stage: divertion colostomy with bowel that contains ganglion cells

second stage: aganglionic portion is removed and the ganglionic segment is anastomosed to the rectum

Question 19

what is the clinical presentation of celiac dz?

Answer 19

diarrhea
failure to thrive
abd distension
abd pain
vomiting
fatigue
constipation

Question 20

what is the MOA of celiac dz?

Answer 20

1. innate immune detection of gluten antigen
2. T-cell development
3. T-cell and B-cell co-stimulation
4. cytokines promote inflammation