Pediatric GI 2: Abdominal Pain In Children Flashcards
How does the blood flow of umbilical cord work?
Muscular umbilical arteries
- carries deoxygenated blood from the fetus to the placenta
Umbilical vein
- carries oxygenated blood from placenta back to the fetus
- contains 20mL/kg
- should delay clamping of the course at delivery for 30-60sec
Remain anatomically patent for 10-20 days
- umblilical arteries -> lateral umbilical ligaments
- Umbilical vein -> ligementum teres
- ductus venosus -> ligamentum venosum
What kind of defects can occur from delayed separation of the umblilcal cord (>1 month)
Neutrophil chemotactic defects and overwhelming bacterial infections
Single umbilical artery defect
Present in approximately 5-10/1,000 with it being 35-70/1,000 in twin births
Very common in trisomies and 30% of infants with this defect result in congenital structural abnormalities
- it does NOT work the other way around (just because you have a single umbilical artery doesn’t mean you have a trisomy)
Other umbilical cord abnormalities
Abnormally short cords:
- fetal hypotonia, oligohydramnios, uterine constraint
Long cord (>70cm): - increase the risk for true knots wrapping around the fetus and causing prolapses
Straight uncoiled cords:
- associated with anomalies, fetal distress, intrauterine fetal demise
Omphalocele
A herniation or protrusion of the abdominal contents into the base of the umbilical cord
- the sac is covered with peritoneum without overlying skin and includes the distal umbilical cord into the sac
- can see herniation of the intestines into the cord in 1/5,000 births
- can see herniation of liver and intestines into the cord in 1/10,000 births
50-70% have associated malformations and 30% have trisomies
- (the 30% is even higher if the liver is not within the sac)
Treatment = cover sac with moist sterile dressings and prompt surgical repair
- usually normal survival rates is >90%
- if cant get to surgery = moist/sterile dressings can encourage epithelialization of the sac
What is the most common genetic condition that is seen with omphalocele’s?
Beckwith-Wiedemann syndrome
- 11p15 mutation in IGF-2 gene
Causes:
- fasting hypoglycemia
- omphaloceles
- macrosomia
GERD in children
Is the most common esophageal disorder in children
- is ONLY pathological GERD if symptoms are seen due to frequent/persistent GER
nearly all infants have some reflux symptoms that dont require therapy
Symptoms:
- heartburn
- poor weight gain
- upper respiratory symptoms
- wheezing
- irritability
- apnea And bradycardia (more common in preterm infants)
Happy spitters
Physiological GER that is evident in first few months of life
- peaks at 4 months and resolves spontaneously in up to 88% by 1 yr of age with almost all gone by 2 years
will show recurrent regurgitation without exhibiting discomfort or refusal to eat and failure to gain weight (differs from GERD)
Sandifer syndrome
Is a combination of GERD and opisthotonos (abnormal posturing and back arching)
- uncommon manifestation
What are red flag warning signs for GERD / happy spitters?
Billous emesis
Frequent projectile emesis
GI bleeding
Lethargy
Diagnosis of GERD and other reflex diseases
Upper GI studies and I-GERQ)
Use endoscopy if needed to diagnosis for erosive esophagitis and complications of GERD
- also can be used to therapeutically dilate reflux-induced strictures
Treatment of GERD
1) Thickening feeding
- either prethickened formulas or tablespoon of rice/oat cereal per 1oz of formula
2) short trial of hypoallergenic diets in infants
3) lifestyle changes: avoid smoke exposure/proper feeding positioning/hydrolysis infant formulas/ avoid acidic foods/ weight reduction if obese
4) Histamine-2 antagonists for kids
- 1st line in younger children and mild GERD
5) PPIs and antiacids
- 1st line in severe/erosive GERD
- infants under 10 kg = 5mg PO daily
- infants 10-20 kg = 10mg PO daily
- infants 20 kg = 20mg PO daily
be careful with rice though since it increases risk of arsenic exposure
cant give meds until later in life
What kind of positioning worsens GERD?
Seated positions worsens infant reflux
- supine positioning also worsens reflux however this is the position recommended for sleeping to reduce risk of SUDS!!
Prone positioning and upright carried position helps minimize reflux symptoms
- should promote this position during awake time
Sleep in older children should be on their left side with only the head elevated (dont get abdominal flexion or compression working)
Foreign bodies
Usually under 5 years old
Coins are by far the most commonly ingested foreign body
Most common lodge point = cricophayngeus (upper esophageal sphincter)
children with development delays and psychiatric disorders are at high risk
Symptoms of foreign bodies
- 30% may show asymptomatic*
- need to follow up on any history of foreign body ingestion even if no symptoms are present
Symptoms:
- acute bouts of choking/gagging and coughing
- excessive salivation
- dysphagia
- emesis
- pain in the neck/throat/sternal notch pain
- stridor
- wheezing
- cyanosis
- dyspnea
