Exam 2 Flashcards
(235 cards)
1
Q
when does physiologic jaundice start
A
at least 24 hours old
2
Q
breast-feeding jaundice is due to
A
inadequate breast milk intake leading to decreased excretion of bilirubin
3
Q
breast-feeding jaundice improves when
A
intake is improved
4
Q
breast milk jaundice starts when
A
5-7 days old
5
Q
bilirubin levels in breast milk/breast feeding jaundice
A
not very high
6
Q
when to evaluate physiologic jaundice
A
if still present at 2-3 weeks
7
Q
breast milk jaundice eval
A
trial of formula
8
Q
breast feeding jaundice treatment
A
increase breast milk, monitor I and O, supplement or change to formula
9
Q
cause of physiologic jaundice
A
increased bili production (high RBC turnover) and decreased excretion
10
Q
when does physiologic jaundice peak
A
3-5 days
11
Q
when does physiologic jaundice resolve
A
1-2 weeks
12
Q
when does breast milk jaundice peak
A
< 3 weeks
13
Q
when does breast milk jaundice resolve
A
< 3 months
14
Q
breast milk jaundice due to
A
slow breakdown of bilirubin
15
Q
what to evaluate in neonate with jaundice
A
CBC/diff, CMP, UA, US (look for atresia), serial HFP, blood type, Coombs, genetic analysis, viral panels, HIDA scan, biopsies
16
Q
most common treatment for indirect hyperbilirubinemia
A
bili lights
17
Q
intrahepatic cholestatic jaundice causes
A
hepatocyte injury (infectious, metabolic, genetic, toxic, endocrine)
18
Q
extrahepatic cholestatic jaundice causes
A
biliary atresia, choledochal cyst, biliary sludge
19
Q
characteristics of intrahepatic cholestasis
A
sick patient, patent bile ducts, elevated direct and total bilirubin
20
Q
characteristics of extrahepatic cholestasis
A
asymptomatic, duct obstruction, elevated direct and total bilirubin
21
Q
cholestasis red flags
A
failure to thrive, poor feeding, lethargy, hepatomegaly, splenomegaly, abnormal labs (direct hyperbilirubinemia, elevated LFTs, hypoglycemia, hyperammonemia)
22
Q
red flags of advanced chronic liver disease
A
fatigue, GI bleeds, jaundice, hepatosplenomegaly, low platelets, low WBC, elevated direct bilirubin, elevated INR
23
Q
what is infant dyschezia
A
a functional condition characterized by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stool
24
Q
infant dyschezia population
A
otherwise healthy infant < 6 months old
25
infant dyschezia episode frequency
several times daily
26
infant dyschezia presentation
healthy infant who cries for 20-30 minutes, turns red, and screams before defecation takes place
27
infant dyschezia pathophys
Pt lacks coordination of 2 events required for defecation: pelvic floor relaxation and an increase in intra-abdominal pressure
28
testing/treatment/prognosis for infant dyschezia
no testing or treatment is necessary, generally lasts only a week or two and resolves spontaneously as child develops
29
types of hernias seen in peds
inguinal, umbilical, hiatal, diaphragmatic
30
ssx of hiatal hernia
reflex, heartburn, regurgitation
31
testing for hiatal hernia
UGI study with barium, EGD
32
treatment for small hiatal hernia
treat for GERD (H2 blockers/PPI/lifestyle for infant GERD)
33
treatment for larger hiatal hernias
laprascopic surgical repair: fundoplication
34
diaphragmatic hernia ssx
respiratory distress, poor breath sounds, scaphoid abdomen, pulmonary hypoplasia/hypertension, cardiac defects, chromosomal abnormalities
35
testing for diaphragmatic hernia
antenatal US, UGI study
36
diaphragmatic hernia treatment
surgical reduction of organs, intubation/gastric decompression, treat for ongoing GERD, pulmonary HTN
37
incarcerated hernia definition
irreducible hernia with viable contents, contents of hernia sack are stuck to one another by adhesions
38
incarcerated hernia aka
obstructed hernia
39
strangulated hernia definition
visceral contents of hernia become twisted or entrapped by narrow opening with compromised blood supply and ischemic/necrotic contents.
40
strangulated hernia presentation
painful/tender on palpation
41
sliding hernia definition
part of a viscus is adherent to the outside of the peritoneum forming the hernial sack beyond the hernial orifice
42
which type of hernia constitutes a medical emergency
strangulated
43
most childhood and congenital inguinal hernias are:
indirect
44
indirect hernia definition
enters inguinal canal at deep inguinal ring and transverses it with spermatic cord. It is lateral to the inferior epigastric vessels and can pass into scrotum or labial majora
45
direct hernia definition
a bulge through weakened fascia of abdominal wall located directly behind superficial inguinal ring, medial to inferior epigastric vessels. Rarely enter the scrotum
46
when do most pediatric umbilical hernias resolve spontaneously
within 3 years
47
what is gastroschisis
eviscerated bowel to the right of the umbilical cord with no covering membrane
48
what is omphalocele
protruding sac containing multiple organs with umbilical cord at apex
49
malrotation ssx
abd distention, pain, vomiting (possibly bilious), hematochezia, possibly toxic appearance
50
volvulus ssx
abd distention, pain, bilious vomiting, constipation, tympanitic abdomen, possibly toxic appearance
51
radiographic sign of duodenal obstruction (volvulus)
double bubble sign
52
what is diaphragmatic hernia
stomach/intestines protrude into chest cavity with displacement of lung and heart
53
where does diaphragmatic hernia usually occur
on the left
54
who is more likely to get inguinal hernia
boys
55
umbilical hernia red flags
red/purple, painful, enlarged, vomiting, severe pain, fever, unable to urinate
56
inguinal hernia treatment
manual reduction, surgery
57
umbilical hernia imaging
US, doppler
58
when is gastroschisis diagnosed
antenatal
59
gastroschisis prognosis
must treat surgically, but Pts do well after reduction
60
what is more emergent, malrotation or volvulus
volvulus
61
most common volvulus location
sigmoid/cecum
62
malrotation imaging
US, KUB, contrast film
63
volvulus imaging
KUB/CT
64
volvulus treatment
urgent/emergent surgery
65
cause of patent omphalomesenteric duct
duct does not dissolve during fetal development
66
consequences of patent omphalomesenteric duct
can leared to hernia or discharge of feces or mucus out of umbilicus
67
what is meckels diverticulum
most common omphalomesenteric duct remnant (ileum): ectopic gastric mucosa that still secretes acid
68
meckels diverticulum presentation
usually asymptomatic, may progress to painless maroon rectal bleeding or melena
69
meckels diverticulum complications
obstruction due to intussusception, volvulus. May get trapped in inguinal hernia
70
meckel's diverticulum diagnosis
meckel scan (nuclear medicine)
71
prognosis of meckel's diverticulum
good prognosis with surgical correction
72
red flags associated with IBD
bloody stools, nocturnal stools, abd pain, tenesmus
73
pediatric age for IBD
older children or teenagers
74
features of crohn's
short stature, poor weight gain or weight loss, fevers, joint pain, fatigue, hair loss, anemia, elevated inflammatory markers
75
goals of crohn's treatment
remission, growth
76
possible IBD etiologies
autoimmune, environmental, genetics
77
treatment for mild crohns
5-ASA, then PO glucocorticoids, +/- abx
78
treatment for moderate-severe crohns
PO glucocorticoids, 5-ASA, thiopurines/methotrexate, biologics
79
treatment for very severe crohns
admission with IV glucocorticoids, resection of affected bowel
80
cure for UC
colectomy (if severe and refractory to meds)
81
peds consideration with UC
may progress to crohns
82
UC in peds (growth, constitutional symptoms)
may or may not be problems
83
Rome IV constipation criteria (general)
at least 2 complaints for the last 3 months with ssx onset at at least 6 months old
84
what percentage of constipation is functional
95%
85
Rome IV criteria for constipation criteria (specific complaints)
straining, lump/hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, manual maneuvers to facilitate defecation, <3 BMs per week
86
peds life events risk factors for constopation
starting solid for the first time, during potty training, during early school, trauma, bullying
87
when to get KUB for constipation
eval of impaction, caliber of colon, eval of cleanout
88
KUB in peds consideration
balance benefits vs radiation exposure
89
when to use barium enema
to look for anatomical abnormalities causing constipation
90
when to get rectal biopsy
to evaluate for Hirschprung disease (look for ganglion nerve cells)
91
when do meckels complications occur
in boys age 0-2
92
encopresis definition
repeated passage of stool into inappropriate places by child older than 4 each month for at least 3 months
93
most common etiology of encopresis
constipation (overflow diarrhea)
94
conditions associated with encopresis
cerebral palsy, spina bifida, hx of crohns, colectomy
95
evaluation of encopresis
physical exam +/- KUB, enemas, psychology/counseling, parent education. Do not pressure or punish child
96
constipation treatment of choice for infants
glycerin suppositories or lactulose syrup (if over 6 months)
97
giving fiber to infants
contraindicated
98
how much fiber do kids need
5 grams of fiber for each year of age
99
treatment of choice for constipation in peds
osmotic laxatives like PEG 3350 (miralax), sorbitol containing foods
100
other treatment options for constipation
enemas, suppositories, PT, biofeedback, counseling
101
treatment for fecal impaction
manual disimpaction, enema, suppository, then maintenance +/- eval for underlying conditions
102
complication of chronic constipation
dilation and loss of bowel tone
103
abdominal pain red flags associated ssx
worsens over time, ill appearance, doesn't want to move
104
abdominal pain red flags abd PE
tense, distended, rigid, reduced/absent bowel sounds, involuntary guarding, tympanitic, tenderness, masses
105
causes of GI malabsorption
celiac, pancreatic insufficiency/chronic pancreatitis, SIBO
106
diarrhea timing in IBD
can be nocturnal
107
rotavirus presentation
watery, green diarrhea in a baby or young child
108
most common cause of infectious diarrhea in peds
viral acute gastroenteritis (rotavirus)
109
causes of infectious diarrhea
rotavirus, c diff, giardia, cryptosporidium, e coli
110
functional causes of diarrhea
diet, motility, IBS, toddler's diarrhea, fecal impaction
111
characteristics of inflammatory diarrhea
small volume, frequent, painful
112
characteristics of steatorrhea
fatty, large volume, weight loss
113
characteristics of exudative diarrhea
blood, leukocytes/pus, damaged epithelium
114
causes of exudative diarrhea
IBD, c diff
115
infectious cause of secretory diarrhea
e coli
116
chronic diarrhea time
>4 weeks
117
persistent diarrhea time
2-3 weeks
118
diarrhea definition
loose/watery stools 3+ times per day, >10 ml/kg/day, >200 g/day
119
what is necrotizing enterocolitis
infection that causes necrosis of bowel
120
necrotizing enterocolitis ssx
hypo/hyperthermia, apnea, bradycardia, hypotension, lethargy, sepsis, abd distention, bloody bowel movements, vomiting, +/- mass, abd cellulitis
121
NEC imaging
KUB
122
NEC imaging findings
pneumatosis intestinalis, pneumoperitoneum
123
what is pneumatosis intestinalis
gas in the wall of the intestine
124
what is pneumoperitoneum
free air in the abdomen
125
NEC treatment
NPO, gastric decompression, IV fluids, broad-spectrum abx,, +/- surgery
126
what percentage of NEC patients need surgery and what surgery is it
50%, resection of necrotic bowel
127
indications for NEC surgery
fixed section of bowel, cellulitis
128
NEC prognosis
10% mortality rate, high risk of postoperative complications, check for short bowel syndrome and vitamin levels
129
NEC risk factors
prematurity, NICU stay, newborn, congenital heart disease, birth problems (ie hypoxia)
130
juvenile polyps characteristics
usually single polyp but less than 5, painless passage of blood PR in an otherwise healthy toddler to young child
131
juvenile polyps diagnosis
colonoscopy or flex sig with removal and biopsy
132
most common juvenile polyp biopsy finding
benign, hamartomatous
133
juvenile polyposis syndrome
>5 polyps anywhere from stomach to colon with high risk of cancer, often inherited
134
what is intussusception
telescoping of bowel
135
most common intussusception cause
idiopathic
136
most common location for intussusception
ileocecal
137
what is the most common cause of bowel obstruction in first 2 years of life
intussusception
138
who is more likely to get intussusception
males
139
catch phrase for intusussecption
currant-jelly stools
140
intussusception complications
incarceration of bowel, perforation, peritonitis
141
what is lead point in intussusception
abnormality that triggered it
142
common intussusception lead points
polyp, anatomical anomaly, foreign body, infection, IBD, lymphoma
143
class intussusception presentation
3-12 month old with recurring spasms of pain, draws up knees and screams +/- sausage-shaped mass in upper mid abdomine
144
combination of these factors lead to high sensitivity for intussusception
paint, lethargy, vomiting and KUB indicating intussusception
145
what can be both diagnostic and therapeutic for intussusception
barium/air enema
146
initial imaging for intussusception
US
147
when to avoid barium in intussusception
if perforation is suspected
148
imaging timing consideration for intussusception
best if within 24 hours of symptom onset
149
what is sentinel pile
anal fissures can heal to form them
150
hemorrhoids in peds consideration and ddx
not common in peds, consider polyp, IBD, prolapse
151
most common location for Hirschsprung
isolated to the rectum
152
what is Hirschsprung
aganglionic bowel
153
when is Hirschsprung diagnosed and presentation
usually at birth: no meconium stool within 24-48 hours, vomiting, abd distention, feeding refusal, +/-explosive diarrhea, toxic appearance
154
presentation when Hirschsprung is diagnosed later in life
constipation, thin stools, abd distention, malnutrition
155
Hirschsprung typical diagnosis
KUB +/- barium enema showing thin rectum and dilated sigmoid
156
Hirschsprung gold standard diagnosis
rectal biopsy (can be done if office if <3 months)
157
Hirschsprung treatment and complications
surgery; persistent constipation, encopresis, diarrhea, surgical complications, perforation, sepsis
158
timing of N/V in appendicitis
after onset of pain
159
appendicitis considerations for very young
high rate of perforation, atypical presentation
160
labs in appendicitis
elevated WBC, CRP
161
what percent of JPS becomes cancer
50%
162
type of bilirubin that is fat soluble
unconjugated
163
type of bilirubin that is water soluble
conjugated
164
what is unconjugated bilirubin bound to
mostly albumin
165
conjugated bilirubin excretion
stool and urine (via portal circulation)
166
bilirubin is a byproduct of
the breakdown of heme
167
which test measures unconjugated bilirubin
indirect
168
how to obtain indirect bilirubin
total-conjugated = unconjugated
169
when level of bilirubin is high risk for kernicterus
>20 mg/dl
170
which kind of hyperbilirubinemia is often non-pathologic
indirect/unconjugated
171
elevated indirect bilirubin ddx
physiologic, breast-feeding, breast milk, hemolytic blood disorders
172
main categories of causes for elevated indirect bilirubin
increased hemolysis, decreased conjugation/excretion
173
2 causes of pathologic unconjugated hyperbilirubinemia
ABO incompatability, Rh-isoimmunization
174
ABO incompatibility presentation
usually mild hemolysis with variable course
175
ABO incompatibility usually affects
type A or type B infants with anti A or anti IgG antibodies born to a type O mother
176
ABO incompatibility treatment
may require transfusion for anemia
177
Rh isoimmunization affects
Rh negative mother with an Rh positive infant
178
Rh isoimmunization presentation
severe hemolysis +/-anemia, edema, heart failure
179
Rh isoimmunization called
erythroblastosis fetalis
180
Rh isoimmunization treatment
phototherapy, transfusion
181
Rh isoimmunization prevention
prenatal screening with maternal administration of Rho D immunoglobulin
182
tests for neonate with jaundice
CBC/diff, CMP, UA, US
183
timing of testing for neonate with jaundice
must get serial HFP, CMP or bilirubin within 24-48 hours
184
other tests to consider for neonate with jaundice
blood type, coombs, genetic testing, viral panels for hep and CMV, HIDA scan, biopsies
185
most common treatment for indirect hyperbilirubinemia and mechanism
phototherapy: converts unconjugated bilirubin to water soluble form
186
phototherapy consideration
shield eyes
187
major categories of causes of neonatal cholestasis
intrahepatic and extrahepatic
188
intrahepatic cholestasis is caused by (generally)
hepatocyte injury
189
causes of hepatocyte injury leading to intrahepatic cholestasis
idiopathic, infectious, metabolic, genetic, hypothyroidism, toxic
190
causes of infectious intrahepatic cholestasis
viruses, TORCH, sepsis, UTI
191
causes of toxic intrahepatic cholestasis
TPN, drugs
192
causes of extrahepatic cholestasis
biliary atresia, choledochal cyst, biliary sludge
193
characteristics of intrahepatic cholestasis
patient is ill with patent bile ducts and elevated direct and total bilirubin
194
characteristics of extrahepatic cholestasis
often asymptomatic with obstructed bile ducts and elevated direct and total bilirubin
195
top 3 causes of neonatal cholestasis
extrahepatic biliary atresia, idiopathic neonatal hepatitis, infectious hepatitis
196
what is biliary atresia
fibro-inflammatory obstruction of extrahepatic bile ducts
197
ssx of biliary atresia
jaundice, splenomegaly, dark urine, hepatomegaly, acholic stools, pruritus
198
biliary atresia surgical treatment
hepatoportoenterotomy
199
hepatoportoenterotomy aka
Kasai
200
biliary atresia nonsurgical adjunct treatment
nutrition, manage portal HTN, abx, ADEK supplementation
201
prognosis of biliary atresia
most children will require liver transplant by 20 y/o and anti-rejection drugs plus frequent monitoring
202
red flags signs of intrahepatic cholestasis
failure to thrive, poor feeding, lethargy, hepatosplenomegaly, hypoglycemia, elevated LFTs, direct hyperbilirubinemia, hyperammonemia
203
most common form of chronic liver disease in children/teens
NAFLD
204
most important NAFLD risk factors in peds
insulin resistance, central obesity
205
global prevlance of NAFLD in peds
3-10%
206
when to screen for NAFLD
overweight/obese, cardio/metabolic risks, ALT>80
207
tests to order when assessing for NAFLD
CBC/diff, CMP, GGT, PT/INR, viral hep panel, A1C, lipids, US, r/o autoimmune, celiac, thyroid, EBV/CMV
208
definitive NAFLD diagnosis
needle biopsy
209
nutrition requirements depend on what factors
growth rate, body composition, composition of new growth, age (decreases after age 4), health status/chronic illness
210
infant formula is generally based on ____
cow's milk
211
sole source of infant nutrition is recommended to be breast milk until what age
6 months
212
contraindications to breast feeding
TB, galactosemia, HIV (relative)
213
newborn feeding frequency
8-12 feedings per 24 hours
214
older infant feeding frequency
7-9 feedings daily, decreases with age
215
what is phenylketonuria
inherited error of metabolism that causes toxic levels of phenylalanine
216
ssx of phenylketonuria
mental retardation, convulsions, behavior problems, skin rash, musty body odor
217
phenylketonuria diet
no meat, dairy, dry beans, nuts, or eggs
218
criteria for undernutrition
weight <5th %
219
z score mild undernutrition
-1 to -2
220
z score moderate undernutrition
-2 to -3
221
z score severe undernutrition
-3 to -4
222
criteria for pediatric metabolic syndrome
at least 10 y/o, abdominal obesity, and 2 or more of: elevated TG, low HDL, HTN
223
when to screen non fasting lipids
9-11 y/o
224
when to screen fasting lipids
2-8 y/o and 12-16 y/o
225
weight loss recommendations for obese child < 12
1 lb/month
226
weight loss recommendations for obese child at least 12 y/o
up to 2 lbs/week
227
criteria for overweight
BMI 85-95%
228
criteria for obese
BMI>95
229
criteria for severe obesity
BMI >99%
230
myplate guidelines
fruits/vegetables: 1/2 of plate, meats/proteins: 1/4 of plate each, side serving of dairy
231
signs that infant is ready for foods
can sit with little/no support, good head control, opens mouth and leans forward when food is offered
232
formula calories
20 kcal/oz
233
newborn feedings schedule
2-3 oz every 2-3 hours
234
feeding schedule 1-5 months
3-4 oz every 3-4 hours
235
feeding schedule 6+ months
6-8 oz 4-5 times daily plus solid foods of 4 oz/meal
