Optimal oral rehydration fluids should contain how much sodium and how much glucose?
2% glucose and 90 mEq sodium
“Traveler’s diarrhea”, when to treat and with what
Enterotoxigenic E.coli; Tx when sx persist >7days and shiga toxin is negative. Tx with Bactrim
2 days after picnic, green malodorous diarrhea
Salmonella
Treatment of salmonella typhi
Ceftriaxone or cefotaxime
Watery diarrhea and fever several days after exposure, bloody diarrhea develops after fever resides. Tx?
Shigella; tx with bactrim
Watery/bloody diarrhea with crampy periumbilical pain relieved by defecation 2-4 days after exposure. Tx?
Campylobacter; tx azithromycin
Most common cause of chronic diarrhea in children up to age 3
Toddler’s diarrhea
Infant with eczema, asthma, cow milk protein intolerance. When does this resolve?
Age 2
Infant with hx polyhydramnios, low birth weight and progressively worsening non-bilious vomiting. How to dx? tx?
Antral web; dx with US, tx with surgery
Metabolic derangements in pyloric stenosis
Hypochloremic hypokalemic metabolic alkalosis, hyponatremia
US findings in pyloric stenosis
pylorus length >14 mm or muscle thickness >4 mm
Bilious vomiting, XR with gastric and duodenal dilatation, decreased intestinal air and corkscrew appearance of duodenum
Volvulus
How to dx malrotation
upper GI series
Treatment of ranula
Excision; make sure it’s not ectopic thyroid first
X-linked disorder with underdeveloped or absent teeth. How to dx?
Ectodermal Hypoplasia; Dx with Skin biopsy = lack of sweat pores
Sydrome with underdeveloped, small teeth
Hallerman Streiff Syndrome
Syndrome associated with too many teeth
Gardner’s Syndrome
Best diagnostic study for PUD
Urea breath test, fecal antigen (gold standard but too invasive: Upper GI endoscopy)
Tx PUD
PPI + 2 abx (clarithromycin + amox; OR clarithromycin + flagyl)
Child with bulky, pale, frothy, foul smelling stools, proximal muscle wasting. How to dx?
Screen with IgA Ab to TTG or IgA ab to endomysium. Confirm with biopsy
Extra teeth, polyps that are pre-malignant in large and small intestine, osteomas. Inheritance? Tx?
Gardner’s Syndrome. Autosomal dominant; tx with surgery
Mucosal pigmentation of the lips and gums, colon polyps
Peutz-Jeghers Syndrome
Teenager with chronic crampy lower abdominal pain, with or without bloody stools. Continuous inflammation of the colon. Tx?
Ulcerative colitis; ASA is first line, then steroids. Colectomy eliminates risk for cancer, but does not stop progression of AS (HLA-B27+)
If suspect infection in patient with UC, what abx?
Flagyl
Weight loss, erythema nodosum, arthritis, uveitis, liver disease and renal sones are all manifestations of what disease?
Crohn’s disease
Skip lesions on XR, transmural lesions, non-caseating granulomas
Crohn’s Disease
Perianal fistulae/oral aphthous ulcers. TX?
Crohn’s Disease. Steroids induce remission but do not change long term course, high rate of relapse
Crampy severe periumbilical pain. What organism?
Yersinia
What to rule out in child >6 that has intussusception
Lymphosarcoma
First step when intussusception highly suspected
Air contrast enema
Natural hx of anal stenosis
resolves by age 1
How to confirm dx of E. histolytica? Tx?
Serology; tx with flagyl for colitis/liver abscess and iodoquinol for asymptomatic disease
Older child with painless rectal bleeding
Juvenile polyposis
> 1 month old with elevated direct bilirubin. First test?Treatment?
Biliary atresia. Dx with US followed by HIDA scan. Tx Kasai if under 2 months
What deficiency in Gilbert syndrome?
Glucuronyl transferase deficiency
Child with recent URI, admitted to PICU with elevated LFTs and ammonia
Reye’s Syndrome 2/2 aspirin
Most specific test to dx pancreatitis? Best test to determine underlying cause?
Ultrasound to dx; Check serum lipids
Abdominal pain that radiates to shoulder is likely to be 2/2 to what organ?
Gallbladder
Child with shoulder pain, nausea, vomiting, fever, and lethargy. How to dx?
Cholecystitis dx with ultrasound
Child with jaundice, palpable RUQ mass or HSM, nasea/vomiting, and abdominal pain. How to dx?
Cholelithiasis
Which Hep B marker indicates high viral load
HBeAg, HBV-DNA
What does a +IgM anti-HBc indicate?
Recent infection with Hep B. Can remain elevated up to 6 months after infection
How to dx acute Hep B infection?
Check for HBsAg, HBV-DNA, HBeAg, and IgM anti-HBc
Most common bloodborne infection in the US
Hepatitis C
First detected with ingestion of solids: Diarrhea, pain, poor growth. Inheritance? Dx? Tx?
Sucrase-isomaltase deficiency. Autosomal recessive. Dx. Must do acid hydrolysis of stool, or hydrogen breath testing. Tx. restriction of sucrose
Pancreatic insufficiency, cyclic neutropenia, bone abnormalities. Inheritance?
Swachmann-Diamond Syndrome. Autosomal recessive.
Electrolyte disturbances in refeeding syndrome
Hypophosphatemia, hypokalemia, hypomagnesemia, HYPERnatremia, hyperglycemia
Neonate with fulminant liver failure, succinylacetone in the urine
Tyrosinemia (autosomal recessive)
Neonate with onset of liver failure after introducing fruit juices
Fructosemia
Which types of hepatitis typically has transaminases >1000s
Hepatitis A and B
The only etiology of hepatitis that causes splenomegaly
EBV
Teenage female with hepatitis, high serum protein and low serum albumin (hypergammaglobulinemia). What tests will aid in diagnosis?
Autoimmune hepatitis
Check for anti-microsomal Ab, anti-smooth muscle, anti-mitochondrial Ab
Triangular facies, pulmonary stenosis, TOF, paucity of intrahepatic bile ducts, butterfly vertebrae
Alagilles Syndrome (Autosomal dominant)
Female school-aged child with RUQ mass, pain, and intermittent jaundice. Dx? Tx?
Choledochal cyst. Dx with US, Tx surgery
Most common primary liver tumor of childhood
Hepatoblastoma
Patient with signs of cholestasis and pancreatitis. Next imaging study?
Magnetic resonance cholangiopancreatography or endoscopic ultrasonography (ERCP should not be attempted in the presence of pancreatitis)
Initial treatment of eosinophilic esophagitis
6 food elimination diet or elemental diet
When should a negative stool culture precede return to daycare in a child with diarrheal illness?
Shiga toxin-producing Escherichia coli, Shigella species, or Salmonella serotype typhi
When should an umbilical hernia be repaired?
IF symptomatic, if the hernia is still present at age 5–6 years, or it increases in size between 1 and 2 years of age
Shwachmann Diamond. How to diagnose?
Abdominal US or other imaging would show fatty infiltration of the pancreas