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Flashcards in Gastroenterology Deck (34):
1

frequency of GI complaints in pediatrics

2nd MC after respiratory illnesses

2

type of exam required with GI complaints

complete abdominal

  • visual inspection
    • distention, discoloration, veins, jaundice, scars, ostomies
  • auscultation
    • normal, hypo/hyper, absent, high pitched
  • palpation
    • organomegaly, retained feces, masses
  • rectal exam
    • masses, fissures, abscesses, fistulas, rectal tone, content

3

abnormal visual exam of abdomen

  • line of differentiation at ribs
  • abnormal venous pattern

4

question to ask parent of child with frequent/persistent abdominal pain

Can you tell when the child is in pain,

or only if they tell you?

(child usually not functional if > 6/10 pain)

5

causes of acute vs. gradual pain

acute - obstruction, rupture

gradual - inflammatory: appendicitis, inflammed bowel

6

acute abdominal pain

labs

  • CBC
  • CRP
  • ESR
  • pregnancy
  • UA
  • AST/ALT/GGT, bilirubin

7

acute abdominal pain

imaging

  • abdominal xray/series
  • CT
  • US
  • endoscopy
  • flouroscopy w/ contrast

8

non-surgical DDx of acute abdominal pain

  • viral illness
  • acute gastroenteritis
  • food intollerance
  • pneumonia
  • gastritis (food related or post-infectious)
  • constipation
  • UTI

9

peak incidence ages of chronic abdominal pain

7-12

10

chronic abdominal pain

warning signs of underlying illness

  • vomiting
  • fever
  • growth failure/weight loss
  • blood in stool or emesis
  • abnormal labs
  • bilious emesis
  • pain wakens child from sleep
  • location other than periumbilicus

11

chronic abdominal pain

when to assess

anxious chid/parent, missed school

12

chronic abdominal pain

history to examine

  • family Hx GI
  • family Hx anxiety
  • diet - too much of one, not enough of another
  • lifestyle - sleep, meals, school, stressors

13

chronic abdominal pain

PE key check

sick vs. not sick

(determines urgency)

14

chronic abdominal pain

labs

  • CBC
  • ESR/CRP
  • ALT/AST, GGT, bilirubin
  • amylase/lipase
  • UA
  • address psych issues

15

2 common causes of chronic abdominal pain

  • functional abdominal pain
    • daily pain not assoc. w/ meals or BMs
    • anxious/perfectionist
    • "bounce back" after few min. of rest
    • no warning signs of serious illness
  • IBS
    • alternating diarrhea and constipation

16

Tx of functional abdominal pain

  • r/o possible causes first
  • look at dietary intolerances
  • do not treat as sick - avoid meds d/t placebo effect and subsequent need for more meds

17

these signs NOT okay in neonates

vomiting and diarrhea

(rarely typical cause, 24hrs gives significant dehydration)

18

causes of vomiting in neonate

  • obstrutction - deadly
    • stomach, sm. bowel, malrotation, imperforate anus
  • metabolic disorder - deadly
  • feeding intolerance
  • ingestion of maternal blood
    • blood from mom's nipples benign
    • NOT other

19

causes of diarrhea in neonate

*newborns normally have liquid, explosive stools

  • protein allergy
    • watery stools soaking diaper
    • positive occult blood
  • overfeeding
  • malabsorption

20

causes of vomiting in infant/child

gastrointestinal virus

(accute onset, associated fever)

21

Sx of acute gastroenteritis

  • abrupt onset of severe vomiting
  • diarrhea follows quickly
  • diarrhea watery w/out blood or mucus

22

Tx of acute gastroenteritis

  • time and rehydration
    • tablespoon fluid after 1hr without vomiting
  • low sugar/artificial sweetner fluids w/ electrolytes
  • oral anti-emetics (Ondansetron) if unremitting

23

acute gastroenteritis

when observation is not enough

  • duration
    • vomiting 24+ hours
    • 10+ days diarrhea
    • fever > 48 hours
  • 5-10% weight loss or dehydration
  • significant abdominal pain
  • sick appearing
  • blood in emesis
  • blood or mucus in stool

24

"sick" AGE tests

  • abdominal xray or US
    • for obstruction, mass, intussusception, volvulus
  • UA
    • infection, glucose, electrolytes, metabolic function, WBCs (abdominal inflammation)
  • Lytes, BUN, Creatinine, CBC, blood culture
  • stool culture - rapid assay for pathogens

25

DDx for chronic vomiting

  • gastroesophageal reflux disease (90%)
  • food allergy
  • food intollerance
  • gastrointestinal obstruction
  • metabolic disease

26

when to treat gastroesophageal reflux

"spitty" babies do not require tx

  • Tx if
    • poor weight gain d/t vomiting
    • aspiration
    • severly/chronically irritable

27

Sandifer Syndrome

back arching d/t ongoing gastritis/esophagitis

28

cause of food allergy response/vomiting

IgE mediated immunity

(treatment is avoiding allergen)

29

MC food allergens in young vs. older

  • young
    • milk, egg, peanut, soy, whet

 

  • older
    • peanut, tree nut, fish, shellfish

30

how to resond to food allergy reaction

  • Epipen
  • ED follow up for delayed reaction or anaphylaxis treatment

31

GI tract infiltrated with eosinphils d/t food allergy

S/s, Tx

eosinophilic esophagitis

  • S/s
    • GERD, intermittent abdominal pain
  • Tx
    • food elimination
    • swallowed steroids

32

blood tinged stools, occasionally vomiting

anemia if blood loss persistent

first 2-4 months of life

food protein induced colitis

Tx: remove offending protein

33

food protein induced colitis

MC causes

  • milk or soy
  • rice, oats, poultry also implicated

 

eliminate from mom's diet if breast fed

34

definintion of diarrhea

3 or more watery/loose stools per day (not newborn)

(increase volume, number, or fluidity)