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Gastroenterology Flashcards

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1
Q

What might you think about bloody vomit?

A

Maternal ingestion, esophageal varices or foreign body

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2
Q

What might you think about bilious vomit?

A

Obstruction-urgent!!

malrotation with/without volvulus or congenital intestinal atresia

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3
Q

How do you differentiate between GER and GERD?

A

GER is a happy spitter while GERD is an unhappy spitter
GER: no complications/consequences, normal physiologic process, declines with age (reflux common <6 mos)– no tx
GERD: complications arise, fussy or irritable/feeding refusal, occult blood in stool

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4
Q

Why do sxs of GERD resolve by 9-12 mos?

A

That is when babies are fed more upright

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5
Q

How diagnosis GERD?

A

Usually made clinically
Use hemoccult to look for hidden blood in stool
Endoscopy, upper GI, with severe sxs

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6
Q

1st line tx for GERD

A

Lifestyle modification (upright positioning 30 min after feeding, hypoallergenic diet, not overfeeding, avoid tobacco smoke exposure, thickened feeds)

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7
Q

Roles of meds in GERD

A

Limited role
Consider in pt with refractory sxs or complicated disease
Use short term PPI (omeprazole) vs H2 blocker (ranitidine)

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8
Q

What might cause infantile hypertrophic pyloric stenosis?

A

Genetic predisposition and environmental factors
Associated with macrolide abx during first wks of life
M>F

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9
Q

Classic presentation of pyloric stenosis

A

3-6 wk old infant with forceful vomiting
Nonbilious, “projectile” emesis (immediately after feeding-postprandial)
“Hungry vomiter”
FTT may be later

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10
Q

What might be seen on a physical exam in pyloric stenosis?

A

Olive-like mass in RUQ (indicating hypertrophy)

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11
Q

Diagnosis of pyloric stenosis

A

U/s is test of choice (thickening of pylorus)

Upper GI barium contrast study (string sign showing narrowed lumen)-when u/s is non-diagnostic

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12
Q

Tx of pyloric stenosis

A

Definitive is surgery (pyloromyotomy, IV fluid and electrolyte resuscitation)
Excellent prognosis

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13
Q

Most commonly affected site of congenital intestinal atresia

A

Duodenum

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14
Q

When is intestinal atresia more common?

A

In pts with cystic fibrosis and down syndrome

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15
Q

What is congenital intestinal atresia?

A

One or more segments of bowel may be absent and/or obstructed at birth

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16
Q

When is congenital atresia usually diagnosed?

A

After birth at sx onset (prenatal u/s may provide)

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17
Q

Presentation of congenital atresia

A

Vomiting (may be bile stained-within 48 hrs)
Abdominal distention
Failure to pass meconium (always think bowel obstruction if this happens)

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18
Q

What might be seen on an Xray in congenital atresia?

A

Duodenal atresia: double bubble sign due to gas and dilation in both stomach and duodenum
Jejunoileal/colonic atresia: dilated loops of bowel with air fluid levels (air on top and everything settle to bottom)

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19
Q

Management of congenital atresia

A

Feedings withheld (IV fluids)
Broad spectrum abx to prevent post op infection
Surgical intervention
Good prognosis

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20
Q

What is midgut malrotation?

A

Abnormal positioning of the intestines (increases risk of volvulus)

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21
Q

What is volvulus?

A

Small bowel twists around superior mesenteric artery (risk of small bowel ischemia)

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22
Q

Classic clinical presentation of midgut malrotation and volvulus

A

Vomiting (typically bilious-green or fluorescent yellow)
Abdominal pain
Hemodynamic instability
+/- hematochezia (sign of bowel ischemia)

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23
Q

What is the gold standard test to detect malrotation +/- volvulus?

A

Upper GI fluoroscopic real time x-ray with contrast

Will see displacement of duodenum, obstruction and “corkscrew appearance” or duodenum

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24
Q

Tx of midgut malrotation +/- volvulus

A

Ladd procedure: bowel is untwisted and repositioned in abdomen which creates adhesions to hold bowel in place (prevent ischemia and recurrent sxs)
Resolution of sxs in 90%

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25
What is intussusception?
Telescoping of intestine (from rotavirus vaccine)
26
What is the most common cause of abdominal emergency in kids < 2?
Intussusception
27
Presentation of intussusception
``` Sudden, intermittent, severe abdominal pain Abdominal mass (sausage shaped)` Currant jelly stools ```
28
Etiology of intussusception
Most idiopathic Others may be lead point (lesion/variation in intestine, dragged by peristalsis into distal segment)- Meckel's diverticulum and others
29
Diagnostic studies for intussusception
Initial test of choice: abdominal u/s | Hydrostatic/pneumatic enema is diagnostic and therapeutic (choice if no perforation!)- opens up the telescope
30
What is the most common pediatric surgical emergency?
Appendicitis
31
Etiology of appendicitis
Obstruction of appendiceal lumen leading to inflammation (rare before 5)
32
Clinical presentation of appendicitis
Anorexia Migrating abdominal pain (periumbilical to RLQ) Vomiting (after onset of pain) Fever Signs of peritoneal irritation (guarding, rebound tenderness, rovsing, obturator, iliopsoas)
33
Treatment of choice for appendicitis
Appendectomy
34
Definition of diarrhea
>3 looser water stools/day usually for at least 5 days
35
Etiology of most causes of diarrhea
Viral (rotavirus, adenovirus, calicivirus, norovirus) | Supportive care
36
Most common cause of gastroenteritis
Viral
37
Clinical manifestations of gastroenteritis
Diarrhea, vomiting, fever, anorexia, headache, abdominal cramps
38
Red flags with presentation of diarrhea
Fever, severe abdominal pain, blood in stool, recent abx, persistent sxs, dehydration, leukocytosis, FTT
39
Reasons for chronic diarrhea (>1 mo)
Celiac disease Allergic Malabsorption (cystic fibrosis) Toddler's diarrhea (6 mos-5 yrs, limit juice intake)
40
How do you diagnose celiac disease?
Inflammatory disease of small intestine caused by gluten sensitivity Diagnose with IgA antibodies to tissue transglutaminase and small bowel bx
41
Are routine stool cultures recommended for diarrhea?
Not in most cases (because viral)
42
Tx for acute diarrhea
Hydration (oral rehydration solution-pedialyte) Sometimes abx Rarely anti-motility agents
43
Why are abx not routinely used in cases of acute diarrhea?
Don't use for well-appearing kids with acute bloody diarrhea unless specific pathogen isolated for risk of HUS
44
2 subtypes of inflammatory bowel disease
Crohns and ulcerative colitis
45
Epidimiology of inflammatory bowel disease
Peak incidence 15-30 | Genetic, environmental and immune factors
46
Presentation of inflammatory bowel disease
Diarrhea, abdominal pain, hematochezia (maybe) Growth failure, delayed puberty Can have extraintestinal manifestations
47
Presentation of Crohns disease
Transmural inflammation (from mouth to anus) Skip lesions (some normal areas) Cobblestone appearance Perianal fissures, fistulas
48
How do you diagnose Crohns disease?
Colonoscopy
49
What is ulcerative colitis?
Rectum and large colon (mucosal layer only) Inflammation starts at rectum and extends proximally into colon Bloody diarrhea is common Diffuse/continuous edema, erythema, friability, ulceration of colon *increased risk of colon cancer
50
How to treat inflammatory bowel disease
Accelerated step up therapy for most and top down therapy for high risk pts
51
5 components of treatment for inflammatory bowel disease
Meds, surgery, nutritional rehab, behavioral health support, colorectal cancer screening for older pts
52
What is the goal of tx for inflammatory bowel disease?
Clinical and laboratory remission with mucosal healing, not just symptomatic improvement
53
Kinds of meds to treat inflammatory bowel disease
Aminosalicylates (decrease inflammation first line)- sulfasalazine Immunomodulating agents or biologics Steroids (primary therapy for acute flare) Maybe abx
54
Etiology of Meckel's diverticulum
Vitelline duct (embryonic remnant) leads to formation of diverticulum (congenital outpouching of small intestine)
55
When does bleeding occur in Meckel's diverticulum?
From mucosal ulceration
56
Rule of 2s in Meckel's diverticulum
2% of population 2:1 M:F ratio 2% develop complication (before age 2) 2 ft from ileocecal valve
57
Presentation of meckel's diverticulum
Painless rectal bleeding | May see obstruction sxs or diverticulitis that mimics appendicitis
58
Diagnostic studies for meckel's diverticulum
Technetium-99 scan-nuclear med identifies ectopic gastric mucosa in diverticulum (lights up when misplaced gastric tissue)
59
Treatment for meckel's diverticulum
Surgical resection (good prognosis)
60
What must you rule out in constipation?
Anatomic or biochemical cause
61
Examples of functional constipation
95% Psychological or psychosomatic Diet
62
Examples of organic constipation
Anal stenosis, hypothyroidism, celiac disease, hirschsprungs, hypercalcemia, cystic fibrosis
63
What can occur when constipation is impacted?
Encopresis (seeping stool/incontinence)
64
What is functional constipation?
Voluntary withholding of stool
65
Periods when kids are more likely to develop constipation
Intro to solid foods or cows milk Toilet training Start of school (ages 5-6)
66
Reasons for diet that lead to constipation
Lack of fiber Dairy excess Poor water intake
67
What might suggest an organic cause for constipation?
``` Failure to pass meconium FTT Abdominal distension or obstructive sxs Lumbosacral problems, neurologic abnormalities Anterior placed anus/other alterations Occult blood in stool ```
68
What kind of bowel sounds indicate impaction?
Hypoactive
69
Red flags for constipation
Wt loss, poor weight gain/growth Anorexia, fever, hematochezia, vomiting History of delayed passing of meconium (cystic fibrosis) Acute onset Failure to respond to conservative measures
70
Management of constipation
``` Fluids Gradual increase in daily fiber intake Decrease dairy intake Juice-apple, prune or pear If encopresis, relieve impaction if present (polyethylene glycol/Miralax is first line) ```
71
What is Hirschprung disease?
Congenital absence of ganglion cells in mucosal and muscular layers of colon (colon fails to relax and may lead to obstruction)
72
Classic presentation of Hirschsprung disease
Failure to pass meconium in first 48 hrs of life (also may be bilious vomiting and abdominal distention) Older kids may present with chronic constipation and FTT
73
What is seen on a rectal exam with Hirschsprung disease?
Tight anal sphincter leads to squirt sign (explosive release of gas/stool when finger removed)- relieves obstruction temporarily
74
What diagnostic studies are used in Hirschsprung disease?
``` Contrast enema (localize transition zone of narrowed aganglionic segment to dilated proximal colon) Rectal biopsy is gold standard for diagnosis (confirms absence of ganglion cells) ```
75
Management of Hirschsprung disease
Surgical resection of aganglionic segment of colon (good prognosis but may have some abnormal bowel function)

X Pediatrics 2 (10 decks)

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