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Pediatrics👶🏻 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Causes of vomiting in infants and children

A
  1. Acute infections
    - CNS infections
    - Pulmonary infections
    - Gastroenteritis
    - Acute pyelonephritis
    - Sepsis
  2. Metabolic
    - Drug poisoning
    - Rye’s syndrome
    - Diabetic keto acidosis
    - Renal failure
    - Drugs: e.g. aspirin
  3. Acute intestinal obstruction
    * Functional: Paralytic ileus
    * Organic:
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2
Q

Chronic vomiting 🤮

A
  • Over feeding
  • Gastro-Esophageal reflux
  • Congenital pyloric stenosis
  • Inborn errors of metabolism/ adrenal insufficiency
  • Psychogenic
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3
Q

Acute abdominal pain

A

🌚Acute infections.

  • Strept. Pharyngitis
  • Pneumonia(lower lobe)

(mesenteric adenitis)

  • Rheumatic fever (peritonitis)
  • Acute hepatitis.
  • Acute pancreatitis
  • Acute pyelonephritis
  • Acute peritonitis
  • Acute appendicitis

😮Acute medical conditions

  • Henoch Schonlein purpura.
  • Familial mediterranean fever.
  • Diabetic keto acidosis

😓 Acute intestinal obstruction

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4
Q

Chronic (recurrent) abdominal pain

A

Functional

  • Irritable bowel syndrome

(in 90%; psychic related)

  • School phobia

Organic

  • Intestinal parasites e.g. Giardiasis
  • Chronic diarrhea (and Malabo sorption)
  • Chronic constipation
  • Inflammatory bowel disease
  • H. Pylori infection
  • Chronic hepatitis
  • Stones (urinary, biliary)
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5
Q

Causes of constipation

A
  • Anal fissure
  • Spina bifida
  • Cretinism
  • Intestinal obstruction
  • Habitual constipation
  • Medications (narcotics)
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6
Q

Acute infectious diarrhea (Gastro Enteritis)

A

Gastroenteritis is due to infection acquired through the fecal-oral route or by ingestion of contaminated food or water

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7
Q

Severity

A
  • Mild = 4-6 motions /day
  • Moderate = 6-10 motions /day
  • Severe > 10 motions /day
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8
Q

Causes of Gastroenteritis

A
  1. Viral (60%)

Examples

  • Rota virus.
  • Norwalk like viruses
  • Adenovirus
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9
Q

Viral gastroenteritis sx

A
  • Age usually less than 2 years.
  • Common in winter
  • May be associated upper respiratory tract infections
  • Pyrexia if present usually (< 38.5 rC).
  • Diarrhea is: - Mild to moderate.
  • Transient = (5-7 days)
  • Watery
  • Odorless
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10
Q

Bacterial gastro enteritis sx

A
  • Common in summer
  • With high fever (>38.5 o C)
  • Cramping abdominal pain
  • Usually severe diarrhea which may be
    Bloody or watery or watery offensive
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11
Q

Bloody with:

A
  • Salmonella
  • Shigella desentyrie type 1.
  • Entero invasive E-Coli.
  • Entero hemorrhagic (Shiga toxin producing) E-Coli
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12
Q

Watery?

A
  • Shigella (diarrheal type)
  • Entero pathogenic E-Coli
  • Entero toxigenic E-Coli
  • Vibrio cholerae O1.
  • Watery offensive for 2-4 days then turn bloody p Campylobacter jejuni.
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13
Q

protozoal

A

🌻Giardia Lambelia

  • Watery
  • Offensive
  • No fever

🌻 Entameaba histolytica

  • Bloody, may be with tenesmus
  • No fever usually
    😀 Rectal tenesmus is a feeling of incomplete defecation. It is the sensation of inability or difficulty to empty the bowel at defecation, even if the bowel contents have already been evacuated.
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14
Q

Complications of Gastroenteritis

A
  1. Dehydration
  2. Shock
  3. Acute renal failure (ARF)
  4. Metabolic Acidosis
  5. Electrolyte disturbance
  6. Convulsions
  7. Bleeding
  8. Persistant diarrhea and eventual Malnutration
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15
Q

Dehydration

A

🌻Fluid loss due to vomiting, diarrhea and anorexia (

🤦🏻‍♀️The main cause of death in gastroenteritis

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16
Q

Shock

A

🌺Types

Hypovolemic shock with severe dehydration Gram negative septic shock.

🌺Clinically

🥀Decreased peripheral perfusion
 o Skin mottling , capillary refill time >2 secondsȺ o Cold extremities
🥀 Decreased vital organs perfusion
 o Brain p lethargy o Kidney p oliguria
🥀 Hypotension and rapid thready pulse
17
Q

Acute renal failure (ARF)

A

Hypovolemia ➡️⬇️ renal blood flow (pre renal failure).

Untreated pre renal failure ➡️ tubular necrosis ➡️ intrinsic renal failure

🥸Clinically

o Oliguria or anuria o Acidotic breathing (Rapid, deep breathing).

18
Q

Metabolic Acidosis

A

😃Due to
Loss of bicarbonate in the stool
Acute renal failure
😶Clinically
o Acidotic breathing (rapid deep breathing pattern) o Disturbed consciousness.
o Arterial blood gases (qpH, qPaCO2 , qHCO3 ) -.

19
Q

Electrolyte disturbance

A

🌼Hypokalemia: (serum potassium < 3 meq /L) Clinically
- Apathy (disturbed consciousness)

  • Arrhythmias
  • Abdominal distension (paralytic ileus)
  • Atony (Hypotonia).

🌼 Hypocalcemia: p Tetany or Convulsions
🌼 Hypo or hyper natremia: p Convulsions

20
Q

Convulsions

A

y Hypoglycemia ; mainly in mal nourished.

y Hypo or Hypernatremia.

y Hypocalcemia
y CNS infections e.g. meningitis or encephalitis may due to shigella or neurotropic virus

21
Q

Workup of Gastroenteritis

A
  1. For the cause
    -  GSE: Look for mucus, blood, fecal leukocytes, or parasites.

 Stool cultures should be obtained early in the course of diseas.

It is usually indicated in the following 4 conditions: bloody diarrhea,

chronic diarrhea, immunosuppression, & outbreaks of HUS.

 Blood tests e.g. CBP, blood culture, serologic tests, & PCR are

sometimes used for specific pathogens.

  1. For the complications (more important)
    - Routine: Blood urea nitrogen, creatinine, sodium ,potassium, and calcium.
    - Blood gases p for metabolic acidosis.
    - Coagulation profile p PT, PTT, FDPs, platelets for bleeding
    - Others: According to clinical suspicion e.g. Abdominal ultrasound /X ray
22
Q

Treatment of Gastroenteritis

A

Go to hot topics

23
Q

Electrolyte disturbance

A

🌼Hypokalemia: (serum potassium < 3 meq /L) Clinically
- Apathy (disturbed consciousness)

  • Arrhythmias
  • Abdominal distension (paralytic ileus)
  • Atony (Hypotonia).

🌼 Hypocalcemia: p Tetany or Convulsions
🌼 Hypo or hyper natremia: p Convulsions

24
Q

Convulsions

A

y Hypoglycemia ; mainly in mal nourished.

y Hypo or Hypernatremia.

y Hypocalcemia
y CNS infections e.g. meningitis or encephalitis may due to shigella or neurotropic virus

25
Q

Workup of Gastroenteritis

A
  1. For the cause
    - Stool analysis for blood, fecal leucocytes , Rotazyme test,parasites
    - Stool culture
  2. For the complications (more important)
    - Routine: Blood urea nitrogen, creatinine, sodium ,potassium, and calcium.
    - Blood gases p for metabolic acidosis.
    - Coagulation profile p PT, PTT, FDPs, platelets for bleeding
    - Others: According to clinical suspicion e.g. Abdominal ultrasound /X ray
26
Q

Treatment of Gastroenteritis

A

Go to hot topics

27
Q

shigella

A

Shigella infection occurs essentially through oral contamination via direct fecal-oral transmission, the organism being poorly adapted to survive in the environment. Resistance to low-pH conditions allows shigellae to survive passage through the gastric barrier, an ability that may explain in part why a small inoculum (as few as 100 CFU) is sufficient to cause infection.

28
Q

Shigella phases

A

Shigellosis typically evolves through four phases: incubation, watery diarrhea, dysentery, and the postinfectious phase.

29
Q

Shigella sx

A

🌻Symptoms include the following:
Sudden onset of severe abdominal cramping, high-grade fever, emesis, anorexia, and large-volume watery diarrhea. Seizures may be an early manifestation.
Abdominal pain, tenesmus, urgency, fecal incontinence, and small-volume mucoid diarrhea with frank blood (fractional stools) may subsequently occur.
🌻Signs include the following:
Elevated temperatures (as high as 106 º F) are documented in approximately one third of cases, and a generally toxic appearance is noticed.
Tachycardia and tachypnea may occur secondary to fever and dehydration. Depending on the degree of dehydration, dry mucous membranes, hypotension, prolonged capillary refill time, and poor skin turgor may be present.
Abdominal tenderness is usually central and lower, although it may be generalized.

30
Q

Extra intestinal manifestations of shigel

A

Major complications are predominantly intestinal (e.g., toxic megacolon, intestinal perforations, rectal prolapse) or metabolic (e.g., hypoglycemia, hyponatremia, dehydration). Bacteremia is rare and is reported most frequently in severely malnourished and HIVinfected patients. Alterations of consciousness, including seizures, delirium, and coma, may occur, especially in children <5 years old, and are associated with a poor prognosis; fever and severe metabolic alterations are more often the major causes of altered consciousness than is meningitis or the Ekiri syndrome, HUS

31
Q

Shigella tx

A

ciprofloxacin (500 mg twice daily for 3 days) Azithromycin and ceftriaxon

Pediatrics👶🏻 (55 decks)

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