Gastrointestinal/Nutrition (Alice) (10%) Flashcards
(195 cards)
1
Q
3 sx of appendicitis
A
crampy/colicky periumbilical pain - first sx
anorexia
nausea
2
Q
describe pain progression w. appendicitis
A
periumbilical -> RLQ
3
Q
what is mcburney’s point
A
2/3 the distnce from the navel to the right ASIS
4
Q
rebound tenderness at mcburney’s point suggests
A
appendicitis inflammation has spread to the peritoneum
5
Q
4 PE signs associated w. appendicitis
A
mcburney’s point tenderness
rovsing
obturator
psoas
6
Q
RLQ pain w. palpation of LLQ
A
rovsing sign
7
Q
RLQ pain w. internal rotation of the hip
A
obturator sign
8
Q
RLQ pain w. hip extension
A
psoas sign
9
Q
what on a CBC suggests appendicitis
A
neutrophilia
10
Q
extremely fussy infant that pulls his legs up as if he is trying to stool - intractable crying x 4 hours for 4 days in a row
A
colic
11
Q
2 hallmark signs of colic
A
-severe, paroxysmal crying in the late afternoon to evening
-drawing up of knees against the abdomen
12
Q
colic peaks at _ and ends around _
A
peaks: 2-3 mo
ends: 4 mo
13
Q
rule of 3’s for colic
A
cry > 3 hr/day
3 days/week
x 3 weeks
14
Q
besides reassurance, 2 things to consider in a colicky baby
A
formula switch
GERD tx
15
Q
childhood constipation is almost always
A
functional
16
Q
diagnostic parameters for constipation
A
< 2 BM’s/week
> 1 episode of encopresis/week
17
Q
what is encopresis
A
-fecal incontinence/soiling
-repeated passage of stool into clothing
18
Q
3 mc triggers of constipation
A
transitioning to solids
potty training
starting school
19
Q
5 red flags w. constipation
A
onset prior to one mo old
delayed passage of meconium after birth
ftt
explosive stools
severe abd distension
20
Q
constipation red flags make you concerned for what d.o (2)
A
hirschprung dz
metabolic abnormality
21
Q
supportive care for constipation (5)
A
increase fiber
decrease cow’s milk
mineral oil
miralax
lactulose
22
Q
3 most accurate signs of dehydration in peds
A
prolonged cap refill
poor skin turgor
abnl breathing
others: sunken eyes, lethargy, lack of tears, dry mm
23
Q
3 tools used for assessment of pediatric dehydration
A
WHO
gorelick
clinical dehydration scale
24
Q
2 day old pretern w. abd fullness, bilious aspirate, and absence of distal bowel gas
A
duodenal atresia
25
what is duodenal atresia
congenital absence or complete closure of a portion of the lumen of the duodenum
26
2 complications of duodenal atresia
polyhydraminos
intestinal obstruction
27
hallmark sign of duodenal atresia
early biliary vomiting in newborn
28
increased assocaition of duodenal atresia occurs with
down syndrome
29
what is this showing
double bubble -> **duodenal atresia**
30
management of duodenal atresia (6)
suction/drain respiratory secretions
elevate head
IV glucose
IVF
abx
**surgery**
31
for dx of encopresis, child must be >/= _ yo
4
32
encopresis is almost always associated w.
severe constipation
33
is encopresis mc among males or females
males
34
encopresis is almost always functional, but you should also consider _ causes
emotional - ex school/divorce
35
3 associated sx of encopresis
abd pain/fecal mass
dilated rectum packed w. stool
urinary frequency
36
acute vs chronic tx of encopresis
acute: Peg/Miralax, glycerin suppository
chronic: elliminate cow's milk, maintenance laxatives, increased fiber/fluids, timed toileting
37
foreign body aspiration is mc in what age group
6 mo - 3 yo
38
4 complications of foreign body aspiration
bowel perforation
bowel obstruction
asphyxia
PNA
39
sx of esophageal foreign body (although often asymptomatic)
bloody saliva
couging
drooling
dysphagia
ftt
anorexia
irritability
stridor
tachypnea
vomiting
wheezing
40
t/f: foreign objects beyond the esophagus have an increased risk of complications
t!
41
5 sx of foreign body obstructions beyond the esophagus
abd pain
n/v
fever
hematochezia
melena
42
5 common foreign body obstruction locations
cricopharyngeal
middle 1/3 of esophagus
lower esophageal sphincter
pylorus
ileocecal valve
43
3 CXR findings of foreign body aspiration
regional/asymmetric hyperinflation
collapse/atelectasis
normal
44
_ is indicated for ALL suspected inhaled foreign bodies regardless of CXR results, unless pt is completely asymptomatic w. normal PE AND CXR
bronchoscopy
45
indication for cultures w. foreign body aspiration
post-obstructive PNA
46
management of foreign body thought to be in the esophagus (3)
observe x 24 hr
serial CXR
endoscopic removal after 24 hr
47
management of foreign body aspiration if timeframe is unknown or if symptomatic
bronchoscopy
48
3 indications for immediate bronchoscopy w. foreign body aspiration
sharp object
batteries
symptomatic
49
management of foreign body aspiration distal to the esophagus
small blunt object: obs w. serial CXR; remove if not past pylorus in 3-4 weeks
large object > 3 cm or sharp object: bronchoscopy removal if in the pylorus; serial imaging if beyond pylorus
50
management of acid/alkali ingestion (3)
do NOT induce emesis
monitor ABCs
endoscopy in 2-3 weeks
51
gastroenteritis/infectious diarrhea usually lasts < _
2 weeks
52
4 HPI clues for gastroenteritis
foreign travel
playing in creek
daycare
poultry
53
gastroenteritis mc has _ etiology
viral
54
mcc of severe gastroenteritis in kids vs adults
kids: rotavirus
adults: norovirus
55
2 parasitic causes of gastroenteritis
giardia
cryptosporidium
56
4 bacterial causes of gastroenteritis
campylobacter
e.coli
clostridium
salmonella
57
reptiles make you think of what cause of gastroenteritis
salmonella
58
7 common food sources of gastroenteritis
raw/undercooked meat
seafood
eggs
raw sprouts
unpasteurized milk
soft cheese
f/v juices
59
3 indications for stool cultures w. gastroenteritis
bloody stools
suspect food poisoning
recent travel
+/- : children < 5 yo, elderly, immunocompromised
60
7 red flags w. gastroenteritis
bloody/mucous stools
wt loss
hypotn
sunken fontanelle
dry mm
no crying
decreased urine output
61
rare complication of campylobacter gastroenteritis
reactive arthritis
62
travelers diarrhea pathogen
enterotoxigenic e. coli (ETEC)
63
diarrhea after a picnic w. egg salad
s. aureus
64
diarrhea from shellfish
vibrio cholerae
65
diarrhea from poultry/pork
salmonella
66
diarrhea w. poorly canned foods
c perfingens
67
diarrhea breakout in daycare
rotavirus
68
diarrhea and horrible muscle cramps after a cruise
norovirus
69
diarrhea 1-3 weeks after camping
waxing/waning foul-smelling bulky stool
giardia
70
3 indications for abx w. gastroenteritis
abx
fever
bloody diarrhea
71
abx used for pediatric gastroenteritis (4)
cipro
doxy (?)
azithromycin
bactrim
72
t/f: mild reflux is common in all infants
t!
73
7 complications of pediatric GERD
ftt
aspiration pna
esophagitis
choking
apnea
hematemesis
anemia
74
mcc cause of pediatric GERD
overfeeding
75
indication that pediatric reflux is NOT GERD
emesis independent of meals
76
work up for mild pediatric reflux
pH probe
77
work up for severe pediatric reflux or projectile emesis (2)
**abd US**
**barium swallow**
CXR
78
lab finding associated w. severe pediatric reflux
hypochloremic, hypokalemic metabolic alkalosis
79
supportive management of mild pediatric GERD (3)
-small, frequent feedings w. head in upright position x 20 mins after feeding
-thickened feeds
-elliminate cow's milk
80
indications for PPI/H2 blocker w. pediatric GERD
suspect esophagitis
81
surgery for pediatric GERD
nissen fundoplication
82
t/f: ppi's are preferred over H2 blockers for pediatric GERD
t!
83
jaundice, clay colored stool, icterus, hepatosplenomegaly
neonatal hepatitis
84
mcc of cholestasis in the newborn
neonatal hepatits
85
t/f: neonatal hepatitis has a male predispsotion
t!
86
50% of neonatal hepatitis present w. what 2 sx
jaundice
hepatomegaly
87
t/f: neonatal hepatitis is usually self limited
t!
88
supportive tx for neonatal hepatitis (3)
MCT containing formula
fat soluble vitamins
+/- TPN
89
pharm for neonatal hepatitis
ursodeoxycholic acid (bile acid)
90
what must you do before using ursodeoxycholic acid
exclude biliary obstruction
91
2 mcc of pediatric viral hepatitis
hep A and B
92
CMP finding of hepatitis
uniformly elevated LFTs
93
lab that is pathognomonic for active hep B dz and is used in hep B vaccine eval
HBsAg (surface antigen)
94
Hep B lab value that can be positive as a result of vaccination OR natural infxn
HBsAb (surface abs)
95
Hep B lab value that results from natural infxn but NOT vaccination, and persists lifelong
HBcAb (core abs)
96
hep B lab value useful in assessing acute infxn
HBeAg (e antigen)
97
Hep B lab value useful in assessing late infxn
HBeAb (e abs)
98
hep B lab value used for both dx and assessing response to therapy
HBV polymerase chain rxn (PCR)
99
what lab value confirms hep A infxn
anti HAV IgM
100
managment of hep B in infants of infected mothers
vaccine
PLUS
HBV immunoglobulin at delivery
101
indication for referral w. pediatric hep B
chronic hep B w. persistently abnl ALT
102
2 week old w. no BM x 5 days, 5th %ile for weight, distended abdomen, absence f stool in rectal vault, dilated loops of bowel, and megacolon
hirschprung dz
103
congenital aganglionic bowel dz caued by lack of caudal migration of ganglion cells from the neural crest -> contraction of distal segment of colon -> obstruction w. proximal dilation
hirschprung dz
104
hirschprung dz is caused by absent _, which regulate bowel fxn
ganglion plexuses
105
t/f: hirschprung dz has a 5x male predominance
t!
106
t/f: at birth, hisrschprung dz is asymptomatic
t!
107
hallmark sx of hirschprung dz
inability to pass meconium 48 hr postpartum
108
work up for hirschprung (4)
rectal suction
bx
barium assisted radiography
DRE
*show absence or paucity of ganglion cells*
109
tx for hirschprung dz (2)
resection of affected segment
colostomy
110
mc type of pediatric hernia
direct: thru external/superficial inguinal ring at hesselbach triangle
111
management of indirect inguinal hernia
asymptomatic: elective repair w.in 14 days
symptomatic: emergent referral if concern for bowel incarceration
112
2 sx of bowel incarceration w. hernia
erythema of overlying skin
pain/tenderness
113
pathway of indirect inguinal hernia
deep inguinal ring -> scrotum
114
which type of hernia passes thru hesselbach's triangle
direct
115
management of direct inguinal hernia
monitor
+/- surgical repair
116
12 mo old w. recurrent belly aches x 2 weeks that culminate in sudden colicky pain q 15-20 min w. vomiting - pt presents squatting w. knees to chest
intussusception
117
2 hallmark findings of intusussception
bloody/mucus stool (currant jelly)
sausage shaped abd mass in RUQ
118
intusussception occurs when a _ portion of the intestines invaginates/telescopes into a _ portion
proximal portion invaginates/telescopes into distal portion
119
peak age incidence for intussusception
5-9 mo
120
mcc cause of neonatal bowel obstruction in infants < 2 yo
intussuception
121
PMH clue for intussuception in peds vs adults
peds: viral infxn
adults: cancer
122
management of intussusception that is diagnostic and therapeutic
barium enema
123
2 XR findings of intussuception
crescent sign
bull's eye/target/coiled spring lesion sign
124
what is this showing
crescent/meniscus sign (intussusception)
125
what is this showing
target sign -> intussusception
126
neonatal jaundice appears when bilirubin levels exceed
2 mg/dL
127
sx of physiologic jaundice (5)
-isolated unconjugated hyperbilirubinemia
-no co-existing illness
-bilirubin rises < 0.2 mg/dL/hr OR 5 mg/dL/day
-bilirubin remains < 18 mg/dL
-hyperbilirubinemia resolves w.in 1 week in fullterm OR 2 weeks in preterm
128
sx of pathologic jaundice
-unconjugated hyperbilirubinemia w.in 24 hr after birth
-serious illness
-bilirubin rises >2 mg/dL/hr OR >5 mg/dL/day
-bilirubin rises > 18 mg/dL
-hyperbilirubinemia lasts > 1 week in term OR > 2 weeks in preterm
129
pathologic jaundice is mc due to a _ cause
prehepatic
130
work up for neonatal jaundice
**coombs test:**
positive: consider Rh OR ABO incompatability
negative: check Hgb levels
131
in neonatal jaundice, if coombs is negative and Hgb levels are low, consider _
if Hgb levels are high, consider _
low Hgb: hematomas
high: diabetic mother, twin-twin or maternal fetal transfusion, delayed cord clamping
132
work up for neonatal jaundice if coombs is negative and Hgb levels are normal, consider _
hemolysis
133
lab findings of hemolysis
increased: reticulocytes, LDH
decreased: haptoglobin
134
dx for hemolysis
-smear: sphreocytosis or elliptocytosis
-presence of G6PD or pyruvate kinase deficiency
-Hgb electrophoresis for thalassemia and SSA
135
you should consider bf'ing jaundice if
normal coombs
normal Hgb
normal LDH and haptoglobin
136
2 neonatal syndromes associated w. jaundice
gilbert
crigler najjar syndromes
137
what type of hyperbilirubinemia is mc benign
unconjugated
138
3 causes of conjugated bilirubin
hepatocellular
dubin johnson
rotor syndrome
139
what should you consider if AST and ALT levels are high in setting of conjugated bilirubin (6)
hepatitis
TORCH infxns
hemochromatosis
wilson dz
alpha 1 antitrypsin deficiency
galactosemia
140
elevated conjugated bilirubin PLUS elevated ALP
post hepatic jaundice -> biliary tree obstruction
141
3 causes of neonatal biliary tree obstruction
biliary atresia
choledochal cysts
alagille syndrome
142
what is borborygmi and what does it make you think of in peds
rumbling stomach
lactose intolerance
143
sx of lactose intolerance mc occur w.in _ min of eating
30
*but may take up to 2 hr*
144
pt w. lactose intolerance may need _ supplementation
calcium
145
lactose intolerance is mc a clinical dx, but what is the definitive dx
**lactose hydrogen breath test**
*alternative: fecal pH test*
146
lactose hydrogen breath test positive findings
post lactose breath hydrogen value rises > 20 ppm over baseline
147
12 yo who easily sunburns and c/o non healing sunburns - PE shows wide stance gait w. instability, extensive erythematous scaling, and hyperkeratotic rash on face, neck, arms, and legs
niacin deficiency
148
4 d's of niacin (b3) deficiency
dermatitis - pellagra (raw skin)
diarrhea
dementia
death
149
what is this showing
pellagra dermatitis - photosensitive pigmented dermatitis
150
rf for niacin deficiency
diets low in tryptophan/niacin -> **corn staple diets**
151
6 dietary sources of niacin
yeast
meats
grains
legumes
tortillas
seeds
152
pediatric RDA for niacin
12 mg/day
153
niacin status can be assessed by measuring (2)
urinary N- methylnicotinamide
erythrocyte NAD:NADP ratio
154
6 week old w. projectile vomiting after feeding x 24 hr
pyloric stenosis
155
hallmark PE finding of pyloric stenosis
olive shaped mass in epigastric region
156
what is pyloric stenosis
congenital condition:
pyloric hyprplasia/hypertrophy -> obstruction of pyloric valve
157
lab finding of pyloric stenosis
hypochloremic, hypokalemic metabolic alkalosis
*2/2 to dehydration*
158
mc age group for pyloric stenosis
< 3 mo old
159
hallmark sx of pyloric stenosis
projectile vomiting after every feeding
160
dx for pyloric stenosis
US
161
2 US findings of pyloric stenosis
double track
string/shoulder sign
162
what is this showing
thickened, hypoechoic muscular wall and elongated pyloric canal -> double track sign -> **pyloric stenosis**
163
what is this showing
stirng sign -> pyloric stenosis
164
tx for pyloric stenosis
pyloromyotomy (ramstedt's procedure)
165
persistent opening of the umbilical ring, which spontaneously closes
umbilical hernia
166
complete closure of the umbilical ring occurs in almost all children by _ yo
5
*can take up until 11 yo*
167
umbilical hernias are mc asymptomatic, but pt's can exhibit
poor feeding
168
hernias may become symptomatic when children _
cry
*due to increased intraabdominal pressure*
169
peds should be referred for surgery if umbilical hernias persist > _ yo
2 yo
170
3 causes of vitamin a deficiency
inadequate intake
fat malabsorption
liver d.o
171
3 sx of vitamin a deficiency
rashes
dry eyes
night blindness
172
4 sources of preformed vit A (retinols)
liver
kidney
egg yolk
butter
173
3 sources of provitamin A (beta carotene)
leafy greens
sweet taters
carrots
174
dx for vitamin A deficiency
serum retinol levels < 20 mcg/dL
175
tx for vitamin A deficiency based on age
6-12 mo: 100,000 IU orally q 4-6 mo
12-59 mo: 200,000 IU q 4-6 mo
176
8 sx of vitamin C deficiency
gingival hemorrhage
bruising
petechial rash
hemarthrosis
anemia
poor wound healing
perifollicular and supperiosteal hemorrhages
corkscrew hair
177
t/f: the human body can NOT synthesize vit C
t!
178
2 rf for vit C deficiency
-food insecurity
-infants eating evaporated/boiled cow's milk
179
dx for vit C deficiency
plasma and leukocyte vit C levels
180
2 MRI findings of vit C deficiency
-sclerotic, lucent, metaphyseal bands
-soft tissue edema
181
most specific sx of vit C deficiency
**perifollicular abnl's**
follicular hyperkeratosis
perifollicular hemorrhage
petechiae
coiled hairs
182
what is this showing
perifollicular abnl's -> vit C deficiency
183
vit C repletion recs: peds vs adults
peds: 100 mg ascorbig acid tid x 1 week, then qd until resolved
adults: 300-1,000 mg qd x 1 mo
184
w. vit C deficiency, constitutional sx resolve w.in _
bruising, gingival bleeding resolve w.in _
constitutional: 24 hr
bruising/bleeding: several weeks
185
t/f: breastmilk provides adequate vit C for newborns/infants
t!
186
4 PE findings of rickets
bowed legs
fractures
costochondral thickening
dental caries
187
what is this showing
rachitic rosary - costochondral thickening -> **rickets**
188
2 rf for vitamin D deficiency
dark skin pigmentation
exclusive bf'ing beyond 3-6 mo
189
what is sufficienct sun exposure for vit D for people w. light skin
10-15 min
190
t/f: reduced vit D stores in MOC correlate w. lowr vit D levels in infant
t!
191
what pt pop makes you think about vit D deficiency (3)
dark skinned pregnant women
higher latitudes in winter mos
premature infants
192
dx for vit d deficiency
serum 250 HD levels:
sufficiency: 20-100 ng/mL
insufficiency: 12-20 ng/mL
deficiency: < 12 ng/mL
193
8 vit D rich foods
oily fish
cod liver oil
liver
egg yolk
milk
OJ
bread
cereal
194
vit D supplementation recs for breastfed infants
400 IU qd w.in a few days after birth
195
vit D supplementation recs for children 1-18 yo
600 IU qd
