Gastrointestinal (Peds)

Question 1

Acute Diarrhea:

• Inflammatory: bloody + fever + abdominal pain
• Non Inflammatory: watery + vomiting + crampy pain

Answer 1

• MCC acute diarrhea in infancy: Rotavirus
• MCC bloody diarrhea:
  Campylobacter, Amoeba, Shigella, E.coli, Salmonella

Question 2

Acute diarrhea - Best initial test:

Answer 2

• Stool cultures with blood, leukocytes (H.U.S.)
• C. diff toxin if recent h/o antibiotics
• Ovum & parasites
• Enzyme immunoassays for viruses

Question 3

Acute diarrhea - Best initial therapy:

Answer 3

Tx: Hydration; fluid/electrolyte replacement

- no antidiarrheals in children; rarely antibiotics

Question 4

Tx if pt is not dehydrated and tolerating oral intake:

Answer 4

normal-age appropriate diet, limit fats, limit sugar

(makes diarrhea worse)

Question 5

Shigella:

Answer 5

TMP-SMX

Question 6

Campylobacter:

Answer 6

Self limited. Erythromycin may speed up recovery - use in severe disease or dysentery.

Question 7

Salmonella:

Answer 7

Tx if < 3 months old who are:

Toxic, have disseminated disease, or who have S. typhi

Question 8

C.difficile:

Answer 8

Metronidazole or PO vancomycin; discontinue other abx

Question 9

E. histolytica or Giardia:

Answer 9

Metronidazole

Question 10

Cryptosporidium:

Answer 10

Antiparascitics.

Question 11

Hemolytic Uremic Syndrome (HUS)

• complication of acute invasive (bloody) diarrhea
• mcc: e.coli 0157: H7

Answer 11

H/P: 5-10 days after infection

• pallor, weakness, oliguria, ARF
• mcc ARF in young children

Question 12

HUS: dx

Answer 12

microangiopathic hemolytic anemia: helmet cells, burr cells, fragmented cells; (-) coombs; low platelets; hematuria

Question 13

HUS: tx

Answer 13

supportive care, tx of hypertension,

aggressive nutrition, early dialysis

Question 14

Chronic Diarrhea:

-nonspecific; normal wt, normal ht; no fat in stool

Answer 14

• h/o excessive intake of fruit juice, carbonated fluids,
  low fat intake
• if wt loss or stool with fat - screen for malabsorption

Question 15

Fat Malabsorption:

Answer 15

Best initial: Sudan black stain
Confirmatory: 72 hour stool for fecal fat (gold standard)
To assess pancreatic function: Serum trypsinogen

Question 16

Carbohydrate Malabsorption:

Answer 16

Best initial: Clinitest (measures reducing substances)

Specific: Breath hydrogen test

Question 17

Protein Malabsorption: cannot be evaluated directly

Answer 17

Initial: spot stool alpha-1-antitrypsin level

Question 18

Vitamins/Minerals:

Answer 18

Measure Fe, folate, Ca, Zn, Mg, vits B12, D, A

Question 19

Celiac:

-chronic diarrhea, FTT, anorexia, growth retardation

Answer 19

initial: antiendomysial and antigliadin antibodies
specific: histology on biopsy

Question 20

Celiac: Tx & Risks

Answer 20

Tx: Lifelong strictly gluten-free diet
Risks: Increased risk T cell lymphoma, Osteoporosis

Question 21

GERD: nonbilous vomiting but maintains normal weight

Answer 21

1st step: Upright positioning, thicken formula with rice

2nd (if 1st fails): H2-receptor antagonist (ranitidine, cimetidine) because of its safety profile

Question 22

Pyloric Stenosis: presentation

- associated with erythromycin

Answer 22

h/p: < 6 wks; post-prandial nonbilous projectile vomiting;

child is hungry immediately after eating

Question 23

Pyloric Stenosis: dx & tx

Answer 23

initial: Abdominal U/S (thickened pyloric sphincter;
1”-mass “olive-sign”) Tx: 1) IVF, correct electrolytes;
2) NGT to decompress bowel 3) Pylorectomy

Question 24

Malrotation and Volvulus: h/p & tx

Answer 24

h/p: Bilious emesis, recurrent abdominal pain w/ vomiting

tx: surgery

Question 25

Malrotation and Volvulus: initial

Answer 25

Initial: abdominal U/S (inversion of SMA and vein and duodenal obstruction) or
barium enema (cecum not in RLQ; duodenum misplaced)

Question 26

Meckel’s (hematochezia): h/p

- only true diverticulum

Answer 26

h/p: painless rectal bleeding; iron def anemia + massive BRBPR due to gastric acid secretion by ectopic tissue
-ectopic gastric and/or pancreatic tissue

Question 27

Meckel’s: dx and tx

Answer 27

Dx: Tc-99m pertechnetate scan detects gastric mucosa
Tx: Surgical removal

Question 28

Intussusception:

• telescoping of bowel; classically occurs in < 2 yrs
• following URI; meckel’s; polyp; viral; lymphoma; stool

Answer 28

h/p: sudden paroxysms of colicky abdominal pain in lethargic child + bilious vomiting + shock + fever + palpable sausage-shaped mass + black currant jelly stool (ischemia)

Question 29

Intussusception: testing

Answer 29

best initial: plain film of abdomen to r/o obstruction
U/S: “doughnut sign,” “target sign”
-concentric alternating mucosa/submucosa

Question 30

Intussusception: diagnosis and curative

Answer 30

Air enema: diagnostic and curative
-if radiographic reduction not successful:
emergent surgical intervention to prevent necrosis