GI Flashcards

Question

Which psychological interventions have proven to be successful in the management of pediatric IBS?

Answer 1

CBT and hypnotherapy. Yoga has shown some promise but not enough evidence is available to make it a recommendation.

Answer 2

Antispasmodics Antidepressants Abx Prokinetics Laxatives

Answer 3

False! Risk of aspiration -> lipid pneumonia.

Answer 4

-Diarrhea -Vomiting -Fever -Anorexia -Abdominal cramps -HA -Myalgias

Answer 5

Viral: Slight fever, malaise, vomiting, vague abdominal pain Bacterial: High fever, severe abdominal pain, poss bloody diarrhea

Answer 6

Glycerin suppository Lactulose PEG 3350

Answer 7

Apple/pear/prune juice (1-3 ml/kg/day) Whole grain cereal Cooked legumes Vegetables and/or fruit.

Answer 8

DEHYDRATION AND THE EXTENT OF IT

Answer 9

Typically clinically CBC, lytes, stool studies in severe cases, if IV hydration required, or if atypical presentation

Answer 10

-Prevention/ treatment of dehydration most important -Early refeeding advisable, with age appropriate diet upon completion of rehydration -Notify public health authorities if appropriate -Promote regular handwashing

Answer 11

24 hours after last diarrhea episode Encourage good handwashing

Answer 12

-Ondansetron for suspected gastroenteritis with mild to moderate dehydration or failed ORT and specific vomiting -Antibiotic or antiparasite therapy when indicated -Antidiarrhea medications not indicated -Rotavirus vaccine

Answer 13

C BASE H2O * Cap refill * BP * Anterior fontanelle * Skin turgor * Eyes (sunken) * HR * Oral mucosa * Output (urine)

Answer 14

Very false BP is a LATE sign and quite ominous Everything else will go first Earliest signs are decreased urine output, dry oral mucosa, thirst Then increased pulse, sunken fontanelles, decreased skin turgor, and increased cap refill Then weak pulses, decreased BP, anuria, prolonged CRT >3 seconds

Answer 15

Give kid a set amount of fluid/ pedialyte (usually age or weight based) every 10 min

Answer 16

1. PEG 3350 x 3 day 2. Try another osmotic (Lactulose, milk of magnesia) or add a stimulant (senna, bisocodyl) 3. Switch to enemas dosed every 2-3 days until disempaction resolves AVOID manual disempaction when possible.

Answer 17

Mild to mod dehydration

Answer 18

IV rehydration if -severe dehydration requiring close monitoring and frequent assessment of electrolytes -inability to tolerate ORT -failure of ORT to provide adequate rehydration

Answer 19

False -One of the most common parasitic infections -Occurs worldwide, all SES groups

Answer 20

Onset from birth or first few weeks of life >48 hr delay in passing meconium Undiagnosed weakness in legs Locomotor delay Abdo distension with vomiting Persistent blood in stool Ribbon stools

Answer 21

B. All toots are stinky.

Answer 22

School age kids (5-10 years) Uncommon <2 yrs

Answer 23

Closed, crowded conditions Lack of handwashing

Answer 24

Fomites Direct contact Fecal oral route

Answer 25

Human host They live in the cecum!

Answer 26

Severe nocturnal perianal itching

Answer 27

Pregnant roundworms migrate from their home in the cecum through the rectum onto the perianal skin to deposit their eggs at night! The body triggers an inflammatory reaction to the worms and eggs.

Answer 28

-Can have asymptomatic carriers -Note that secondary bacterial infection can result if the excoriation is severe -Occasional vaginitis -Can have ectopic migration to appendix or other pelvic organs -High worm burden can cause abdominal pain, nausea, vomiting

Answer 29

Yep- pin shaped, 8-13mm, may look like cotton thread- confirm by lab ID

Answer 30

Usually not- worms and eggs are not passed in the stool

Answer 31

-Visual inspection of the anal verge, undergarments -Samples collected from under the fingernails may be analyzed for pinworm eggs -Sticky tape test: eggs adhere to tape applied to perianal skin (need 5-7 tests to rule out) -Examination of perianal skin at night may reveal adult worms -Usually no eosinophilia as no tissue invasion (ie no need for labs)

Answer 32

* Infectious (abscesses, STI (condyloma, herpes, syphilis, gonorrhea), bacterial (S. aureus), scabies, candida) * Dermatologic (fissures, fistulas, SCC, psoriasis, contact dermatitis, atopic dermatitis) * Other causes (prolapse internal hemorrhoids, poor hygiene, diarrhea, dietary irritants

Answer 33

-Change underwear, bathe in morning, pajamas to bed, wash hands, trim fingernails -Wash bedding and clothes -Treat all family members simultaneously -Re-infection common

Answer 34

Anti-helminthic: Mebendazole 100mg orally once, repeat in 2 weeks; Abendazole 400mg orally once on empty stomach, repeat in 2 weeks (inhibits microtubule formation and glucose uptake; nonspecific GI AE. CI in pregnancy and infants. -Pyrantel 11mg/ kg (max 1g) once orally; repeat in 2 weeks in pregnancy -Cure rate 90-100%

Answer 35

Child not growing and developing at an appropriate rate for their age

Answer 36

o Poverty = risk for undernutrition, inadequate access to food o Neglect, depressive episode in mother o A home with problems such as domestic violence, many children, substance use, etc

Answer 37

o Organic FTT – underlying medical problem causing FTT, ex. CF or CHD o Nonorganic FTT – inadequate growth d/t lack of nourishment and a non-nurturing home environment (also called environmental deprivation) o Can be a mix of the two – called multifactorial or mixed FTT

Answer 38

Insufficient calories to meet nutritional needs For example: o Insufficient intake of food: inadequate access to food, poverty, improper formula preparation, eating difficulties, vomiting o Increased caloric needs (chronic lung disease, congenital heart disease) o Increased loss of ingested food (diarrhea, malabsorption syndromes) o Impaired caregiver-infant relationship (especially maternal depression)

Answer 39

Low weight, weight loss, short stature, poor appetite, failure to gain weight or grow

Answer 40

Weight <5th percentile Height <5th percentile Weight for height <5th percentile Rate of growth lower than expected Deceleration of growth rate Delayed developmental milestones Disturbed interactional skills Parental concern about the child's eating

Answer 41

o Routine: Hgb, lead level (based on risk factors), urinalysis o Other as indicated: stool O&P (if diarrhea), thyroid function or GH levels if indicated by history, genetic consultation/chromosomal assessment if dysmorphic features o Consider radiography to determine bone age in short stature not related to parental heights

Answer 42

Adequate caloric intake * Base ideal caloric intake on ideal weight rather than actual weight * Review formula mixing to ensure not overly diluted. Some infants may require increased formula concentration or calorie additives * Observe breastfeeding session to assess milk supply and ability of infant to suck and swallow * Older children can be placed on supplemental feedings like boost /instant breakfast drinks prepared with whole milk. This should be in addition to a balanced diet * Many children tolerate 6 small meals a day better than 3 larger meals * If children are picky, it is better they freely consume the foods they like than nothing

Answer 43

* Can refer to parenting programs, drug treatment programs, counseling for MH conditions * Avoid conflicts about meals with children, encourage independence in toddlers around mealtime * Refer to supplementary services for food and financial resources * Home visitation can be useful

Answer 44

* Child protective services may be needed if severely malnourished, parent/guardian is unable to comply with medical recommendations or intentional neglect is occurring * Hospitalization may be needed for severe malnourishment, recurrent illness or concern for refeeding syndrome

Answer 45

A new test that replaces stool cultures and O&P, also detects C. Diff. IDP detects the most common enteric viral, bacteril and protozoal pathogens. It should be ordered if diarrhea is severe of prolonged >7 days. It should only be ordered once/episode.

Answer 46

Only if symptomatic as the test doesn't differentiate b/n infection and colonization.

Answer 47

Any time duration of: -10 or more stools /24 hrs -bloody stools -fever 38.5+ -severe pain

Answer 48

Meds Dietetic Foods Fish-Associated toxins Plant-associated toxins Allergic reactions Carbon monoxide poisoning MSG Ethanol Heavy metals Opiate withdrawals

Answer 49

Fecal calprotectin or fecal lactoferrin (Low quality of evidence) Giardia (High) If no travel, low quality evidence suggests this test not be done. Celiac disease (moderate) Bile acid diarrhea (low)

Answer 50

Fecal-oral. Ewwwww

Answer 51

-Avoid dehydration. Offer smaller amounts of fluids more often, offer breast/bottle more often. Oral rehydration solution may be recommended. Protect diaper area with zinc oxide or another barrier cream. Wash hands wash hands! Keep child home while having diarrhea.

Answer 52

No, abx diarrhea is a common S/E and often resolves within 1-2 after finishing the course. Counsel about hydration, red flags and when to reach out to HCP again.

Answer 53

500 mls per 10 kg of body weight over 4 hours.

Answer 54

No. Benefits do not outweigh risks.

Answer 55

Viral infection.

Answer 56

if pain precedes vomiting, it is likely a surgical cause; however, if the pain follows vomiting, it is more likely to be a medical cause

GI Flashcards

(84 cards)