GI Flashcards

Question

Intussusception

Answer 1

prolapse of one portion of intestine into th alum one adjoining part, usually ileocolic -85% idiopathic -lymphoma is primary cause in kids >6 males>female 60% before 1 yr., 80% by 2. Sx: healthy infant with sudden cycle of inconsolable crying, flexing legs, colic abdominal pain., 90% non bilious vomit, sleepy in between episodes, eventual shock, currant jelly stool within 12 hr, - sausage shaped mass RUQ or mid abdomin, distended, tenderness, bloody stool, if not reduced develops perforation/peritonitis Dx: no gas in RLQ, c/w obstruction, contact enema with air alone or barium enema- diagnostic and therapeutic- reduces 90% US- tubular mass on longitudinal image. doughnut on transverse. TX: reduction with barium or air, emergency surgery if unsuccessful, can reoccur in 24hr, observe for 24-36h.

Answer 2

acute inflammation of appendix due to lumen obstruction by facliths or lymphocytic hyperplasia. - most common6-14, peak 9-11 -autumn;/spring, male>female -increaed after GI infection -most common pediatric surgery SX: abdominal pain- vague, midline, constant, then localized to RLQ, want at night, pain with walking, vomiting, diarrhea or constipation, afebrile to very low grade in beginning **Rovsing's sign: pain RLQ with left side pressure -rotation thigh may produce pain, rebound tenderness, McBurney's point- halfway between umbilical and anterior superior ileac crest. DX: CT most sensitive, US because quicker, UA to r/o UTI, CBC-may have left shift/leukocytosis -look at throat, chest, testicles to rule out other cuases -perforation/peritonitis in 24-48h (40% incidence in young chidren)

Answer 3

episodic or continuous pain occurs at least weekly for at least 2 mos. No evidence of an inflammatory, anatomic, metabolic or oncological process. -Causes: unclear, multi-faceted (predisposition aggravated by early life events or personality), most common cause of chronic pain in school age and young adolescent, 8-15 years most common, girls>boys, family history of GI complaints SX: Crampy or dull ache, no radiation, periumbilical, nothing relieves, interferes with activities, NO NIGHT WAKING, unrelated to meals, normal wt. afebrile, no guarding, healthy child -anxiety, protective parents, internalization of feelings, adverse school performance (increased absence is red flag) DX: by exclusion, Pay attention to growth, exacerbating factors, family hx, guiac stool, CBC, ESR, CRP, UA, Giardia, rule our H. Pylori, amylase/lipased (increased with pancreatitis) TX: emphasize pain in real, even though no organic cause. reinforce normal behavior- go to school, decrease hurried meals/hectic lifestyle, identify stress/biofeedback, relaxation, pain diary

Answer 4

recurrent pain in Upper abd. -no evidence pain is relieved with defecation, acid suppression can help

Answer 5

three or more paroxysmal episodes of acute, midline and pain eating 2 + hrs to days with intervening symptom free. -anorexa, N/V/pallor, headache. family history +. TX: serotonergic agent (pizotifen) and antihistamine (cyproheptadine)

Answer 6

chronic disorders sx: pain, altered bowel habits, bloating, fecal urgency, incomplete evacuation TX: diarrhea- consider fructose and lactose slim for 2-3 weeks, antidiarrheal and antispasmodic constimationg- increase fiber, stool softener

Answer 7

Cause: a. functional- voluntary withholding after painful passage, toilet training, delated defecation due to playing or lack of toilet, holding results in reabsorption of fluid in colon= hard stool, infancy with changing formula, 1-3 years after life change, dancing around, straining, blood streak d/t fissure, normal growth and develop b. encopresis (involuntary fecal soiling)- chronic withholding leads to impaction and soiling, result in megacolon. 4-7 years, male>female, impacted stool, dilated rectal vault, sausage mass in left pelvis c. anatomic/rectal abnorm- Hirschsprungs (delayed passage of meconium >24h, small ribbon like stool, tight, empty rectum, FTT), family history, downs ( intrinsic motor disorder) d. metabolic- hypothyroid e. neurologic- spingal cord, tumors, myelomenin. -anal. wink should be normal, evaluate for sacral dimple DX: XR to look for stool, unprepared barium enema to r/o Hirsch. TX: straining with soft stool in infancy in NORMAL, ensure proper prep of formula, >6 mos: prune juice, -disempaction: Polyethylene glucol 3350 with laxative(Senna or bisacodyl), glycerin suppository in infant. -sit on toilet for 1 minute per year, twice per day, reward system

Answer 8

chronic hepatic steatosis not related to metabolic do, infection, drugs, alcohol. -liver inflammation, fibrosis, cirrhosis and failure -assoc with metabolic syndrome -insuline resistance and fat deposition- most common liver disease in children HISPANIC -obese children should screen ALT between 9-11 yrs or earlier with increased risk such as +family history DX: Increased ALT greater than 2x upper limit x3 mos should be referred for further eval (imaging not recommended)

Answer 9

-umbilical hernia- common, 60% African American. many resolve by 2. as late as 11 in AA. If not closed by 4-5 years refer to surgeon. -inguinal- failure to close processus vaginalis. congenital defect, 9x more in males, greater with preterm, hydrocele assoc with increased risk. DX: ultrasound if unclear RX: refer inguinal hernia for surgical correction, emergency referral if incarcerated/stranguated

Answer 10

Inflammation of the liver Causes: fecal/oral contaminated food and water, infected person, international adoptee HIGH RISK: Native Americans, alaskan natives, homosexuals, IV drug, hispanic, SX: asymptomatic or non-specific (N.V.D, no jaundice, fever, abdominal. pain, later pruritis -self limiting disease- weeks to months, NO CHRONIC CARRIER STATE DX: Anti-HAV immunoglobulin- current or recent infection (IgM), disappears in 4 mos. Anti-HAV IgG- resolved infection with immune status TX:L. IG available to decrease course, DEFER MEASLES OR MMR immunization for 3 mos after IGG RX: HAV inactive vaccines >12mos, prior to travel, post-exposure prophylaxis, <12 mos immunocompromised, chronic liver dx, 0r allergic to vaccine

Answer 11

MOST COMMON HEP in world. Transmitted through blood and body fluid., can be chronic carrier, high risk- sexually active, clotting disorders, household contacts, hemodialysis, travelers to china, SE asia. SX: asymptomatic,, macular rash and arthritis (early sign) anorexia, nausea, malaise, arthralgia, 90% perinatally infected develop carrier state. -Chronic carrier can lead to chronic liver dx DX: HBsAg (surface antigen)- high in acute and chronic, earliest marker of acute infection, after 6 mos= carrier, + means INFECTIOUS. Anti-HBc (core antibody)- appears at onset of symptoms in acute hep B, persists through life, IgM anti-HBc- recent infection <6mos Anti-HBs- immune status- vaccine or resolve illness TX: Interferon a-2B tx for chronic HBV- limited improvement Lamivudine if interferon fails, Entecavir for >2 years old, daily use, Tenofovir and Adefovir >12yrs RX: Hep B vaccine at birth and beyond HEPATITIS D ONLY IN PEOPLE IWTH HEP B, causes increased severity of Hep B

Answer 12

- very low rates in children <12 -transmitted through blood/blood products, maternal-fetal (dont test for anti-HCV until after 18 mos due to passive maternal antibody) SX: asymptomatic, mild disease, icteric, headache, fever, fatigue, anorexia, 50-85% become chronic carriers can can lead to chronic disease DX: Oraquick HCV rapid antibody test or HCV antibody. IF positive HCV antibody- get HCV RNA to confirm current infection. TX: Interferon a-2B 3x per week, oral fibavirin,

Answer 13

SX: hepatosplenomegaly, RUQ tenderness, jaundice DX: elevated liver enzymes, serum bili, ESR, serologic antigen/antibodies TX: supportive, good nutrition, decreased activity, monitor hydration, and chronic state Report to state health department

GI Flashcards

(38 cards)