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Flashcards in GI Deck (32)
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1
Q

What is the approach you should take for abdominal pain in pediatrics?

A

Look at vital signs; FULL exam including genitalia & rectal; labs (CBC, ESR/CRP, LFT’s, H&H), plain abdominal xray; and ultrasound

2
Q

What does functional constipation lead to and what does it cause?

A

Leads to Voluntary Stool Withholding – usually occurs at the introduction of solid foods

Cause: frightening, painful/bad experience

3
Q

What would you notice on exam with constipation in a child?

A

Abdominal distention, palpable stool mass, soiled underwear, impacted stool on rectal exam

4
Q

How do you diagnose constipation in peds?

A

Abdominal x-ray

5
Q

How do you treat constipation in peds?

A

Infants = glycerin suppository; sorbitol-containing juices (apple, prune)

Children = polyethelen glycol (miralax), disimpaction, and diet change

6
Q

What is the definition of diarrhea in peds?

A

Loose or watery stools 3 or more times/day

7
Q

What do you need to look for on exam when you suspect diarrhea?

A

Eval for dehydration (urine output, HR, dry mucus membranes, delayed cap refill, and reduced skin turgor); is stool bloody; have you traveled; recent Abx

8
Q

How do you diagnose & treat diarrhea in a child?

A

Diagnose = abdominal x-ray, stool culture (for bloody), UA (to r/o UTI), or air contract enema

Treat = hydration

9
Q

What disorder is the most common congenital craniofacial anomaly that can lead to feeding difficulties and nasal regurgitation?

A

Cleft lip/palate

10
Q

If an infant has a chronic cough, wheezing, asthma, acid brash (wet burps) and vomiting shortly after feeding – what diagnosis do you think of?

A

GERD

11
Q

How do you confirm the diagnosis of GERD in peds?

A

2-4 weeks of a PPI (or just start with H2 blocker) → Barium swallow → endoscopy if sxs continue for 2 years

12
Q

How do you treat GERD in a child?

A

Lifestyle modifications, PPI’s, and H2 blockers

13
Q

What is commonly connected with GERD?

A

Asthma

14
Q

IF a brand new baby comes out and they have drooling, choking, respiratory distress, and gastric distention – what diagnosis?

A

Tracheoesophageal Fistula & Esophageal Atresia

15
Q

How would you confirm diagnosis of a tracheoesophageal fistula?

A

Inability to pass a NG tube into the stomach

16
Q

If an infant has projectile vomiting after feeding – what diagnosis? What would see on exam?

A

Pyloric stenosis & see an olive-shaped

17
Q

What is occurring in pyloric stenosis?

A

Hypertrophy of the musculature around the pyloric sphincter resulting in gastric outlet obstruction

18
Q

How would you confirm diagnosis of pyloric stenosis? How do you treat?

A

Ultrasound
Barium swallow – “string sign”
Tx = Surgery

19
Q

If an infant has sudden onset of bilious vomit (green) and is inconsolable, what diagnosis?

A

Volvulus (malrotation of the intestine – caused by lads bands)

20
Q

How do you confirm diagnosis of volvulus? How do you treat?

A

Barium study = bird-beak cut off and corkscrew of duodenum & Abdominal x-ray shows “double bubble” sign.
Treat = emergent surgery!

21
Q

What must you consider if a neonate is unable to pass Meconium within 72 hours of life?

A

Hirschsprungs disease

22
Q

What would you do on exam for Hirschsprungs disease? How would you confirm diagnosis?

A

Explosive expulsion of gas & stool after digital rectal exam (squirt sign)

Must do a rectal biopsy**

23
Q

If a child presents with painless GI bleeding and sxs similar to appendicitis (even after an appendectomy) what diagnosis do you think of? How do you confirm diagnosis?

A

Meckel’s diverticulum

Do a Meckel’s Scan! “The Rules of Twos!”

24
Q

If a child presents with sudden onset of intermittent severe abdominal pain with episodes of drawing the knees towards the chest in, what diagnosis should you have on your differential?

A

Intussusception

25
Q

What would you find on PE and how would you confirm diagnosis of intussusception?

A

PE = sausage-shaped abdominal mass on the right side of the colon & currant-jelly stools

Diagnose = Ultrasound showing “target sign” or “bulls eye”

26
Q

How do you treat intussusception?

A

Barium or Air-enema (help diagnose & treat)

27
Q

Right after a baby is born, what do you always need to check on their bum?

A

Their Anus! Making sure it’s not imperforated → if it is imperforated something else is wrong

28
Q

If you suspect appendicitis in a pediatric patient what would you do on exam and how would you confirm?

A

+McBurney’s point (peritoneal inflammation = Rovsing sign, obturator sign, psoas sign); pain with coughing or jumping; CT imaging; and if a girl has started her period be sure to R/O ectopic pregnancy!

29
Q

What are the 3 types of hernias seen in children?

A

Umbilical, diaphragmatic (diagnose with chest x-ray), and inguinal hernia

30
Q

What are the 3 ways a hernia can present?

A

Either reducible, incarcerated (cannot reduce but blood supply is not compromised) or strangulated

31
Q

What type of hernia is the worst and often seen within the first hours of life?

A

Diaphragmatic hernia allows the abdominal viscera to herniate into the chest. Do chest xray

32
Q

How do you diagnose lactose intolerance in children?

A

Lactose breath hydrogen test