Flashcards in GI Deck (95)
What is esophageal atresia?
blind esophageal pouch w/ or w/o a fistulous connection between the proximal or distal esophagus & trachea
Clinical presentation of esophageal atresia?
Polyhydramnios (excess amniotic fluid)
only sxs within hrs of birth : infants in the 1st few hrs of life w/ copious secretions, choking, cyanosis & respiratory distress
Can esophageal FBs pass spontaneously?
What is the MC FB ingested?
management for coin ingestion?
Plain neck, chest, &/or abdominal radiographs
Esophageal coin on AP CXR
Tracheal coin - tends to be on its edge
Protect the airway
Give continuous oropharyngeal suction
Tx for coin ingestion?
Not passed into stomach
What FB ingestion is a medical emergency?
may have perforation in 2 hrs
Tx for button battery?
Requires endoscopic retrieval if lodged in the esophagus:
If in stomach, watch for 24-48 hours to see if it passes, if not, must be removed endoscopically
Gastroesophageal reflux (GER) v GERD?
GER: uncomplicated recurrent spitting & vomiting
present when reflux causes secondary sx or complications
What is GER?
Reflux of gastric contents into the esophagus
occurs during relaxation of LE sphincter
common in young infants
sxs of GER?
infants: postprandial regurgitation from effortless to forceful
Tx of GER?
expected to resolve by 12-18mo of life
When infants develop sx like FTT, food refusal, pain, GI bleeding, upper or lower airway sx, etc. GER becomes GERD
sxs of GERD?
Older children = heartburn, dysphagia
Who is at risk for GERD?
asthmatics, Cystic Fibrosis, Developmental handicaps, Hiatal hernia, repaired TE fistula
complications of GERD?
warning signs for GERD?
bile stained emesis (intestinal obstruction)
Onset of vomiting after 6mo
Failure to thrive (FTT)
diarrhea, fever, hepatosplenomegaly
abdominal tenderness or distension or neuro changes
Need further work up!
Tx for GERD?
thickened feeds with oat cereal
milk free diet for 2 wks
H2 blocker v. PPI
Surg: Nissen Fundoplication
Epidemiology of eosinophillic esophagitis? EOE
all ages, M >F
What are the 2 MC comps of EOE?
1) esophageal food impactions
2) esophageal stricture
s/s of EOE?
feeding dysfunction, vague non specific sx of GERD
long meal times (washing down food w/ liquids)
avoidance of highly textured foods
No response to medical/ surg GERD tx
FH or PMH of atopy, asthma, dysphagia or food impaction
Dx of EOE?
esophageal mucosa w/ thickening, mucosal fissures, strictures & rings
esophagus sprinkled w/ pinpoint white exudates (resembles candida)
white spots composed of eosinophils
Need to r/o other causes
Tx of EOE?
elimination of food allergens
swallowed topical steroids (MDI)
-2 puffs of Fluticasone BID
What is Pica?
Persistent eating of nonnutritive substances
ex. Animal feces, Clay, Dirt, Hairballs, Ice, Paint, Sand
At least 1 month
Inappropriate to developmental level
Pica may be assoc. with...
iron and zinc deficiency
What is rumination?
Repeated regurgitation and re-chewing of food
At least 1 mo
More common 3 to 12 months
Less common in older children
Presentation of rumination?
Failure to thrive
Presentation of malabsorption?
Diarrhea/steatorrhea (fat malabsorption)
Assessment of malabsorption?
Substance removal and challenge
Work up for celiac disease or cystic fibrosis
What is PhenylketonuriaPKU?
Most common inborn error of amino acid metabolism
Decreased activity of phenylalanine hydroxylase (enzyme that converts phenylalanine to tyrosine)