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Flashcards in GI Deck (56):
1

if patient presents with bilious vomiting and pain, think

volvulus (malrotation or twisting of bowel - surgery needed)

2

Management of gastroenteritis (3 points)

- most cases are viral and self-limiting
- probiotics
- fluids to maintain hydration

3

Apley's rule

the further the pain from the umbilicus, the greater the likelihood of organic disease

4

RLQ pain with extension of right hip is ___ sign

psoas

5

the best method to first check for signs of dehydration in a child is:
- look for production of tears
- check cap refill
- check for reduced BP
- see if lips are cracked

tears

6

are antiemetics or antidiarrheals recommended in children?

no

7

Most common cause of gastroenteritis in summer? What age group?

BACTERIAL
campylobacter
giardia (daycare)
shigella
salmonella
e coli
c diff

8

what's the treatment for hypertrophic pyloric stenosis

surgical release of the pyloric muscle after US confirmation

9

bowel clean-out protocol for children 6 months-2 years with miralax is what?

1 tsp for each 6 months, up to 3 tsp
Q12 hrs x 3 - pm/am/pm

10

RLQ pain when pressure applied to left abdomen is ___ sign

Rovsig

11

Most common cause of parasitic gastroenteritis?

girdia lamblia

12

therapeutic management for intussception

hydrostatic reduction with barium or air enema

13

if patient presented with drawing up legs in pain, vomiting, currant jelly stool, tender sausage-shaped abdominal mass in RUQ, think

intussusception

14

most cases of umbilical hernia resolve spontaneously by what age?

1 year

15

2 main components of GERD management for infants

1. small and frequent feedings of hypoallergenic/predigested formula (nutramigen or Pregestimil)
2. positioning

16

correct radiographic study for intussception (2)

abdominal flat plate xray and ultrasound

17

if infant is healthy at birth, then acholic (without color) stool, bile-stained urine, hepatomegaly and jaundice, think?

biliary atresia

18

constipation in childhood often due to ____

environmental changes or control over body functions

19

in appendicitis, does pain or vomiting start first?

PAIN first then vomiting

20

if gastroenteritis and vomiting, should you continue breastfeeding? if older child, what should you give to rehydrate?

Y cont breastfeeding

ORT for fluids

21

miralax maintenance dosage for 6 months-2 years is?

2 tsp in the pm

22

When would you order a stool study?

if stool was positive for pus, blood, mucous

23

diagnostics for biliary atresia (3 labs + 1 type of imaging)

- CB, serum bili and LFTs
- abdominal US

24

a 12 month old infant comes to urgent care, mom says he's been lethargic and there's a 2 week history of alcoholic stools. liver is palpated 3cm below the RCM and he's slightly jaundiced. accurate assessment would be:

1. normal presentation
2. suggestive of rapid hemolysis
3. infant likely has heptatits
4. infant likely has obstruction to the hepatic system and cannot excrete big into intestines

4. infant likely has obstruction to the hepatic system and cannot excrete big into intestines

25

gold standard diagnostics for wall defects (gastroschisis or oomphalocele)

rectal exam
flat plate/KUB/abdominal film

26

2 main interventions for constipation in infancy

1. juices containing sorbitol (prune, pear, apple) - 1 oz per month of age, divided BID, starting at 6-8 weeks
2. adding or increasing fiber (cereal, fruits, veg)

27

This would be what level of dehydration?
- weight loss up to 10-15%
- rapid pulse
- decreased BP
- hyper irritable or lethargic
- intense thirst
- sunken eyes and anterior fontanelle
- delayed cap refill
-absent/scant urine

severe

28

rupture of appendix is very common in what age group

under 5

29

for intussception patient, if hydrostatic reduction with barium or air enema is unsuccessful or patient is too ill, what to do?

surgical reduction

30

Cleft lip is more common in males or females? Cleft palate more common in males or females?

Cleft lip: males
Cleft palate: females

31

in infancy, constipation is often related to ___

diet

32

average age for appendicitis

10

33

miralax maintenance dosage for 2-5 yrs is?

3/4 capful BID, then down to once daily

34

prognosis for the kasai procedure (to treat biliary atresia) is best if by __ weeks of age

8

35

This would be what level of dehydration?
- weight loss 5-10%
- decreased urine output of greater than 8 hrs in infants and 12 hrs in children
- increased thirst
- dry mucous membranes
- increased pulse
- slight drop in BP
- decreased tears
- increased cap refill

moderate

36

Labs to assess hydration? (4)

BUN
specific gravity
Lytes
Serum osmo

37

4 main etiologies for appendicitis

- viral infection
- impacted fecal material
- foreign bodies
- parasites

38

if pt has not passed meconium after 36 hrs of birth and has ribbon like foul smelling stool think

hirschprung's

39

Most common cause of gastroenteritis in winter? What age group?

VIRAL
rota
6-24 months

40

Are withholding of fluids for first 24 hours after onset of V/D or BRAT diet evidence based or recommended?

NO

41

RLQ pain with internal rotation of right hip is ___ sign

Obturator

42

if an infant has projectile non bilious vomiting, olive shaped mass in RUQ, strong peristaltic waves from LUQ to RUQ, "happy hungry baby", think

hypertrophic pyloric stenosis

43

miralax maintenance dosage for 6-10 yrs is?

1 capful BID then down to once daily

44

This would be what level of dehydration?
- weight loss up to 5%
- slight decrease in urine output
- mucus membranes slightly dry
- slight thirst
- normal pulse and bp

mild

45

Most common cause of emergency surgery in children and adolescents

appendicitis

46

If child is older than 1 year, what would you recommend for constipation management (2)

- dietary changes (increase water, high fiber foods and decrease processed foods)
- stool softeners, MOM, senna syrup, Miralax, enemas

47

main components of GERD management for older children

avoid chocolate, caffeine, high fat foods, bedtime snacks, alcohol
possible meds (antacids, PPI, h2 receptor antagonists, pro kinetics)

48

What types of gastroenteritis would you give antibiotics for? (4)

salmonella
shigella
yersinia
campylobacter

49

bowel clean-out protocol for children 2 years-10 and older with miralax is what?

1 capful Q12 hrs x 3 - pm/am/pm

50

intussusception primarily occurs in what age group

under 2 years (range: 2mo-5 yrs)

51

first meconium should be passed within ___ to ___ hrs of life. if not, assess for:

24-36 hrs

hirschprung dieases
hypothyroidism
meconium plug
meconium ileum (initial manifestation of CF)

52

treatment for hirschprung's?

stat barium enema (surgery next if unsuccessful)

53

when would surgery be needed for umbilical hernia?

- if it persists beyond 5 yrs
- strangulates
- non reducible
- dramatically enlarges

54

What is the most common etiology of gastroenteritis worldwide?

rotavirus

55

cardinal symptom of appendicitis

pain begins at umbilicus and migrates to RLQ at mcburney's point

56

miralax maintenance dosage for 10 yrs and older is?

2 capful BID then down to once daily