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Flashcards in GI/nutritional Deck (59)
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1

Colic presentation

peaks at 6 wks

Wessel's rule of 3's: crying for >3 hrs per day for >3 days per week for > 3 mo

Paroxysmal, facial grimacing, drawing up of legs

2

Colic tx

Parental support and reassurance

5 S's → swaddle, shush, swing, suck, side or stomach position

Sx usually resolve by 3-6 mo of age → benign self-limiting condition

~15% of infants continue to have excessive crying after 3 mo

3

Constipation presentation

Encopresis, UTIs, chronic abdominal pain, poor appetite, lethargy, rectal skin tags

(Nrml bowl fn s 3 stool/day to 3 stool/wk)

4

Constipation rome criteria

Rome III Criteria

2 or less defications/wk, 1 episode of incontinence after acquisition of toileting skills, hx of excessive stool retention or posturing, gx of painful or hard bowel mvts, large fecal mass in rectum, large diameter stools that may obstruct toilet

Infants and toddlers → at least 2 present for at leasrt 1 mo→

Children 4-18 yo → at lesat 2 present for at least 2 mo

5

Constipation tx

↑ fiber (10-20g/day) and fluid intake and ↑ exercise

Initial disimpaction with enema or Golytely (or lactulose or sorbitol- containing juices in infants) then → maintenance w/ Miralax (if > 2 years old, but safety has also been demonstrated in infants)

Adjust maintenance therapy to goal of 1 soft stool per day

“Rescue plan” to use stimulant laxative, enema, or suppository if there are signs of constipation recurrence

Behavioral modification with toileting regimen and bowel training sit on toilet for 5-10 min after each meal, give sticker or game reward for each effort, record BMs and symptoms with log

6

Duodenal atresia presentation

Polyhydramnios→ excess amniotic fluid

Bilious vomiting as neonate

7

Duodenal atresia etiology

Duodenum fails to recanalize in utero

8

Duodenal atresia w/u

X-ray→ Double bubble sign + no distal air

9

Duodenal atresia tx

Surgery

10

Encopresis presentation

Stool withholding → accumulation of large mass of stool n rectum

Liquid stool seeps around the mass of stool (cannot be controlled)

11

Encopresis tx

Tx aimed at underlying constipation (stool softeners)

Timed sitting after meals and in afternoon in conjunction w/ oral laxative use

Parental education → child is not lazy

12

Gastroenteritis etiology

MC form of Salmonella infection

8-48 hr incubation period after igestion of contaminated food or drink

13

Gastroenteritis tx

Self limited (3-5 d)

Symptomatic tx

TMP-SMX, ampicillin, ciprofloxacin for severely ill or malnourished pts, sickle cell dz or pts who develop bacteremia

14

Gastroesophageal Reflux Disease presentation

Hera burn = MC presenting sx

Worse after meals and when lying down and often is releived with antacids

Regurgitation or dysphagia

Hoarseness, halitosis, ouh, hiccuping, sore throat, laryngitis, atypical chest pain

15

Gastroesophageal Reflux Disease tx

Lifestyle mod → smoking cessation, avoid eating at bedtime and large mewals, avoid alc and food that cause irritation and raise head of bed

Antacids or alginic may be used for mild sx

H2 blockers (cimetidine, ranitidine, famotidine, nizatidine) for sx relief

PPI is most powerful anti-GERD medication (omeprazole, rabeprazole, esomeprazole, lansoprazole, dexlansoprazole, pantoprazole)

16

Gastroesophageal Reflux Disease protective factors

Protective factors: gravity, lower esophageal spincter tone, esophagealmotility, salivary flow, gastric emptying and tissue resistance

17

Hepatitis presentation

Fatigue, malaise, anorexia, nausea, tea-colored urine, vague abd discomfort

18

Hepatitis w/u

Aminoransferase elevations

Bilirubin >3 mg/dL

IgM Ab to Hep A at 15-40 days

IgG w/ resolved HepA

HepB core → acute infection

HepB envelope → active highly contagious infection

Hep C or D Ab → active infection

19

Hepatitis tx

Supportive tx for vira hepatitis

HepA→ don’t share food, proper hand washing

Avoid alcohol

HIV + → tenofovir w/ emtricitabine or lamivudine to cover Hep B

Vaccinate against A and B

A and E are self limited and mild w/o LT sequelae

B and C can cause liver damage and req tx

D only with B (more severe)

20

Hepatitis etiology

A, E → fecal oral transmission

B, C, D →. Parenterally or mucous membrane contaact

21

Hirschsprung Disease etiology

Congenital absence of Meissner and Auerbach autonomic plexuses enervating the bowel wall

22

Hirschsprung Disease presentation

Constipation, obstipation, vomiting and FTT

Failure to pass meconium→ diagnose with contrast enema

DRE→ stool eruption

Overflow incontinence

23

Hirschsprung Disease w/u

X-ray → dilated proximal colon and nrml looking distal colon

Contrast enema → shows transition zone → bx

24

Hirschsprung Disease tx

Surgical resection of affected bowel

25

Indirect Inguinal Hernia

*MC→ passage of intetine through internal inguinal ring down inguinal canal, may pass into scrotum

26

Direct Inguinal Hernia

passage of intestine through external inguinal ring at Hesselbach traingle, rarely enters scrotum or femoral (least common)

27

Inguinal Hernia tx

Transabdominal preperitoneal herniorrhaphy (TAPP)→ MC method of repair

Emergent repair if incarcerated

Refer to surgeon promptly if reducible

28

Intussusception presentation

Periodic colicky abd pain, vomiting, bloody "vurrant jelly" stools, palpable mass or "sausage" in RUQ, lethargy

29

Intussusception w/u

Plain film → SBO

US → pseudokidney sign or laagna sign *TOC

Barium or air enema (diagnostic and therapeutic)

30

Intussusception tx

Refer to emergeny reduction via enema or surgical repair