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Flashcards in GI/nutritional Deck (59):
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

31

Jaundice etiology

Mc cause of unconjugated hyperbilirubinemia → physiologic jaundics, prematurity, breast-feeding jaundice

Over production of bili
or
↓ rate of conjugation

32

Jaundice w/u

Bilirubin >5 mg/DL in 1st wk of life

Direct and indirect bili

CBC + retic + blood smear

Conj bili > 2→ biliary obstruction/atresia, hepatitis, hypothyroid, CF, RBC abnrml

33

Jaundice tx

Must eval hyperbilirubinemia that presents in 1st 24 hr of life

If cause is ABO incompatibility → transfusion

Phototherapy (↓ risk that total bili conc will reach level at which exchange transfusion is recommended)

34

If bilirubin >20-25

kernicterus (brain damage)

35

Lactose intolerance presentation

Abdominal pain, bloating, farts, diarrhea, and possibly vomiting after ingestion of lactose

36

Lactose intolerance tx

Avoid milk and ice cream as they have the highest amount of lactose

Lactase supplementation (variable results)

Add Lactaid to milk and let sit overnight before drinking

Utilize yogurt or cheese for dietary calcium needs, or supplement

37

Pyloric Stenosis epi

3-6 wk olf, usually firstborn males

Rare after 12 wks

38

Pyloric Stenosis presentation

Projectile nonbilious vomiting

Ravenous hunger

Palpable pyloric olive

Poor weight gain, visible peristaltic waves

39

Pyloric Stenosis w/u

KUB → “caterpillar sign” of distended, hypertrophic stomach

US → thickened stomach muscle *TOC

40

Pyloric Stenosis tx

Refer for surgical pyloromyotomy

41

Umbilical Hernia epi

Congenital and appears at birth

42

Umbilical Hernia etiology

Caused by open umbilical ring, which usually closes in all kids by 5 years but may be slower to close in black children

43

Umbilical Hernia presentation

May interfere w/ feeding if contains bowel

Rarely becomes incarcerated or strangulated in kids

44

Umbilical Hernia tx

Referral for surgical repair indicated when hernia is incarcerated, extremely large, or symptomatic

45

Vitamin A deficiency

Night blindness, dry skin, hyperkeratosis, diarrhea

46

Vit A source/fn

Liver, fish oils, fortified milk, eggs

Fn: vision, epithelial cell maturity, resistance to infection, antioxidant

47

vit A toxicity

Toxicity → skin d/o, hair loss, teratogenicity

48

Vit A deficiency risk pop

Elderly, alcoholics, liver dz

49

Vitamin C deficiency

Scurvy (poor wound healing, petechiae, bleeding gums)

50

Vitamin C deficiency risk pop

Alcoholism, elderly men

51

vit C source/fn

Citrus fruits, strawberries, broccoli, greens

Fn: collagen synthesis, hormone fn, neurotransmitter synthesis

52

vit C toxicity

Toxicity → diarhea

53

Vit D deficiency

Rickets, osteomalacia, osteoporosis, paresthesias

54

vit D risk pop

Elferly, shut-ins w/ low sun exposure

55

vit D source/fn

Fortified milk

Fn: calcium regulation, cell differntiation

56

vit D toxicity

Toxicity → hypercalcemia, kidney stones, soft-tissue deposits

57

Niacin (Vit B3) deficiencies risk pop

Poverty, alcoholism

58

Niacin (Vit B3) deficiencies presentation

Flushing → sunburn-like lesion bilaterally (tender and symmetrical

Weakness, anorexia, dermatitis, disturbed mental status, nausea, abd pain, glossitis, diarrhea

Muscle weakness, gait problems

59

Niacin (Vit B3) deficiencies source and fn

Bran, tuna, salmon, chicken, beef, lifer, peanuts, grains

Fn: energy, fat, metabolism