GI/nutritional Flashcards
(59 cards)
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
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
Constipation presentation
Encopresis, UTIs, chronic abdominal pain, poor appetite, lethargy, rectal skin tags
(Nrml bowl fn s 3 stool/day to 3 stool/wk)
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
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
Duodenal atresia presentation
Polyhydramnios→ excess amniotic fluid
Bilious vomiting as neonate
Duodenal atresia etiology
Duodenum fails to recanalize in utero
Duodenal atresia w/u
X-ray→ Double bubble sign + no distal air
Duodenal atresia tx
Surgery
Encopresis presentation
Stool withholding → accumulation of large mass of stool n rectum
Liquid stool seeps around the mass of stool (cannot be controlled)
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
Gastroenteritis etiology
MC form of Salmonella infection
8-48 hr incubation period after igestion of contaminated food or drink
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
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
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)
Gastroesophageal Reflux Disease protective factors
Protective factors: gravity, lower esophageal spincter tone, esophagealmotility, salivary flow, gastric emptying and tissue resistance
Hepatitis presentation
Fatigue, malaise, anorexia, nausea, tea-colored urine, vague abd discomfort
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
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)
Hepatitis etiology
A, E → fecal oral transmission
B, C, D →. Parenterally or mucous membrane contaact
Hirschsprung Disease etiology
Congenital absence of Meissner and Auerbach autonomic plexuses enervating the bowel wall
Hirschsprung Disease presentation
Constipation, obstipation, vomiting and FTT
Failure to pass meconium→ diagnose with contrast enema
DRE→ stool eruption
Overflow incontinence
Hirschsprung Disease w/u
X-ray → dilated proximal colon and nrml looking distal colon
Contrast enema → shows transition zone → bx
Hirschsprung Disease tx
Surgical resection of affected bowel
