GI/nutritional Flashcards Preview

Peds EOR > GI/nutritional > Flashcards

Flashcards in GI/nutritional Deck (59):

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



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


Indirect Inguinal Hernia

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


Direct Inguinal Hernia

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


Inguinal Hernia tx

Transabdominal preperitoneal herniorrhaphy (TAPP)→ MC method of repair

Emergent repair if incarcerated

Refer to surgeon promptly if reducible


Intussusception presentation

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


Intussusception w/u

Plain film → SBO

US → pseudokidney sign or laagna sign *TOC

Barium or air enema (diagnostic and therapeutic)


Intussusception tx

Refer to emergeny reduction via enema or surgical repair


Jaundice etiology

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

Over production of bili
↓ rate of conjugation


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


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)


If bilirubin >20-25

kernicterus (brain damage)


Lactose intolerance presentation

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


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


Pyloric Stenosis epi

3-6 wk olf, usually firstborn males

Rare after 12 wks


Pyloric Stenosis presentation

Projectile nonbilious vomiting

Ravenous hunger

Palpable pyloric olive

Poor weight gain, visible peristaltic waves


Pyloric Stenosis w/u

KUB → “caterpillar sign” of distended, hypertrophic stomach

US → thickened stomach muscle *TOC


Pyloric Stenosis tx

Refer for surgical pyloromyotomy


Umbilical Hernia epi

Congenital and appears at birth


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


Umbilical Hernia presentation

May interfere w/ feeding if contains bowel

Rarely becomes incarcerated or strangulated in kids


Umbilical Hernia tx

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


Vitamin A deficiency

Night blindness, dry skin, hyperkeratosis, diarrhea


Vit A source/fn

Liver, fish oils, fortified milk, eggs

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


vit A toxicity

Toxicity → skin d/o, hair loss, teratogenicity


Vit A deficiency risk pop

Elderly, alcoholics, liver dz


Vitamin C deficiency

Scurvy (poor wound healing, petechiae, bleeding gums)


Vitamin C deficiency risk pop

Alcoholism, elderly men


vit C source/fn

Citrus fruits, strawberries, broccoli, greens

Fn: collagen synthesis, hormone fn, neurotransmitter synthesis


vit C toxicity

Toxicity → diarhea


Vit D deficiency

Rickets, osteomalacia, osteoporosis, paresthesias


vit D risk pop

Elferly, shut-ins w/ low sun exposure


vit D source/fn

Fortified milk

Fn: calcium regulation, cell differntiation


vit D toxicity

Toxicity → hypercalcemia, kidney stones, soft-tissue deposits


Niacin (Vit B3) deficiencies risk pop

Poverty, alcoholism


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


Niacin (Vit B3) deficiencies source and fn

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

Fn: energy, fat, metabolism