GI part 2

Question 1

Sx of GI foreign body

Answer 1

Choking
Gagging
Drooling
Coughing
Wheezing
Dysphagia
Dyspnea
Dysphonia
Fever
Hematochezia
Neck, chest or abdominal pain

Question 2

Sx of button battery ingestion

Answer 2

Refusal to take fluids
Drooling with black flecks in the saliva
Dysphagia
Vomiting
Hematemesis

Question 3

Indications for endoscopic or surgical exploration and removal of ingested foreign bodies

Answer 3

Retention in the same location of esophagus for more than 12 hrs
Signs of airway compromise
Complete esophageal obstruction
A diseased esophagus obstructed by food boluses
Sharp or pointed objects >4 cm in length, 2 cm in diameter, or with no movement at 3 days after ingestion
Button batteries
Symptomatic pt at any time
Objects causing acute abdominal findings

Question 4

The majority of foreign bodies that pass the level of ________ proceed through the remainder of the gut without complication

Answer 4

Lower esophageal sphincter

Question 5

Imaging studies for GI foreign body

Answer 5

Plain radiography
Flat plate radiography of the abdomen/pelvis in older child or teenager
Barium swallow or upper GI contrast study if FB is radiolucent

Question 6

What foreign bodies should be able to be passed through without incident?

Answer 6

Coins
Small toys
Buttons
Marbles

Question 7

Tx of GI foreign body

Answer 7

Flexible endoscopy
Rigid endoscopy
Foley catheter removal
Surgery

Question 8

S/sx of encopresis

Answer 8

Hx of constipation (sometimes very remote) or painful defecation
Inability to differentiate passing gas and passing feces
Soiling episodes usually occurring during the daytime
With retentive encopresis, intermittent passage of extremely large bowel movements

Question 9

PE of encopresis

Answer 9

Palpable stool throughout the distribution of the colon, esp in the LLQ
Stool smeared around the anus
Lax and patulous anal sphincter
Rectum enlarged and filled with soft stool that yields negative results on fecal occult blood testing

Question 10

Workup for encopresis

Answer 10

Plain abdominal radiography
Anorectal manometry
Biopsy

Question 11

Tx of encopresis

Answer 11

Demystification and education
Colonic disimpaction followed by routine laxative therapy
Toilet training
Meds:
Polyethylene glycol
Sodium phosphate
Magnesium citrate
Enemas

Question 12

What is the most common hepatitis in children?

Answer 12

A

Question 13

Major risk factors for hep B and C

Answer 13

Injectable drug use
Frequent exposure to blood products
Prenatal transmission from maternal infection

Question 14

Preicteric phase of hepatitis

Answer 14

Lasts approximately 1 wk
HA
Anorexia
Malaise
Abdominal discomfort
N/V

Question 15

Extra presentation of preicteric phase in infants of hepatitis B

Answer 15

Immune complexes accompanied by urticaria nd arthritis

Question 16

Icteric phase of hepatitis

Answer 16

Jaundice

Tender hepatomegaly

Question 17

What can be common be common with hep A, B, and C, esp in young children?

Answer 17

Asymptomatic or mild, nonspecific illness without icterus

Question 18

Labs of hepatitis

Answer 18

Elevated alanine aminotransferase and aspartate aminotransferase
PT
Serologic testing
Maternal HBsAg status in children <1 yo

Question 19

Tx of hepatitis

Answer 19

Largely supportive:
-Rest
-Hydration
-Adequate nutrition
Hospitalization
Chronic HBV: interferon alfa-2b or lmivudine
HCV: interferon alpha alone or in combination with ribavirin

Question 20

When should hospitalization occur for hepatitis?

Answer 20

Severe vomiting and dehydration
Prolonged PT
Signs of hepatic encephalopathy

Question 21

Presenting s/sx of duodenal atresia

Answer 21

Onset of vomiting within hrs of birth
Most often bilious, but may be nonbilious
Dehydration
Weight loss
Electrolyte imbalance
Hypochloremic/hypokalemic metabolic alkalosis

Question 22

Labs for duodenal atresia

Answer 22

Serum electrolytes
UA
Chromosome analysis

Question 23

Imaging for duodenal atresia

Answer 23

Prenatal u/s in polyhydramnios
Erect and recumbent plain radiography of the abdomen
Cardiac and/or renal u/s

Question 24

Tx of duodenal atresia

Answer 24

Pre-surgical
-IV hydration
-TPN
-Gastric decompression
Surgery

Question 25

Hx of niacin deficiency

Answer 25

``` Tends to be seasonal and occurs during spring and early summer Poor appetite Nausea Epigastric discomfort Increased salivation Gastritis Glossitis Diarrhea Dermatitis Lethargy Apathy Depression Anxiety Irritability Poor concentration Delirium ```

Question 26

Tx of niacin deficiency

Answer 26

Nicotinamide or PO niacin Diet high in protein and adequate in calories -Addition of meats, milk, peanuts, leafy green vegetables, whole or enriched grains, and brewers' dry yeast

Question 27

PE of vitamin A deficiency

Answer 27

``` Bitot spots- areas of abnormal squamous cell proliferation and keratinization Blindness Poor adaptation to darkness Dry skin and hair Pruritis Broken fingernails Keratomalacia Xerophthalmia Corneal perforation Follicular hyperkeratosis ```

Question 28

Labs for vitamin A deficiency

Answer 28

``` Serum retinol study Serum RBP study Iron panel Albumin levels CBC with diff if anemia, infection or sepsis is a possibility Electrolytes Liver function studies ```

Question 29

Imaging for vitamin A deficiency

Answer 29

Radiographic films of long bones

Question 30

Tx of vitamin A deficiency

Answer 30

``` Consume more: -Liver -Beef -Chicken -Eggs -Fortified milk -Carrots -Mangoes -Sweet potatoes -Leafy green vegetables Daily oral supplements ```

Question 31

What are the 4 Hs of vitamin C deficiency?

Answer 31

Hemorrhage Hyperkeratosis Hypochondriasis Hematologic abnormalities

Question 32

Sx of vitamin C deficiency

Answer 32

``` Initial: Malaise Lethargy Loss of appetite Ill-tempered Poor wt gain Diarrhea Tachypnea Fever Later: Irritability Pain and tenderness of the legs Pseudoparalysis Swelling over the long bones Hemorrhage ```

Question 33

Early clinical manifestations of infantile vitamin C deficiency

Answer 33

Pallor Irritability Poor wt gain

Question 34

Advanced infantile vitamin C deficiency

Answer 34

Major manifestation is extreme pain and tenderness of the arms and legs Frog leg posture Wasted and edematous body Petechiae and ecchymoses

Question 35

What circulatory features are observed late in vitamin C deficiency?

Answer 35

Hypotension Cardiac enlargement EKG changes Anemia