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Clin med sem 2 > GI- peds > Flashcards

GI- peds Flashcards

(105 cards)

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1
Q

Physiologic Jaundice- pathophysiology

A

Yellowing of skin/sclera from deposition of bilirubin

Inability of immature liver to metabolize and excrete bilirubin

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2
Q

Physiologic Jaundice- epidemiology

A

2-3d - peak Day 4

Gone by 1-2w

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3
Q

Physiologic Jaundice- treatment

A

Reassurance

Feed and Poop - faster it will all get out

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4
Q

Physiologic Jaundice- concerns

A

Concerns:

  • Maternal -fetal blood group incompatibility - ABO, Rh, minor traints
  • Elevated direct hyperbilirubinemia - biliary atresia, gallstones, alpha 1 anti-trypsin deficiency, CF, infection
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5
Q

Breast Milk Jaundice- pathophysiology

A

Enzymatic activity causes inc absorption of bilirubin from the intestine

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6
Q

Breast Milk Jaundice- epidemiology

A

Start - End of 1w

Last - 3-10w

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7
Q

Breast Milk Jaundice- treatment

A

Resolves spontaneously

Can still breast feed

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8
Q

Breast Milk Jaundice- risk

A 
Risk - 
J - jaundice w/in first 24 hr of life
A - a sibling who was jaundiced as a neonate
U - unrecognized hemolysis
N- non-optimal sucking/nursing
D - deficiency of G6PD
I - infection 
C - cephalohematoma/bruising 
E - east Asian/north Indian
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9
Q

Breastfeeding jaundice- pathophysiology

A

Newborn doesn’t get adequate milk intake

Delayed/insufficient milk production

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10
Q

Breastfeeding jaundice- S/S & PE

A

Dehydration
dec stooling
Dec bilirubin excretion

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11
Q

Gastroesophageal Reflux (GER)- pathophysiology

A

Passage of gastric contents into the esophagus

Nl in infants

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12
Q

Gastroesophageal Reflux (GER)- epidemiology

A

80% resolve by 6m

90% resolve by 12m

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13
Q

Gastroesophageal Reflux (GER)- S/S & PE

A

After feeding
Gaining weight

GERD?

  • fussiness, sleep disturbance, dec appetite
  • arching, chocking, gagging, pulling off the breast/bottle
  • Not gaining weight
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14
Q

Gastroesophageal Reflux (GER)- diagnosis

A

Vitals - growth

Clinical

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15
Q

Gastroesophageal Reflux (GER)- treatment

A 
Reassurance
Lifestyle mods: 
- prop up after feeds
- elevate head of bed
- carry upright
- tummy

Dec volume/inc frequency

Thicken formula

Trial - hypoallergenic milk formula or exclude mother’s intake of dairy

Empiric trial - acid suppression w/ H2- receptor antagonist or PPI x4weeks
- only when really bad

SEVERE - Peds GI referral, Nissen

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16
Q

Pyloric Stenosis- pathophysiology

A

hypertrophic musculature surrounding pylorus

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17
Q

Pyloric Stenosis- epidemiology

A

4w of life

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18
Q

Pyloric Stenosis- S/S & PE

A

Projectile emesis - nonbilious
Hungry!!!
Olive size mass

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19
Q

Pyloric Stenosis- diagnosis

A

U/S

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20
Q

Pyloric Stenosis- treatment

A

Rehydration

Surgery

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21
Q

Pyloric Stenosis- prognosis

A

If cont -> metabolic alkalosis

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22
Q

Intestinal Atresia and Stenosis- pathophysiology

A

Pylorus - atresia - 1%
Duodenum - atresia, stenosis, web - 45%
Jejunoileal - atresia, stenosis - 50%
Colon - atresia - 5-9%

Multiple sites

Do not let the sun set!!!

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23
Q

Intestinal Atresia and Stenosis - epidemiology

A

w/in 48hr of life

1/3 of all cases - neonatal gut obstruction

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24
Q

Intestinal Atresia and Stenosis - S/S & PE

A

Bile-stained vomiting

Abdominal distention

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25
Intestinal Atresia and Stenosis - diagnosis
x-ray - dilate loops of bowel, absent gas bubble
26
Intestinal Atresia and Stenosis- treatment
Surgery
27
Midgut Volvulus- epidemiology
Presents - 3w
28
Midgut Volvulus- S/S & PE
``` Severe diffuse abdominal pain and distention Persistent bilious emesis Bloody stools Lethargy Poor Feeding ```
29
Midgut Volvulus- diagnosis
KUB - corkscrew pattern, dilated loops of bowel overlying the liver, no gas distal to obstruction Upper Gi - GOLD
30
Midgut Volvulus- treatment
SURGICAL EMERGENCY!
31
Diaphragmatic Hernia- pathophysiology
Found early on | - incidental or w/u of GERD
32
Omphalocele- pathophysiology
Midline abdominal wall defect - covered by amnion and peritoneum Containing abdominal contents Defect - at base of umbilical cord - cord inserting at its apex
33
Omphalomesenteric Duct- pathophysiology
Remnant ligament b/t ileum and abdominal wall Meckel diverticulum Patent duct - stool leaks out of umbilicus
34
Ileus- pathophysiology
Impaired intestinal motility/dec gut peristalsis
35
Ileus- cause
Abdominal surgery Infections Electrolyte disturbances Meds - narcotics, anesthetics, chemo
36
Ileus- S/S & PE
Abdominal pain Distention V Hypoactive bowel sounds
37
Ileus- treatment
``` Supportive NPO IVF Decompression w/ NG tube Surgery consult ```
38
Meconium Ileus- pathophysiology
Mechanical ileal obstruction | Inc consistency of meconium - thicker than nl due to high protein
39
Meconium Ileus- cause
CF - needs to be ruled out if <6m
40
Meconium Ileus- prognosis
Lead to ileal perf and meconium peritonitis
41
Cow's Milk Protein Allergy- pathophysiology
Inflammation in distal colon NON IgE mediated
42
Cow's Milk Protein Allergy - cause
one + food proteins | - Cow's milk, soy
43
Cow's Milk Protein Allergy - epidemiology
1st week | Resolves - late infancy
44
Cow's Milk Protein Allergy - S/S & PE
Rectal bleeding
45
Cow's Milk Protein Allergy- treatment
Elimination diet via mom | - then slowly introduce things back into her diet
46
Intussusception- pathophysiology
Telescoping bowel | - proximal to ileocecal valve - 90%
47
Intussusception - epidemiology
6-36m or <2y | Usually, viral illness in last 2 w
48
Intussusception - S/S & PE
``` Sudden onset Severe cramping intervals Vomiting Sausage mass Lethargy Currant Jelly stools ```
49
Intussusception - diagnosis
Barium/air enemas
50
Intussusception- labs & imaging
Rectal | US - doughnut or target appearance
51
Intussusception- treatment
Barium/air enemas
52
Pancreatitis- pathophysiology
infection of pancreas
53
Pancreatitis - cause
Trauma, gallstones, idiopathic, infectious, drug associated, vasculitis, genetic, autoimmune
54
Pancreatitis - S/S & PE
``` RUQ or epigastric pain Radiation to back Vomiting Anorexia low-grade fever ``` Tenderness to palpation w/out peritoneal signs
55
Pancreatitis - labs & imaging
Serum lipase - inc Serum amylase - inc Ca - inc Abdominal US or CT
56
Pancreatitis- treatment
Admit Pain control H2O Bowel rest
57
Pancreatitis- Complications
Complications - hypovolemic shock, hypocalcemia, hyperglycemia
58
Appendicitis- S/S & PE
Vague periumbilical pain -> localized to RLQ Fever Anorexia
59
Appendicitis- labs & imaging
WBC - high or nl - w/ left shift CT w/ contrast US - thickening of appendix
60
Appendicitis- treatment
Surgical removal
61
Appendicitis - prognosis
Complications - appendix per-> peritonitis
62
Functional abdominal Pain- treatment
Get them function | individual management
63
Viral Gastroenteritis- cause
Roavirus Adenovirus Enterovirus Norwalk
64
Viral Gastroenteritis - S/S & PE
``` Mild fever Non-bloody emesis Cramping Discomfort Diarrhea ``` Lasts - 2-10day
65
Viral Gastroenteritis - labs & imaging
Labs, x-rays?
66
Viral Gastroenteritis- treatment
Supportive
67
Viral Gastroenteritis - complications
Complications - temporary lactose intolerance
68
Eosinophilic Esophagitis- pathophysiology
Eosinophil's infiltrate into the esophageal epithelium
69
Eosinophilic Esophagitis - cause
Food allergies
70
Eosinophilic Esophagitis - S/S & PE
``` Vomiting Chest pain Epigastric pain Dysphagia Food impaction/stricture Ineffective antireflux therapy ```
71
Eosinophilic Esophagitis - diagnosis
Endoscopy w/ biopsy - patch testing
72
Eosinophilic Esophagitis - treatment
Elimination diet Steroids Repeat endoscope
73
Cyclical Vomiting Syndrome- pathophysiology
Idiopathic Recurrent, stereotypical bouts of vomiting
74
Cyclical Vomiting Syndrome- cause
Abdominal migraines Hypothalamic-pituitary axis hyperreactivity Rapid gastric emptying Cannabis
75
Cyclical Vomiting Syndrome- epidemiology
Anxiety
76
Cyclical Vomiting Syndrome- S/S & PE
Baseline/normal b/t episodes
77
Diarrhea- pathophysiology
Gastrointestinal infection - most common cause
78
Diarrhea - cause
Viral - most common cause
79
Diarrhea - treatment
Loperamide and other antidiarrheal - NOT INDICATED | Symptomatic care
80
Bacterial Gastroenteritis- pathophysiology
HUS? - microanemia - Thrombocytopenia - Acute kidney injury
81
Bacterial Gastroenteritis- cause
``` Shigella Salmonella Campylobacter Yersinia Ecoli ```
82
Bacterial Gastroenteritis- S/S & PE
Fever Abdominal pain Diarrhea - bloody/mucous
83
Bacterial Gastroenteritis- treatment
``` Hydration BRAT diet Avoid fruit juice/high surage food Priobiotics ? Rule out concerning causes - porlonged/severe Refer if necessary ```
84
Toddler's Diarrhea- pathophysiology
Chronic nonspecific diarrhea
85
Toddler's Diarrhea- cause
``` Non-infections Malabsorption Protein/cars Food allergies ingestion Systemic disease ```
86
Toddler's Diarrhea- epidemiology
9-24m
87
Toddler's Diarrhea- S/S & PE
explosive loose stools w/ flecks of food
88
Toddler's Diarrhea- treatment
``` Limit fruit juice Adjust fiber Fat in diet Keep hydrated Find cause Refer for chronic ```
89
Constipation- pathophysiology
Infrequent and/or passage of hard stools
90
Constipation - cause
``` Poor diet inadequate fluid intake Medications Anxiety/behavioral Underlying issues ```
91
Constipation - epidemiology
Common during toilet training
92
Constipation - S/S & PE
``` Overflow diarrhea Committing Abdominal pain Anal fissures Rectal bleeding Impaction UTI ```
93
Constipation- diagnosis- diagnosis (scale)
``` Bristal Stool Scale Type 1 - pellots Type 2 - sausage-shaped but lumpy Type 3 - sausage but w/ cracks Type 4 - sausage or snake - smooth Type 5 - soft blobs w/ clear-cut edges Type 6 - fluffy pleces w/ ragged edges, mushy stool Type 7 - watery, no solid pieces, entirely liquid ```
94
Hirschsprung Disease- pathophysiology
Absence of ganglion cells in mucosa and muscular layers of colon -> functional obstruction
95
Hirschsprung Disease - S/S & PE
``` Failure to pass meconium w/ first 24hr of life Distention Overflow diarrhea Enterocolitis Sepsis - megacolon Constipation - older kids ```
96
Hirschsprung Disease - diagnosis
Contrast enema - transition zone - ganglionic portion dilated Rectal biopsy
97
Hirschsprung Disease - treatment
Surgery
98
Anorectal Anomalies- pathophysiology
Anterior displacement of anus Anal stenosis Imperforate anus
99
Foreign body in Esophagus- cause
Coin | Small toys
100
Foreign body in Esophagus- epidemiology
6m-3y
101
Foreign body in Esophagus- S/S & PE
``` Asymptomatic Choking Gagging Coughing salivation Dysphagia refusal to eat vomiting Stridor Perforation ```
102
Foreign body in Esophagus- diagnosis
Hx | Xray
103
GI Foreign body- pathophysiology
Pass on own
104
GI Foreign body- cause
Batteries and magnets - surgery
105
Growth- pathophysiology
``` 24/32oz/day BW - 10-14 days Doubled - 4-6m Tripled -12 m 5-7 wet diapers per day 3-4 dirty diapers per day ```

Clin med sem 2 (30 decks)

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