GI- Peds

Question 1

whole milk should not be given under 1 bc?

Answer 1

can cause microscopic bleeding and allergies

Question 2

when should solid foods be introduced?

Answer 2

at 4 months

Question 3

what foods are choking hazards for infants?

Answer 3

raisins, nuts, hot dogs, grapes

Question 4

if a peds pt vomits their med within 20 mins of taking it, what do you do?

Answer 4

you can re-dose and not worry about overdosing

Question 5

when to be concerned about vomiting

Answer 5

• bile in vomit
• blood in vomit
• severe dehydration
• significant changes in mental status/activity level “lethargic”

Question 6

limit dairy to___ servings per day

Answer 6

2
*The more dairy they have, the more fluid they need to push it out

Question 7

for constipation, what do you recommend?

Answer 7

a strict toileting schedule; at least have them attempt to sit and have a BM at least daily when constipation is a concern

Question 8

if mucus in stool more concerning for a….

Answer 8

food intolerance/allergy

Question 9

if blood in the stool, can be…

Answer 9

post-viral and if large amount and constant this is concerning!

Question 10

when to be concerned about diarrhea

Answer 10

• large amounts of blood in diarrhea
• symptoms of diarrhea
• significant weight loss
• family hx of IBD
• daily abd pain

Question 11

tx of diarrhea

Answer 11

• increase fluids
• BRAT diet: bland, starching foods to bulk up stools–bananas, rice, applesauce, toast

Question 12

constipation

Answer 12

• dairy is VERY constipating
• avoid Miralax
• increase fluids
• increase fiber: fruits with skin, most fibrous: peaches, pears, prunes, plumes, pineapples

Question 13

giardiasis

Answer 13

• can be passed to person to person contact (spread through feces)
• poor sanitation and unsafe water increase the risk of catching intestinal parasites

Question 14

giardiasis: s/s (typically appear 2 weeks after infection)

Answer 14

• watery diarrhea
• soft, greasy stools
• fatigue
• abd cramping
• bloating
• nausea
• weight loss
• does not have blood/mucus in stool

Question 15

diagnosis giardiasis

Answer 15

stool culture

Question 16

tx giardiasis

Answer 16

• metronidazole
• albendazole
• mebendazole
• nitazoxanide
• tinidazole
• albendazole

Question 17

pinworm

Answer 17

• Transmitted indirectly; eggs from an infected person can stick to toys/bedding/clothing/objects. (can live off of a host on material for up to 2 weeks)
• Tiny, white, thread-like worms that live in the rectum
• At night the worm crawls out of the anus and lays eggs in the nearby skin; this causes severe itching

Question 18

pinworm s/s

Answer 18

o Itchy in anus: worst at night (when they are active)
o Parents report at times seeing something move in and out of the rectum (in the bath, when changing a diaper)

Question 19

pinworm diagnosis

Answer 19

o Tape test: Cellophane tape is pressed against the skin around the anus. If doing the test at home, it is best to do it in the morning before your child bathes or goes to the bathroom. When you look at the piece of tape, you will see the worms.
o Another way to test for pinworm is if you see the adult worm around your child’s anus, in underwear or diapers, or in the toilet after going to the bathroom. Remember, they are white and only about a centimeter long.

Question 20

tx of pinworm

Answer 20

• albendazole
• mebendazole
• pyrantel pamoate

Question 21

tapeworms

Answer 21

• Caused by contaminated food or water
• Flat, hermaphroditic worms that can live as parasites in the human gastrointestinal tract
• Eggs move from intestines to form cysts in tissue/organs. Eaten tapeworm larvae can grow into adult tapeworms, which live in the intestines.

Question 22

tapeworms s/s

Answer 22

o Some can be asymptomatic
o Visible worms in stool
o Nausea
o Anorexia (not want to eat)
o Epigastric pain
o Urticaria

Question 23

diagnosis of tapeworm

Answer 23

stool culture

Question 24

tx of tapeworms

Answer 24

• 1st line Praziquantel

Question 25

appendicitis

Answer 25

inflammation of appendix

Question 26

appendicitis testing

Answer 26

o Psoas sign: have the pt lie on his or her left side and then you flex their right thigh backward. If they have pain when flexing that right thigh backward that’s bc the muscle of the thigh and the movement is pushing up that inflamed appendix. If positive will elicit pain o Obturator sign: have the pt lie on their back and do a slow internal movement of their hip joint while the right knee is flexed. o Mc' Burneys: Rebound tenderness; pain worse when you let go of RLQ, more than with pressing in o Rovsing’s: Pain radiates to RLQ, when you palpate LLQ

Question 27

s/s appendicitis

Answer 27

o Sudden pain that begins on the right side of the lower abdomen o Sudden pain that begins around your navel and often shifts to your lower right abdomen o Pain that worsens if you cough, walk or make other jarring movements o Nausea and vomiting o Loss of appetite o Low-grade fever that may worsen as the illness progresses o Constipation or diarrhea o Abdominal bloating o Flatulence o RLQ pain

Question 28

concerns with appendicitis

Answer 28

* rupture/sepsis * abscess

Question 29

diagnostics for appendicitis

Answer 29

ultrasound/CT to confirm this

Question 30

Hirschsprung’s Disease

Answer 30

* large intestine becomes swollen due to a blockage * affects the large intestine (colon) * causes problems passing stool

Question 31

Hirschsprung’s Disease: s/s in infants

Answer 31

o Failure to pass meconium o Swollen belly o Vomiting (bile stained) o Flatulence

Question 32

Hirschsprung’s Disease: s/s in older children

Answer 32

o Swollen abdomen o Chronic constipation o Gas o Failure to thrive o Fatigue o Ribbon-like (pencil) foul smelling stool

Question 33

Hirschsprung's disease diagnosis

Answer 33

o Biopsy of colon o Abdominal x-ray using contrast dye (avoid in pts with kidney issues, or family hx of allergies to contrast dye)

Question 34

Hirschsprung's disease tx

Answer 34

Surgery: to bypass/remove portion of the colon lacking nerve cells * Pull-through surgery: diseased portion of colon removed; normal section pulled through the inside of the colon and attached to the anus * Ostomy: to allow time for colon to heal/rest; can be reverse

Question 35

pyloric stenosis

Answer 35

o Blocks foods from entering the small intestine o Normally, a muscular valve (pylorus) between the stomach and small intestine holds food in the stomach until it is ready for the next stage in the digestive process. In pyloric stenosis, the pylorus muscles thicken and become abnormally large, blocking food from reaching the small intestine. This causes an “olive pit” palpable in the pylorus.

Question 36

pyloric stenosis: s/s

Answer 36

o Typically appear within 3-5 weeks after birth; rare in babies >3 months. o Projectile vomiting after feeding o Persistent hunger o Abdominal contractions o Dehydration o Changes in bowel movements o FTT

Question 37

risk factors for pyloric stenosis

Answer 37

o More often in males o Caucasians o Prematurity o Family history o Smoking during pregnancy o Early antibiotic use

Question 38

how is pyloric stenosis diagnosed?

Answer 38

by ultrasound

Question 39

tx of pyloric stenosis

Answer 39

surgical correction is needed

Question 40

intussusception

Answer 40

Telescoping of a section of the intestines into the adjacent part of the intestines; this blocks food/fluid from passing through. It can also cut off the blood supply to the affected portion of the intestine, which can lead to a perforation in the bowel. This can result in infection/death of the bowel.

Question 41

intussusception: s/s

Answer 41

o "Currant jelly stool”; stool mixed with blood and mucus o Vomiting o Lump in the abdomen o Weakness/lack of energy o Diarrhea

Question 42

intussusception risk factors

Answer 42

o Age: more common in younger children; most common cause of bowel obstructions in children between the ages of 6months-3 years o More common in males o Increased risk when there is intestinal malrotation history o Certain disorders predispose someone: * CF * Henoch-Schonlein Purpura (HSP) also known as IgA Vasculitis * Crohn’s disease * Celiac disease

Question 43

intussusception: complications

Answer 43

peritonitis * Abdominal pain * Abdominal swelling * Fever * Vomiting * Cool, clammy, pale skin * Weak, rapid, thready pulse * Abnormal breathing * anxiety/agitation * Listlessness

Question 44

diagnostics of intussusception

Answer 44

* abd ultrasound * x-ray * CT scan * any imaging will show a "bullseye": intestine coiled within the intestine

Question 45

tx of intussusception

Answer 45

* air enema (1st line) * surgery (if perforation/peritonitis)