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GI Week 6 > GI Problems in Children > Flashcards

GI Problems in Children Flashcards

1
Q

WHat is an objective measure of dehydration?

A

percentage of weight loss

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2
Q

What are some exam maneuvers you can do to check dehydration?

A

capillary refill time (over 2 seconds is bad)

skin turgor (tenting is bad)

deep breathing

sunken eyes

dry oral mucosa

altered mental status

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3
Q

What are some lab evaluatoins of dehydration?

A

urine output

urine specific gravity

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4
Q

Why are serum electrolyte determinations usually not needed in mild dehydration?

A

most episodes of dehydration caused by diarrhea are isonatremic and won’t affect the electrolyte levels

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5
Q

What drug should be used for treatment of vomiting in children?

A

ondansetron (zofran)

NOT metoclopramide - no evidence supports it

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6
Q

Almomst all children who have vomiting and dehydration can be treated with what?

A

oral rehydration therapy

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7
Q

Describe oral rehydration therapy.

A

administer small amounts of a glucose-electrolyte solution frequently

as the vomiting lessens, larger amounts of the solution can be given at longer intervals

when rehydration is achieved, other fluids and foods may be started

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8
Q

If a child has diarrhea but isn’t dehydrated, what should they drink?

A

just normal age-appropriate diets

so infants should continue to drink milk or regular strength formula

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9
Q

Which is more effective at rehydrating children with mild to moderate dehydration - ORT or IV hydration?

A

trick question - they’re equally as effective, making ORT the preferable choice

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10
Q

Does early refeeding with food after rehydration prolong diarrhea?

A

nope

milk might, so maybe wait a day or two

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11
Q

What sorts of foods are good to offer after successful rehydration?

A

rice creal
bananas
potatoes
carb-rich foods without lactose

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12
Q

True or false - the clear liquids recommended in the past are not appropriate for us in oral rehydration therapy.

A

true

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13
Q

What children wlll require IV hydration?

A

those that are severely dehydrated and in a state of shock or near shock

or those that are moderately dehydrated but cannot retain oral liquids because pf persistent vomiting

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14
Q

How much normal saline should you give in this situation? WHat are the other options?

A

20 mL per kg of normal saline

or

20 ml per Kg of 5% dextrose

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15
Q

How much of a benefit will probiotics give you for diarrhea in a kid?

A

on average, they’ll reduce the duration of diarrhea by about one day

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16
Q

True or false: the AAP considers opiates, bismuth subsalicylate, and attapulgite safe for use in young children and thus use of these antidarrheal agents is advised.

A

false - they can have serious adverse effects in infants and young children

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17
Q

When should you check for white blood cells in the stool?

A

in any child who appears toxic with high fever and diarrhea

if there is leukocytosis in the stool, you should further investigate for invasive bacterial diseases

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18
Q

What are the top three viral causes of infectious idarrhea in children?

A

Rotavirus
Calicivirus
Norovirus

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19
Q

What are the top three bacterial causes of infectious diarrhea in children?

A

Camylobacter jejuni
Salmonella
E coli

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20
Q

What are the two most common parasitic causes of diarrhea in children?

A

cryptosporidium

Giardia

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21
Q

If the child has bloody diarrhea, what are the likely cuprits?

A

more likely to be bacterial - shigella, campylobacter and EHEC

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22
Q

About 1 in ___ of infants are described as having colic.

A

1 in 5

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23
Q

Describe colic.

A

it’s inconsolable crying often accompnied by drawing up of the legs and gaseous distension of the abdomen

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24
Q

When does colic usually start in a baby’s life?

A

usually by 3 weeks of age, with a peak occuring by 6 weeks of age

may occur around the clock but more commonly occurs at a predictable time in the evening

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25
Q

At what age does the severity of colic typically decline and normal patterns reestablish?

A

about 3 months

26
Q

Before you just call a baby colicky, what should you rule out?

A

other causes for irritability and crying like otitis, another infectious cause like UTI, intussusception, hairs around the penis, fingers or toes

27
Q

WHat drug has been found to be significantly better at reducing symptoms of colic than placebo?

A

Dicyclomine

28
Q

What are the issues with dicyclomine though?

A

Severe adverse effects were mroe common in those receiving the active medications (especially if younger than 7 weeks)

manufacturer no longer believes dicyclomine is appropriate for children younger than 6 months and it’s now contraindicated

29
Q

True or false: soy formula may decrease the duration of colic symptoms.

A

true

30
Q

True or false: sucrose solution was associated with a reduction in colic-associated crying, and the effect was surprisingly long-lived.

A

false - short-lived at only a matter of minutes

31
Q

Have herbal teas been found to reduce colic symptoms?

A

Yes actually

but the issue is that using tea may lead to a decreased intake of milk with consequential nutritional adverse effects

32
Q

What are some potential treatments for colic that have been found to have no effect?

A 
Simethicone
Methylscopalamine
Hypoallergenic diet
lactase enzymes
carrying infant more
using car-ride stimulators
decreasing infant stimulatin
training parents in a behavioral approach
33
Q

90-95% of childhood consipation is ____

A

functional

34
Q

What should the physical evaluation of a child with chronic constipation include?

A

an abdominal AND a rectal exam (check for fecal impaction)

35
Q

What percent of encopresis cases involve fecal constipation and retention? What is this called?

A

80-95%

this is retentive encopresis

36
Q

Describe the type of encopresis that will occur with retentive encopresis?

A

children will often soil small quantities of loose fecal matter several times a day, but periodically pass very large bowel movements

also…they may present wiht urinary complaints and abdominal pain or distention

37
Q

What is nonretentive encopresis. What percentage of encopresis cases?

A

inappropriate soiling without evidence of fecal constipation or retention

makes up about 20% of cases

38
Q

Describe the characteristics of nonretentive encopresis?

A

soiling accompanied by daily bowel movements that are normal in size and consisency

39
Q

Which one is likely to have an abnormal physical exam: retentive or nonretentive encopresis?

A

retentive - will have clinical signs of constipation

nonretentive will typically be normal

40
Q

Hirschpsrung disease is frequently mentioend in the differential diagnosis of encopresis, but why doesn’t he like this?

A

they typically don’t pass large bowel mvoements and rarely every soil

41
Q

What is the first step management for retentive encopresis?

A

dietary changes or short term use of supplements like flavored fiber dirnks or bran sprinkles to increase the numer of bowel movements and to maximize daily toileting opportunities

42
Q

If these steps don’t work and obtaining frequent soft and well-formed bowel movements is still a problem, what could you add?

A

stool softeners or laxatives

43
Q

What are some stool softener options for children?

A

polyetheylene glycol (miralax)
Milk of magnesia
Mineral oil (but not if they’re at risk for aspiration!)
Sorbitol

44
Q

Why might these supplements make soiling accidents more common?

A

they bulk up stool so sometimes they make it difficult for children to withold bowel movements

45
Q

In general, you can expect the treatment to last ____ as long as the duration of the problem.

A

twice

46
Q

If stool witholding leads to impaction in a child, what can you try as opposed to the trauma of rectal manipulation?

A

polyethylene glycol - will trigger a bowel movement in about 2-3 days

47
Q

How long must abdominal pain last in a kid to be called chronic?

A

2 weeks

48
Q

Night pain or pain on awakening suggest what origin of pain?

A

peptic

49
Q

Pain occuring in the evening or during dinner is likely from what?

A

constipation

50
Q

Recurrent abdominal pain syndrome is a prepubertal functional pain with two distinct peaks of frequency. When?

A

Peak 1 is between 5 and 7 years of age (equal frequency between boys and girls0

Peak 2 is between 8 and 12 and is far more prevalent in girls

51
Q

How will the pain in recurrent abdominal pain syndrome be described?

A

typically vague and around the umbilicus or epigastric area

not related to meals, activity or stool pattern

52
Q

What autonomic features usually accompany the pain in recurrent abdominal pain syndrome?

A

pallor, nausea, dizziness, headache and fatigue

53
Q

Family history is often positive for what in recurrent abdominal pain syndrome?

A

functional bowel disease like IBS

54
Q

Describe management for recurrent abdominal pain syndrome

A

Acknowledge te pain is real!

no extensive investigation is warranted

make sure the child continues normal routine - go to school, activities, normal diet, etc.

55
Q

In older children and adolescents, a component of recurrent abdominal pain syndrome is seen in cases of what disorders?

A

depression or panic disorder with a learned symptomatic conversion reaction

56
Q

IBS is best characterized by what?

A

an intestinal dysmotility with intervals of nuisance diarrhea or constipation

57
Q

Whatis periodic syndrome or cyclic vomiting/abdominal migraine?

A

kids present with nausea, abdominal pain and significant emesis beginning during the night or early hours lasting about 6-48 hours

then intervening weeks to months with no symptoms or findings at all.

58
Q

True or false: headache is very common in children with cyclic vomiting syndrome.

A

false - headache will be rare, but it can evolve into a more classic migraine when the child enters adolescence

59
Q

Describe the abdominal pain that kids will complain of in UC or CD?

A

lower abdominal cramping that increases after meals or activity

60
Q

Why do kids with CD or UC often have growth impairment?

A

the pain is reduced by eating smaller meals, so they develop anorexia

61
Q

WHat are some things that will make the diagnosis of childhood IBD easy?

A
  1. bloody diarrhea
  2. need to defecate during the night
  3. perianal disease
  4. ileal mass on abdominal exam
62
Q

What are some other subtle features of IBD in kids?

A
  1. delayed puberty
  2. anemia not responsive to iron supplmentation
  3. recurrent oral aphthous ulcers
  4. chronic liver disease
  5. large joint synovitis or arthritis

GI Week 6 (14 decks)

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