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Flashcards in Initial GI peds Deck (19):

features of GERD in infants

emesis (may be absent, or may cause FTT). Sandifer syndrome (toticollis with back arching caused by painful esophagitis), feeding refusal or constant hunger (both indicate esophagitis).


sequelae of GERD in kids

upper and lower airway disease, bronchopulmonary constriction (can cause aspiration, laryngitis, wheezing, vocal cord nodules), FTT, esophageal strictures, (barrett's)


predictors of outcome in GERD in kids

-infants who have GERD after 1 year of age, or older kids, usually don't have spontaneous resolution of symptomsa and need medical management or surgery


GERD management in kids

-upright positioning, thickened foods, acid inhibition (antacidis, histamine H2 blockers, PPI)
-motility agents to incr.gastric empyting (metoclopromide). often limited by side effects (drowsiness, dystonia)
-Surgery- nissen fundoplication, with gastrostomy tube to help stretch the stomach and give tube feeds in infants


features of congenital pyloric stenosis

-nonbilious projectile vomiting
-hungry, irritable infants
-jaundice in 5% (low levels of glucuronyl transferase)


diagnosis of congenital pyloric stenosis

ultrasound is first choice
UGI may show a long, narrow pyloric channel (string sign)


What is malroatation/midgut volvulus?

anatomic abnormality of intestinal rotation that allows the midgut to twist around the superior mesentaeric vessels (volvulus). may cause obstruction and bowel infarction.


features of midgut volvulus

-bilious vomiting and sudden onset abd pain in an otherwise healthy infant. older kids may have crampy pain and vomiting.
-anorexia, distention, bloody stools
-physical exam usually normal at first, but may progress to peritoneal signs, shock, cardiovascular collapse


evaluation for midgut volvulus

abdominal xrays (gastric andproximal intestinal distention and obstruction)
upper intestinal contrast imaging is study of choice. show abnormal position of the ligament of treitz, obstruction, jejunum right of midline


intussusception: what age kids, most common location,

-most common cause of bowel obstruction between 1 month and 2 years; usually between 5-9 months of age
-most commonly occurs at ileocolic location


etiology of intussusception

usually unknown, but consider lead points (meckel's diverticulum, polyp, intestinal duplication, peyer's patch, lymphoma). lead points are actually rarely identified, and more commonly found in older kids


why is intussusception dangerous?

causes bowel wall edema/hemorrhage, and can lead to bowel ischemia and infarction


clinical features of intussusception

-previously healthy kid with sudden onset crampy/colicky abd pain. pain occurs in intervals followed by periods of calm
-normal stool or currant jelly stool
-sausage shaped mass


intussusception evaluation

-fluid resuscitation
-radiographs are of limited utility
-possible abdominal ultrasound
-air or contrast enema is the gold standard. contrast enema shows coil spring sign


management of intussuscpeiton

-contast enemas
-surgery if contrast enema fails to reduce the intussusception or if kid has peritoneal signs or pneumoperitoneum
-risk of recurrance 5% after contrast enema and 1% after surgery


what causes duodenal atresia? epidemiology?

failure of the lumen to recaunlize at 8-10 wks gestation
-most common cause of obstruction in neonatal period; 1/4 cases in pts with trisomy 21


features of duodenal atresia

-polyhdramnios in utero
-scaphoid abdomen with epigastric distentions
-feeding intolerance and vomiting
-stenosis may present with emesis, FTT


evaluation of duodenal atresia

-abdominal radiography --> double bubble
-intestinal contrast studedies


jejunoileal atresia: epi, cause, clinical features

-usually isolated anaomaly
-usually caused by amesenteric vascular accident during fetal life
causes BILIARY emesis within a few days of life