Lecture 18: Pediatric GI Disorders Flashcards
1
Q
Generally, yellow emesis suggests (), while a greenish discoloration suggests ()
A
- Yellow = mostly just stomach
- Greenish = more bile
Bile in emesis could suggest SBO
2
Q
The MCC of vomiting in children is…
A
Viral Gastroenteritis
3
Q
() describes an infant/newborn with postprandial spitting/and or vomiting that resolves spontaneously by 12 months in 85% of cases. Only lifestyle changes are needed.
A
GER
no D!
4
Q
GERD in an infant is treated with…
A
Medications! Intractable symptoms can be life-threatening.
5
Q
GER and GERD can be diagnosed ()
A
clinically
6
Q
The 5 infant risk fators for GER/GERD are:
- () stomach capacity
- () volume feeds
- () esophagus
- () positioning
- () swallowing response
A
- Small stomach
- Large feeding
- Short esophagus
- Supine positioning
- Slow swallowing
7
Q
Your infant keeps spitting up their formula and arching their back when feeding. Sometimes they choke and turn blue. You suspect they have…
A
GERD
Chest pain/burning would be more in children and older
8
Q
The 4 underlying conditions that are risk factors for GERD are…
A
- Asthma
- CF
- Developmental delays
- TEF
9
Q
Apenic spells in newborns are typically caused by (), especially if it occurs with position change
A
Reflux
10
Q
GERD is confirmed via () after clinical presentation and can cause ()
A
- UGI
- BRUE
11
Q
In an infant, you can trial (med) daily for GERD
A
Famotidine/Pepcid or Prilosec or Nexium
12
Q
Basic behavior modifications to help with infant GERD include:
- () feedings
- () 45 minutes after feeds
- () feeds or pre-() formula
- Breasfeeding to eliminate (2 allergens) for 2-4 weeks
A
- Smaller feedings
- Sit them upright 45 minutes
- Thicken their foods
- BFeed to eliminate eggs and milk
13
Q
The surgery for persistent or life-threatening GERD is…
A
Nissen fundoplication
14
Q
The MC virus to cause viral gastroenteritis is…
A
Norovirus
15
Q
Viral gastroenteritis most commonly peaks in the (season) and 95% of admissions are children under the age of () years
A
- Winter
- age of 5
16
Q
You should be concerned for a child with viral gastroenteritis if they start experiencing…
A
- Dehydration S/S (sunken fontanelles, BP drops)
- Wt loss
- Blood/mucus
- Weird breathing
17
Q
If you suspect gastroenteritis and want to order stool studies, you should order… (3)
A
- SSYC (salmonella, shigella, Yersinia, and campylobacter)
- O&P (ova and parasites)
- Viruses (GE panel)
18
Q
The treatment for Gastroenteritis is () relief, IVF, and treating the causative agent
A
Symptom relief
19
Q
The MC indication for emergency surgery in Peds is…
A
Acute appendicitis
MCC: Fecalith
20
Q
Acute appendicitis differs from gastroenteritis because vomiting usually is (before/after) pain onset
A
Vomiting comes AFTER pain
21
Q
The two items that are worth more than 1 point on the pediatric appendicitis score are…
A
- Pain with cough/percussion/hopping
- RLQ tenderness
22
Q
Generally, appendicitis presents with WBCs no greater than () and an elevated ANC of greater than ()
A
- WBCs no greater than 15k
- ANC > 7500
CRP + leukocytosis is a 92% indicator of appendicitis apparently
23
Q
Generally, first line imaging for acute appendicitis in a pediatric patient is…
A
U/S
Followed by CT abdomen
24
Q
Prior to appendectomy in a kid, you should give 1 dose of…
A
Cefoxitin or cefotetan
TinTan
25
Buzzwords for Pyloric stenosis
* Projectile vomiting
* Hypertrophy of pylorus
* Non-bilious emesis
* Dehydration
* Olive sign in RUQ
26
Usage of (drug class) is a risk for pyloric stenosis in children under 2 weeks of age.
Macrolides (Erythromycin & Azithromycin)
27
The two studies you can do for pyloric stenosis are...
U/S vs UGI
| I think US is #1 though
28
The characteristic sign of pyloric stenosis on an Upper GI w/ barium is...
String sign
29
Tx for pyloric stenosis is...
Pyloromyotomy
30
Acute, non-inflammatory **encephalopathy** + hepatic dysfunction with () use in a child that had a **viral URI a few weeks ago** describes () syndrome
* Salicylate (ASA) use in a child
* Reye syndrome
31
The MC ethnicity for Reye's syndrome is...
Caucasian
32
T/F: You must report Reye's syndrome to the local health department
Yup
33
Buzzwords for Reye's syndrome
* **Aspirin use** in a kid with **recent viral URI**
* **Encephalopathy + hepatic dysfunction**
34
Reye's syndrome is managed via IVF, () and ()
* Diuretics
* Coagulants (Vit K, plasma, plts)
| Reducing ICP and increasing fluid loss
35
() describes inflammation of the entire esophagus, most specifically in children with food allergens. Esophageal mucosa gets infiltrated with T-cells, B-cells, eosinophils, and IgE mast cells.
Eosinophilic Esophagitis
| Asthma of the esophagus?
36
Generally, you should suspect () in infants who have GER symptoms that are **unresponsive to PPIs**
Eosinophilic esophagitis
| They have very similar S/S
37
Diagnosis of Eosinophilic Esophagitis is via histologic confirmation showing...
15+ eosinophils per hpf
| Need multiple esophageal bx
38
Besides avoiding food allergies, you can also treat eosinophilic esophagitis using (medication) or (procedure) to treat strictures
* Inhaled steroids
* Esophageal dilation
39
The 3 organ systems affected most commonly with peanut allergies is...
* Skin
* Respiratory
* GI
40
Peanut allergies usually are ()
Lifelong
41
() is both diagnostic and prognostic for peanut allergies
ImmunoCAP (peanut specific IgE levels)
42
The main stay of peanut allergy management is...
Prevention!!!!!!!
43
The most effective future management option for peanut allergies is...
Food **oral** immunotherapy
44
Generally, babies with severe eczema/egg allergies should be introduced to peanuts between () and () months of age, while mild-mod eczema should get it at () months
* 4-6 months for severe
* 6 months for mild-mod
| Earlier if more severe allergy!
45
The MCC of gastric/duodenal ulcers is...
H pylori
46
Tx of Gastric/duodenal ulcers is via...
* Amoxicillin
* Clarithomycin
* Omeprazole
| 2 weeks
## Footnote
I guess not metronidazole for amoxicillin in kids?
47
Passage of () loose/watery stools is diarrhea
3+
48
The FIRST question to ask about a child presenting with acute diarrhea is...
Are they immunocompromised?
49
Acute diarrhea must fall within the timeframe of ...
5-14 days
50
Chronic diarrhea is usually associated more with... (4)
* ABX use
* Fruit juices/starch
* MPA
* Toddler's diarrhea (?)
51
The MC virus that causes diarrhea is...
Norovirus
| 2-3 days i think? its short
52
The MC age range to get viral diarrhea is... () to () months
3-15 months of age
53
The MC symptom in virus associated diarrhea is...
Vomiting
| Followed by low grade fever and watery diarrhea.
54
A stool culture for a viral diarrhea should have () blood or WBCs
No blood or WBCs in stool
55
The treatment for diarrhea due to a virus is usually...
Supportive care
| and treat any bicarb loss/metabolic acidosis with pedialyte probs
56
In a child younger than 2, () is the MCC of intestinal obstruction
Intussusception
| Esp between 6-12 months
57
Buzzwords for Intussusception
* Colicky pain
* Drawing up legs
* **Currant, jelly stool**
* **Sausage shaped abdominal mass in mid-right abd**
58
Gold standard to diagnose intussusception is...
Barium enema
59
Pseudomembranous enterocolitis, or C. Diff, is MC due to...
ABX use
60
The first line tx for C Diff is...
Discontinuing abx use :)
61
The first line pharm tx for C Diff is either **ORAL** () or ()
Oral vanco or metronidazole
| MUST BE ORAL
62
Your healthy 15 month old has watery diarrhea during their **waking hours only**. They are **growing normally** and have all negative tests. They love apple juice! You suspect that they have...
Toddler's diarrhea
| Excessive fruit juice worsens it.
## Footnote
Self-resolving by age 3-4
63
T/F: Milk protein allergies are IgE mediated.
False. It is a NON-allergic food sensitivity
64
Generally, you would suspect MPA in a healthy infant showing () in their stool.
Flecks of bright red blood in stool (heme positive)
65
The treatment for MPA is...
Avoiding milk protein via formula.
| Disappears by 8-12 months usually.
66
The lab test for Celiac disease is...
tTG (tissue transglutaminase)
| 99% specificity
67
() is diagnostic for celiac disease
Endoscopy with small intestine biopsy
68
IBD induced diarrhea is (bloody/watery)
Bloody
69
The definition of constipation timing-wise in an infant/toddler is that it must be present for at least () month, and () month in older children.
* 1 month in infants/toddlers
* 2 months if older
70
Constipation occurs during 3 main transitions in a child's life, which are...
* Introduction to solid foods/cow's milk
* Toilet training
* School entry
71
A child less than 2 years old who is constipated should try to eat at least () grams of fiber daily.
5g of fiber daily
| Also drink less milk since it slows intestinal motility.
72
Once a child becomes school-aged, they should aim for () grams of fiber daily.
11-24 grams daily
| And drink more water. No poop shy pls
73
T/F: Pain with pooping counts as constipation
True
74
In a toddler/child, the pharm tx for constipation is () or ()
* PEG/miralax 1-1.5g/kg/day
* Lactulose 1-2 g/kg/day
75
Encopresis is..
Fecal incontinence/soiling
| Accidentaly pooping your pants
## Footnote
Builds up hard, painful stools until your sphincters give up
76
Diagnosis of encopresis is via () or ()
* Rectal exam
* KUB XR
77
Acute treatment of encopresis is via...(5)
* PEG/Miralax for kids **6 months or older**
* Fleets enema for kids **2 years or older**
* Dulcolax suppository
* **Glycerin suppository for infants**
* Rectal stimulation PRN
78
What is toilet sitting?
* Pooping at the same time 5-10 minutes after meals.
* Timing them via stopwatch
* **Reward for effort not success**
| Habit training!
79
Avoiding what common food/drink is important for constipation?
Cow's milk
80
Absence of ganglion cells in the mucosal and muscular layers of the colon describes...
Hirschsprung's Disease
| Congenital Aganglion megacolon
81
The first sign of Hirschsprung's disease once a neonate is born would probably be failure to ...
Failure to pass meconium in the first 24-48 hrs
82
The definitive dx of hirschsprung disease is via...
Rectal biopsy showing no ganglion cells.
| Can do KUB XR first tho!
83
Abdominal distension is (more/less) common in Hirschsprung's over functional megacolon.
More common in hirschsprung's
84
The treatment for Hirschsprung's disease is...
Diverting colostomy or ileostomy
85
Anal fissures are characterized by () with defecation and () on toilet paper
* Pain with defecation
* Bright red blood on toilet tissue
86
75% of all rectal anomalies in children is a...
Imperforate anus
87
Ribbon-like stools probably suggest
Imperforate anus or anal stenosis
| or Hirchsprung's
88
Severe dehydration is greater than () volume loss
10%
89
Sunken () and () are suggestive of volume depletion in a child
* Fontanelles
* Eyes
90
If a child loses 2 kg of wt, they prob lost () liters of fluid
2 liters of fluid
91
**The most useful lab to assess the degree of dehydration in a child is**
Serum Bicarb
| < 17 mEq/L
## Footnote
also BUN goes up
92
Oral rehydration is best achieved using a (tool), and by administering (fluid choice)
Syringe, adminstering pedialyte
93
Besides rehydrating a child, you can also trial (med) in children older than 2
Zofran 4mg ODT
94
IV rehydration of a child uses (fluid)
NS
95
**Pedialyte must be used for oral rehydration** over something like gatorade or ginger ale in a child because...
It contains 30 mEq/L of bicarb
