Pediatric gastroenterology, dehydration and rehydration Flashcards Preview

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Flashcards in Pediatric gastroenterology, dehydration and rehydration Deck (17):


telescoping of distal ileum into cecum, for reasons unknown (lymphoid hyperplasia?) produces pain eventually necrosis
-mc presentation is intermittent pain in toddler, bloody diarrhea is late.
-most cases under 2 yo; presentation in infants is less specific; may present as lethargy, altered mental status, sepsis-like picture



commn in infants. dx with h and P 50%
most children grow of out of it by 12 mos
treat with reassurance; sometimes thickened feeds, smaller feeds, positioning.
distinguised from GERD because greater more forceful emesis, complications.
-may treat with proton pump inhibitors


celiac disease

intestinal reaction to gluten (a protein) that causes malabsorption. sxs are diarrhea, abdominal bloating, irritability, decreased appetite, failure to thrive. dx by small bowel bx. treat by removing gluten from diet .


IBD clinical presentation ulcerative colitis

abdominal pain, bloody stools, diarrhea, most children dont present with fever and weight loss.


IBD clin presentation chrons disease

abd pain, diarrhea, weight loss. may have perianal disease, apthous ulcers, decrease in height velocity. arthralgias and arthritis extraintestinal manifestations


diagnosis IBD

h and p and endoscopy with bx


treatment IBD s

stepwise accorcing to severity of disease, and inversely toxicity of meds
first: budesonide in CD, 5 asa agaents in UC
second: immunomodulators in both uc and cd, methotrexate with cd.
third: biologic therapy


what is darrhea?

passage of 3 or more loose or liquid stools per day, or more freqnatly than is normal for individual


what in history predicts dehydration?

not much-of course, look for decreased urination, frequency and volume of stool/vomitus, whether child is drinking


hemolytic uremic syndrome triad

anemia, renal failure, thrombocytopenia


life threatening causes of vomiting

newborn: anatomic problems, central nervous system infection, inborn errors of metabolism
older infant: obstructtion, gastroenteritis with dehydration, occult head trauma
older child: GI, neurologica, uremia, infectiuosm metabolic, toxins/drugs



2/3 INTRAcellular
1/3 extracellular


fluid needs over 24 hours

maintenance 100 ml/kg for 1st 10 kg body weight
50 ml/kg for next 10 kg
20 ml/kg for anything above
rehydration--depends on weight lost, either measured or calculated
replacement of ongoing losses.


electrolyte needs

maintenance: sodium 2-3 mEq/kg for 24 hours, potassium 1-2 mEq/kg
rehydration: see ORT composition, normal saline for IVfluids
typical maintenance for older child: d51/2 NS with 20 mEq/L KCL


severe dehydration

treat initially with IVfluid bolus 20 ml/kg NS or LR to restore intravascular volume. (CV status)
look for signs of better hydration: better mental status, lower heart rate, higher bp


severe dehydration next 24 hours

give 1/2 of deficit over 8 hours, 1/2 over next 16 hours.


hypernatremic (type of dehydration)

Na over 145
causes: diarrhea (more water loss than na sometimes coupled with hyponatremic fluid intake, vomiting.
appearance: pr doesnt look as bad because of relative protection of ICF early on.
treatment: same as Iso initially, after rehydrate slowly (no more than 12 meq/L per 24 hours or risk cerebral edema