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
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
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
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.
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
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.