Pediatrics GI 1: Upper And Lower General GI Disorders Flashcards
What is the most common cause of acute abdominal pain in children?
Acute gastroenteritis
Types of imaging to use on children with GI disorders based on suspected GI disorder
Plan upright xrays = bowel obstruction, appendiceal fecalith, free intraperitoneal air, kidney stones, constipation, masses
CT scans = intrabdominal or pelvic abscesses, appendicitis, crohn disease makes pancreatitis, gallstones/kidney stones
Barium enema = intussusception or malrotation of the colon
Ultrasound = gallstones, appendicitis, intussusception, pancreatitis, kidney stones
Lower endoscopy = colitis
Upper endoscopy = PUD
Lab values to order for abdominal pain and/or GI disorders
CBC/CRP/ESR = inflammation
AST/ALT/GGT = biliary or liver damage
Amylase and lipase = pancreatitis
Urinalysis = UTI, bleeding due to stones/trauma or obstruction
Pregnancy test*
Most common causes of GI associated ab pain among 2-5 yrs
Sickle cell with pain crisis
Lower lobe pneumonia
UTIs
Gastroenteritis
Most common causes of GI associated ab pain among 5yrs
And up
Appendicitis
Pregnancy
Pelvic inflammatory disease
Pancreatitis
Cholecystitis
Gastroenteritis
IBD
E. Coli O157:H7
shiga-toxin producing E.coli
Frequently causes HUS
- thrombocytopenia
- hemolytic anemia
- uremia
Pyloric stenosis
Is a post natal idiopathic hypertrophy of the muscularis mucosa of the pylorus of the stomach
- incidence = 1-8/1000 w/ 5x more likely as male
Can present as early as 1 week or as late as 5 months**
- causes progressive non billous vomiting, dehydration and alkalosis*
- vomit can show blood
**always presents with a palpable “olive-like” mass along the right upper quadrant of the abdomen
***ultrasound is usually enough for diagnosis which requires the pylorus sphincter to be greater then 3-4mm thick
*** treatment = laparoscopic pyloromyotomy w/ fluid and electrolyte resuscitation
Differential diagnosis of pyloric stenosis
1) GERD
- need radiographic studies to determine difference
2) adrenal insufficency
- this shows metabolic acidosis and elevated serum potassium however (theses re not found in pyloric stenosis)
3) gastroenteritis
- almost always presents diarrhea w/ vomiting in tandem (pyloric stenosis rarely produces diarrhea)
4) genetic abnormalities in enzymes
- usually shows really bad secondary sided defects though (seizures/malaise/neuropsychiatric complications/etc.)
Intussusception
A portion of the GI tract gets “telescoped” into an adjacent distal segment and constricted
- this is usually caused by an abnormal brief paralysis of peristalsis along the intestines somewhere
Most common cause of intestinal obstruction between 5 months- 2yrs
- is an abdominal emergency*
- 80% of cases are before 2 yrs
- occurs in 1-4/1000 with males 3x more likely
90% are idiopathic and some can reduce spontaneously, however if symptoms arise it is an emergency
the most common sections = terminal ileum and iloceacal region
What other medical conditions have ties to increased intussusception rates in children?
Adenovirus type C infections
Chronic otitis media
Chronic gastroenteritis
Henoch-Schonlein purpura
very slight increased risk within 3 weeks after getting 1st dose of rotavirus vaccine
Clinical presentation of intussusception
Sudden onset of severe paroxysmal colicky pain that is frequent
- child often tries to strain like they are using the toilet and loud cries (kinda looks severely constipated)
Also produces vomiting (initially non-billous but chronic becomes billous)
*60% show “currant jelly stool” which is bloody mucus stool in children
Late stage = lethargic and signs of shock
***the only way to tell intussusception apart from extreme gastroenteritis is to pay attention to how the child looks in between bouts of pain. in intussusception = looks perfectly normal in between bouts (unless late stage) . In gastroenteritis = looks very ill always
What is treatment of intussusception?
Hydrostatic saline reduction Before surgery to remove constriction
- if there are signs of shock or peritoneal signs = DONT do this and just go straight to surgery
95% of children can survive this as long as reduction occurs before 24hrs. After this mortality rates rise with a quick spike after 48hrs
Hirschsprung disease (congenital aganglionic megacolon)
Absences of ganglion cells in the Submucosa and myenteric plexus from the distal colon
- results in inadequate relaxation of the bowel wall and bowel wall hypertonicity = results in intestinal obstruction
Is the most common cause of lower intestinal obstruction in neonates
- 1:5000 live births
- males are 4x more likely
most key symptom to clue you into thinking about hirschsprung disease = failure to pass meconium within first 48hrs of birth
Clincial manifestations of hirschsprung disease
most obvious = failure to pass stool, palpable mass in lower right quadrant and failure to grow
- *commonly causes proliferation of bacteria which can lead to secondarily enterocolitis**
- common organisms = C.Diff, staphylococcus aureus and anaerobic bacteria
If not treated well and enterocolitis sets in = high mortality rate!!
- can be due to infection and sepsis, perforation or ischemic bowel
How to diagnosis and treat hirschsprung disease?
Diagnosis = rectal sanction biopsy with contrast enema
Treatment = operative intervention
- primary pull through procedure is most common**
(The exception is if enterocolitis is present, then decompressing ostomy is used)
