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Pediatrics GI Flashcards

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1
Q

What is a common co-morbidity of T1DM?

A

Celiac disease

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2
Q

Child 6-12 months old presents with pale/bulky/frothy/greasy/foul-smelling diarrhea or constipation, abdominal pain, and vomiting. What do you suspect?

A

Celiac disease

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3
Q

How is celiac disease diagnosed?

A
  • measure fecal fat (increased fecal fat in most cases)
  • hypoproteinemia
  • edema d/t decreased albumin level
  • Tissue transglutaminase Ab (IgA)/Endomysial Ab
  • intestinal biopsy (celiac mucosa w/ shortened/absent villi)
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4
Q

What should be initially restricted in pts diagnosed with Celiac?

A

lactose

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5
Q

What is indicated for celiac crisis?

A

corticosteroids

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6
Q

Patient presents with profound malnutrition, diarrhea, edema, and hypokalemia. What do you suspect?

A

celiac crisis

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7
Q

3 wk old infant presents w/ bile stained vomiting, colicky episodic abdominal pain, and decreased feeding. Upper GI shows partial/complete SBO. What do you suspect?

A

malrotation

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8
Q

pt presents w/ intermittent abdominal obstruction, diarrhea and malabsorption. Upper GI shows partial/complete SBO. what do you suspect?

A

malrotation

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9
Q

What is the treatment for malrotation?

A

surgical emergency (time is of the issue)

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10
Q

What accounts for 10% of neonatal intestinal obstructions?

A

malrotation w/ or w/o volvulus

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11
Q

what is intussusception?

A

condition in which one segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage)

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12
Q

What is the most common cause of intestinal obstruction in children < 2yrs old and seen predominantly in males?

A

intussusception (peak 5-9 months)

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13
Q

What are predisposing factors to intussusception?

A

Meckel Diverticulum, Henoch-Schonlein Purpura, Polyps, lymphoma (most common cause over 6 yrs old), parasites, foreign bodies, CF (thick sludgelike stool), Celiac, rotavirus vaccine

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14
Q

pt presents with intermittent abdominal pain, vomiting, diarrhea, bloody currant jelly stools with mucus, fever, and lethargy. what do you suspect?

A

intussusception

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15
Q

upon PE, abdominal distention, tenderness, and sausage-shaped mass is found at the upper-mid abdomen. what do you suspect?

A

intussusception

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16
Q

what are complications of intussusception?

A

hemorrhage, incarceration and necrosis of intussuscepted bowel , perforation, peritonitis

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17
Q

how is intussusception diagnosed?

A

ultrasound, barium enema, air contrast enema

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18
Q

what is the treatment for intussusception?

A

barium enema, air contrast enema, surgery

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19
Q

What is Meckel Diverticulum?

A

congenital, a slight bulge in the small intestine present at birth and a remnant of the omphalomesenteric duct; often asymptomatic

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20
Q

When does Meckel Diverticulum become problematic?

A

when mucosa has gastric cells that secrete HCl in an improper area (ileum) causing ulceration and bleeding

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21
Q

pt has PAINLESS PASSAGE of maroon/MELANOTIC STOOL, SHOCK secondary to acute bleeding, ANEMIA, intestinal obstruction/volvulus, perforation resulting in peritonitis, and chronic recurrent abdominal pain. what do you suspect?

A

Meckel Diverticulum

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22
Q

How is Meckel Diverticulum treated?

A

surgical resection

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23
Q

what is the most common cause of abdominal pain in children?

A

constipation

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24
Q

if infants below 3 months old are grunting/straining with passage of soft stools, what should be done?

A

nothing, this is normal

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25
what are complications of constipation?
anal fissures, fecal retention leading to encopresis (fecal soiling), dysfunctional voiding
26
4-7 yr old has hard stools and stool is palpable on PE, what do you suspect?
constipation
27
what are treatment options for constipation?
increased fluids/fiber- add prune juice (1 tsp/oz formula/breastmilk) Miralax 1g/kg once daily establish regular toileting times
28
what is the fiber recommendation for children?
5g + age (yrs)
29
what is encopresis?
involuntary fecal soiling in child >4 yrs old (more prevalent in boys)
30
what is retentive encopresis?
most common stool retention leads to constipation --> fecal impaction, leakage of liquid feces around impaction large, infrequent stools (painful defacation)
31
what is continuous encopresis?
no hx of achieving primary bowel control (e.g., spina bifida)
32
what is discontinuous encopresis?
loss of normal bowel control occurs in response to episodic stress (shit your pants)
33
what are associated findings of encopresis?
``` large fecal mass palpable in rectum occult blood pilonidal dimple absent "anal wink" lower extremity weakness ```
34
what is the treatment for encopresis?
miralax 1-2 caps w/ 8 oz water daily (may add senekot) increase fiber encourage routine postprandial toilet sessions positive reinforcement for successes
35
what are causes of chronic recurrent abdominal pain (CRAP)?
constipation stress/school phobia/anxiety family hx
36
child presents with central abdominal pain of variable duration and intensity during the day. this has not impacted their physical activity. PE and lab testing are normal. what do you suspect?
CRAP
37
what is the treatment for CRAP?
increase fiber decrease lactose coping strategies for stressors may consider tricyclic antidepressants or stool softeners reserve antispasmodic meds (hycoscyamine) for IBS
38
when should a child w/ CRAP be referred to a specialist?
``` weight loss nocturnal pain focal pain GI bleeding vomiting fever arthritis family hx of IBD or ulcers ```
39
happy spitting is normal until what age?
18 months
40
regurgitation with inadequate weight gain may be caused by what?
cow's milk protein intolerance
41
what are treatment options for regurgitation and irritability in an infant?
frequent, smaller feedings and thickened feedings w/ rice cereal trial eliminating cow's milk protein from infant/mother upright positioning avoid tobacco smoke exposure
42
in infants and toddlers with mild esophagitis/significant symptoms, what is the tx?
trial acid suppression meds for 2 weeks
43
in infants and toddlers w/ moderate-severe esophagitis documented w/ endoscopic biopsies, what is the tx?
3-6 months PPI
44
what should you treat an older child w/ mild/infrequent heartburn?
antacids/histamine type 2 receptor antagonists (famotidine) PRN
45
what should you treat an older child w/ moderate-severe heartburn?
trial 4-8 wks PPI
46
what should you treat an older child w/ mild esophagitis?
4-8 wks PPI
47
what should you treat an older child w/ erosive esophagitis?
3-6 months PPI
48
what should you treat an older child w/ persistent moderate-severe asthma AND symptoms suggesting GERD?
3 months PPI trial (GERD can exacerbate asthma)
49
What's the difference between PPIs and H2RAs?
PPIs can take up to 4 days for full acid suppression, but keeps pH higher and longer (better healing of esophagitis) and doesn't lose effectiveness
50
what are H2RA drugs?
famotidine (pepcid) and cimetidine (tagamet)
51
What are adverse affects of acid suppressors?
HA, diarrhea, constipation, nausea B12, calcium malabsorption may increase infectious risk
52
when are prokinetic agents recommended?
GENERALLY NOT RECOMMENDED d/t adverse affects | cisapride, erythromycin, metoclopramide, baclofen
53
what prokinetic agent can be considered for trial prior to anti-reflux surgery in children?
baclofen
54
can antacids be used in infants?
NO
55
can antacids be used in children/adolescents?
can be used short-term aluminum can increase risk of bone disease magnesium typically causes diarrhea
56
why is sucralfate not recommended in pediatrics?
Al toxicity, minimal efficacy
57
what are risks of anti-emetics in pediatrics?
sedation, respiratory depression, extrapyramidal symptoms, lack of data
58
which anti-emetic is first line therapy?
ondansetron (zofran)
59
what are adverse effects of ondansetron?
headache, QTc prolongation | may increase diarrhea in gastroenteritis
60
which anti-emetics have a BW warning and should be avoided?
promethazine and metoclopramide
61
what are the adverse effects of promethazine?
respiratory depression, over-sedation may be fatal can cause extrapyramidal symptoms
62
when should anti-diarrheal agents be d/c'd?
if no benefit w/in 24-48 hrs
63
what are adverse effects of anti-diarrheal agents?
abdominal distention, ileus, toxic megacolon | xerostomia, dry skin
64
when should anti-diarrheal agents be avoided?
in pts <3 yrs of age for acute gastroenteritis
65
loperamide is contraindicated in?
pts <2 yrs d/t cardiac adverse rxns (Torsades des pointes) enterocolitis caution w/ bloody diarrhea and high fevers
66
what is the dosing for loperamide (imodium)?
0.08-0.24 mg/kg/day divided in 2-3 doses per day
67
what anti-diarrheal medication is not recommended in children <6 yrs old?
diphenoxylate/atropine (lomotil)
68
what agents can be used for constipation treatment in infants?
glycerin (tolerance may develop) lactulose polyethylene glycol (miralax)
69
what is the dosing for glycerin in infants?
0.5-1 pediatric suppository daily PRN
70
what is the dosing for lactulose in infants?
1 ml/kg/day added to formula
71
what is the dosing for polyethylene glycol (miralax) in infants?
0.2-0.8 g/kg/day OR 4.25 g (1/4 cap) mixed in 2 oz fluid daily PRN
72
what is the dosage of polyethylene glycol (miralax) for disimpaction?
1-1.5 g/kg daily (max 17g)
73
what population should sodium phosphate enemas be avoided in?
children <2 yrs old
74
what is the recommended dosage of polyethylene glycol (miralax) in children ages 2-4 yrs?
8.5g (1/2 cap) mixed in 4 oz fluid 1-2x/day
75
what is the recommended dosage of polyethylene glycol (miralax) in children ages 5+ yrs?
17g (1 cap) mixed in 8 oz fluid 1-2x/day
76
what is the recommended dosing of lactulose in children ages 2 yrs and up?
1-2g/kg 1-2x/day

Pediatrics (7 decks)

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