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Flashcards in Peds - Gastrointestinal Deck (70):
1

Gastroenteritis defined

Non-specific term for acute syndrome of nausea, vomiting, and diarrhea

Caused by acute irritation/inflammation of the gastric mucosa

2

Most common cause of gastroenteritis?

other causes?

Viral causes

Especially ROTAVIRUS

bacterial
parasitic
inorganic food contents
emotional stress

3

Examples of bacteria which may cause gastroenteritis and associated symptoms?
(4)

Salmonella
Campylobactor (particularly odorous stool)
Shigella (bloody stools, fever spikes, seizures)
E. coli (mild, loose stools)

4

Classification of dehydration #

mild (loss of 3 - 5 % of body weight)
moderate (loss of 6 - 9 %)
severe (loss of 10% or more)

5

Diagnostics for gastroenteritis

None unless bloody stools or persists beyond 72 hours

then:
Stool studies for guaiac, culture, ova and parasites
WBC

6

When can a child return to school after E. coli or Shigella?

after 2 negative stool cultures

7

Management of gastroenteritis #

Oral rehydration therapy
moderate: 50 mL/hr
severe: 100 mL/hr

Resume regular diet gradually

8

Should anti-motility drugs be used for gastroenteritis?

Generally avoided.

Can prolong illness.

9

When is ABT considered for gastroenteritis?

8 - 10+ stools per day

when bacterial cause is isolated

when symptoms are not resolving

10

First line ABT for gastroenteritis?

Trimethoprim/sulfamethoxazole (TMP/SMZ)
aka BACTRIM

11

Pediatric GERD -
3 classifications

physiological - infrequent, episodic vomiting
functional - painless, effortless vomiting
pathological - frequent vomiting with failure to thrive, aspiration pnuemonia

12

By what age does GERD typically resolve?

18 months

13

GERD -
What causative agent should be suspected in children of color?

H. pylori

14

GERD - signs and symptoms

obvious ones +
choking, coughing, wheezing
otitis media
dental erosion

15

GERD - diagnostics

CBC - r/o anemia
UA, UC
Stool for occult blood
Abdominal US - r/o pyloric stenosis

16

GERD - in infants
non-pharmacologic management

small, frequent meals
burp often
continue breastfeeding
weighted formula
medication

17

GERD - pharmacotherapy

first line - H2 antagonist (blocker)

if needed, add PPI and refer

18

H2 antagonist examples

"histamine --> -tidine"

ranitidine (Zantac)
famotidine (Pepcid)

19

PPI example

omeprazole (Prilosec)

20

PPI may cotribute to what condition

anemia
others? <

21

Pyloric stenosis -
description?
age?
typical infant?

"baby disease"

obstruction from thickening of pylorus (distal stomach)

usually from 3 weeks to 4 months of age

white male

22

Pyloric stenosis -
symptom

PROJECTILE vomiting (NON-bilious)
hungry afterward
palpable mass immediately after vomiting (pyloric olive)

23

Pyloric stenosis -
diagnostics and management

ultrasound

if not definative, upper GI imaging which commonly shows "string sign"

surgery has very good success

24

Intussuception -
description?
age?

telescoping of one part of the intestine onto itself

"baby disease" - up to 2 years

can be fatal

25

Intussuception -
symptoms

previously healthy infant develops sudden colicky pain
sausage shape mass in RUQ
current jelly stool (late)

26

Intussuception -
diagnotics and management

radiograph
barium enema (may produce reduction)
surgery

27

Hirschprung's disease
AKA?
sequelae?

aganglionic megacolon

enterocolitis may develop; can be FATAL

28

Hirschprung's disease -
symptoms

BILIOUS vomiting (serious)
infrequent, explosive BM

29

Hirshprung's disease -
diagnostics

radiograph - by FNP then refer to GI for:
barium enema
rectal colon biopsy
surgery

30

Appendicitis -
SIGNS

PROM

Psoas
Rebound
Obturator
McBurney's Point

31

Appendicitis -
symptoms

colicky, vague around umbilicus
shifts to RLQ
worsens with cough
nausea with up to 1-2 vomits
low grade fever

32

Psoas sign

pain with R thigh extension
positive for appendicitis

33

Obturator sign

pain with internal rotation of R thigh
positive for appendicitis

34

McBurney's point tenderness

1/3 the distance from iliac crest to umbilicus

35

Appendicitis -
diagnostics

WBC 10,000 to 20,000
ESR elevated
US or CT

36

Malabsorption -
possible causes

cystic fibrosis
celiac disease
IBD
hepatic disease

37

Celiac disease -
AKA

sprue

38

Malabsorption -
signs and symptoms (5)

severe, chronic diarrhea
steatorrhea
cheilosis
fatigue
pallor

39

Malabsorption -
diagnostics

Hint SBBBS

Wide net - many differentials
STOOL - BLOOD - BONE - BREATH - SKIN

- stool: culture, hemoccult, O&P
- blood: calcium, phosphorus, alkaline phosphatase, total protein, ferritin, folate, liver function tests
- bone age
- lactose and sucrose breath hydrogen testing --> H. pylori
- sweat chloride test --> CF

40

Celiac disease must avoid what?

wheat, oats, rye, barley

41

CF treatment (2)

pancreatic enzyme replacement
vits A D E K (fat soluble)

42

Neuroblastoma -
what is typical age?

Prior to Kindergarten

43

Neuroblastoma -
description

tumor arising from neural tissue
frequently from adrenal gland
can spread to bone marrow, liver, lymph nodes, skin, and orbits of eyes

44

Neuroblastoma -
signs and symptoms (4)

profuse sweating
tachycardia
enlarged abdominal mass
failure to thrive

45

Neuroblastoma -
diagnostics and treatment (4)

urine catecholamines (elevated)
abdominal CT
surgical biopsy

refer to pediatric oncologist

46

Examples of catecholamines? (3)

epinephrine (adrenaline)
norepinephrine
dopamine

47

Hepatitis in pediatric population?

A - B - C

until age 10, usually do not see icteric state (liver hasn't matured yet)

48

Hep A -
transmission route
frequent sources of infection

oral -fecal

contaminated water and food, esp. raw shellfish

49

Hep A -
incubation period

2 - 6 weeks

blood and stool are infectious during this time

50

Can Hep A become chronic?

No
chronic carrier state does not exist

51

Hep B -
transmission route

blood and body fluids - saliva, semen, vaginal secretions

spread by contact with blood, sexual activity, and mother to fetus

52

vertical transmission

transmission from mother to fetus/baby during pregnancy or childbirth

53

Hep B -
incubation period

6 weeks to 6 months

54

Does Hep A or Hep B tend to have more insidious onset?

Hep B

55

Can Hep B become chronic?

Yes, Hep B can cause ACUTE and CHRONIC disease

56

Hep B -
mortality rate

risk of fulminant hepatitis is <1%

BUT when it occurs, mortality is 60%

57

Hep C -
transmission route

blood - transfusion, IV drug use

Risk of sexual transmission is small, vertical transmission rare

58

Hep C -
incubation period

4 weeks to 3 months

59

Hepatitis -
pre-icteric symptoms

(almost like early pregnancy)
fatigue
malaise
anorexia
n/v
headache
aversion to certain odors
taste changes (salty tastes sweet, etc.)

60

Hepatitis -
icteric symptoms

jaundice
clay colored stool
dark urine
pruritis
weight loss
RUQ pain

61

Hepatitis -
additional symptoms

low grade fever
hepatosplenomegaly

62

Hepatitis -
diagnostics

CBC
UA - proteinuria, bilirubinuria
elevated AST and ALT - PRIOR to onset of jaundice

lactate dehydrogenase (LDH), bilirubin, alkaline phosphatate, and prothrombin test time are NORMAL or SLIGHTLY elevated

63

Anti-HAV, IgM

Active Hep A

IgM = iMmediate infection

64

Anti-HAV, IgG

Recovered Hep A

IgG = Gone infection

65

HBsAg, HBeAg, Anti-HBc, IgM

Active Hep B

HBsAg = surface antigen
HBeAg = envelope -->> ACTIVE REPLICATION
Anti-HBc = core

IgM = iMmediate infection

66

HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG

Chronic Hep B

IgM and IgG indicate that it's ongoing because it's iMmediate and Gone

67

Anti-HBc, Anti-HBsAg

Recovered Hep B or Immunized against Hep B

68

Anti-HCV, HCV RNA

Indicates both acute and chronic Hep C
(there is no recovery)

69

Hepatitis management

rest
increase fluids
Vit K for prolonged PT
avoid alcohol
low to no protein
rebetron (interferon and ribavirin) for Hep C

70

Bilious vomitus suggests:

obstruction below the ampulla of Vater