Peds - Gastrointestinal Flashcards by Paige Lucarelli

Gastroenteritis defined

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

Caused by acute irritation/inflammation of the gastric mucosa

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Most common cause of gastroenteritis?

other causes?

Viral causes

Especially ROTAVIRUS

bacterial
parasitic
inorganic food contents
emotional stress

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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)

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Classification of dehydration #

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

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Diagnostics for gastroenteritis

None unless bloody stools or persists beyond 72 hours

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

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

after 2 negative stool cultures

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Management of gastroenteritis #

Oral rehydration therapy

moderate: 50 mL/hr
severe: 100 mL/hr

Resume regular diet gradually

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Should anti-motility drugs be used for gastroenteritis?

Generally avoided.

Can prolong illness.

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When is ABT considered for gastroenteritis?

8 - 10+ stools per day

when bacterial cause is isolated

when symptoms are not resolving

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First line ABT for gastroenteritis?

Trimethoprim/sulfamethoxazole (TMP/SMZ)

aka BACTRIM

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Pediatric GERD -

3 classifications

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

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By what age does GERD typically resolve?

18 months

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GERD -

What causative agent should be suspected in children of color?

H. pylori

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GERD - signs and symptoms

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

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GERD - diagnostics

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

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GERD - in infants

non-pharmacologic management

small, frequent meals
burp often
continue breastfeeding
weighted formula
medication

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GERD - pharmacotherapy

first line - H2 antagonist (blocker)

if needed, add PPI and refer

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H2 antagonist examples

“histamine –> -tidine”

ranitidine (Zantac)
famotidine (Pepcid)

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PPI example

omeprazole (Prilosec)

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PPI may cotribute to what condition

anemia

others? <

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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

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Pyloric stenosis -

symptom

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

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Pyloric stenosis -

diagnostics and management

ultrasound

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

surgery has very good success

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Intussuception -
description?
age?

telescoping of one part of the intestine onto itself

“baby disease” - up to 2 years

can be fatal

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Intussuception - | symptoms

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

Intussuception - | diagnotics and management

radiograph barium enema (may produce reduction) surgery

Hirschprung's disease AKA? sequelae?

aganglionic megacolon enterocolitis may develop; can be FATAL

Hirschprung's disease - | symptoms

``` BILIOUS vomiting (serious) infrequent, explosive BM ```

Hirshprung's disease - | diagnostics

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

Appendicitis - | SIGNS

PROM Psoas Rebound Obturator McBurney's Point

Appendicitis - | symptoms

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

Psoas sign

pain with R thigh extension | positive for appendicitis

Obturator sign

pain with internal rotation of R thigh | positive for appendicitis

McBurney's point tenderness

1/3 the distance from iliac crest to umbilicus

Appendicitis - | diagnostics

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

Malabsorption - | possible causes

cystic fibrosis celiac disease IBD hepatic disease

Celiac disease - | AKA

sprue

Malabsorption - | signs and symptoms (5)

``` severe, chronic diarrhea steatorrhea cheilosis fatigue pallor ```

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

Celiac disease must avoid what?

wheat, oats, rye, barley

CF treatment (2)

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

Neuroblastoma - | what is typical age?

Prior to Kindergarten

Neuroblastoma - | description

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

Neuroblastoma - | signs and symptoms (4)

profuse sweating tachycardia enlarged abdominal mass failure to thrive

Neuroblastoma - | diagnostics and treatment (4)

``` urine catecholamines (elevated) abdominal CT surgical biopsy ``` refer to pediatric oncologist

Examples of catecholamines? (3)

epinephrine (adrenaline) norepinephrine dopamine

Hepatitis in pediatric population?

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

Hep A - transmission route frequent sources of infection

oral -fecal contaminated water and food, esp. raw shellfish

Hep A - | incubation period

2 - 6 weeks blood and stool are infectious during this time

Can Hep A become chronic?

No | chronic carrier state does not exist

Hep B - | transmission route

blood and body fluids - saliva, semen, vaginal secretions spread by contact with blood, sexual activity, and mother to fetus

vertical transmission

transmission from mother to fetus/baby during pregnancy or childbirth

Hep B - | incubation period

6 weeks to 6 months

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

Hep B

Can Hep B become chronic?

Yes, Hep B can cause ACUTE and CHRONIC disease

Hep B - | mortality rate

risk of fulminant hepatitis is <1% BUT when it occurs, mortality is 60%

Hep C - | transmission route

blood - transfusion, IV drug use Risk of sexual transmission is small, vertical transmission rare

Hep C - | incubation period

4 weeks to 3 months

Hepatitis - | pre-icteric symptoms

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

Hepatitis - | icteric symptoms

``` jaundice clay colored stool dark urine pruritis weight loss RUQ pain ```

Hepatitis - | additional symptoms

low grade fever | hepatosplenomegaly

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

Anti-HAV, IgM

Active Hep A IgM = iMmediate infection

Anti-HAV, IgG

Recovered Hep A IgG = Gone infection

HBsAg, HBeAg, Anti-HBc, IgM

Active Hep B ``` HBsAg = surface antigen HBeAg = envelope -->> ACTIVE REPLICATION Anti-HBc = core ``` IgM = iMmediate infection

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

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

Anti-HBc, Anti-HBsAg

Recovered Hep B or Immunized against Hep B

Anti-HCV, HCV RNA

Indicates both acute and chronic Hep C | there is no recovery

Hepatitis management

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

Bilious vomitus suggests:

obstruction below the ampulla of Vater

Peds - Gastrointestinal Flashcards

(70 cards)