Peds gastrointestinal tract

Question 1

GerD

Answer 1

Eti: passage of aastric contents into the esophagus
S/sx: heartburn, regurg, dysphagia
Dx: HPI
Tx: Diet and life style, PPI

Question 2

Acute appendicits

Answer 2

Eti: obstruction of the appendix leading to inflammation and infection
Sx: Periumbical/epiG pain localizing to RLQ(Mcburney’s) becoming constant and worse with movement, rebound tenderness
Dx: CBC, uninalysis, abd CT, bedside US
Tx: Abx is primary treatment in uncomplicated cases

Question 3

Intussusception

Answer 3

Eti: idipathic
S/sx: abdominal pain, drawing up of the knees, V/D bloody bowel movements (CURRANT JELLY STOOLS). Sausage shaped mass palpated usually in mid upper abd.

Question 4

Pyloric stenosis

Answer 4

S/sx: projectile postprandial vomiting. Infants usually hungery and nurse avidly.
Olive shaped mass, a “string sign” or railroad track sign
Tx: US, barium swallow

Question 5

Hirschsprung disease

Answer 5

Colonic muscle cannot relax in front of a bowel due to absence of ganglionic cells in the colon.
S/sx; failure to pass meconium within 48 hrs, explosive diarrhea on DRE
Tx: surgical

Question 6

Volvulus

Answer 6

S/sx: Constant abd pain, no BM, distention, tympany, high-pitched bowel.
Bile-stained vomit
CXR: coffee bean sign
Barium enema: birds beak sign

Question 7

Celiac disease

Answer 7

Eti: Immune-mediated caused by sensitivity to gluten
S/sx :N/D/C, abd pain, distension, dermatitis herpetiformis, short stature, delayed puberty, iron def.
labs: IgA antibody to TTG and serum IgA, intestinal biopsy to confirm
Tx: gluten-free

Question 8

Lactase deficiency

Answer 8

S/sx: N/D/sometimes V, bloating, flatulence, cramping
Dx: trial elimination, lactose hydrogen test (rarely used)
Pt.ed: Highly associated with IBS

Question 9

Milk protein intolerance

Answer 9

Immun reaction to cows milk protein
S/sx: itchy eyes, nose, mouth, throat, blood or mucus in stool, vomiting, diarrhea, or constipation
Dx: IgE test, skin test, food challenge

Question 10

IBS

Answer 10

Pres; chronic (3d/mo x 3 month)
Abd discomfort/pain, that:
- relieved with defecation
- onset w/ change in frequency of stool
onset w/ a change in form of stool
S/sx: bloating and distension, , does not occur at night or interfere w/ sleep
Dx: exclusion of other dz

Question 11

Crohn’s disease

Answer 11

Chronic recurrent dz characterized by patchy transmural inflammation involving any segment of GI tract from the mouth to the anus.
S/sx: failure to thrive, intermittent low grade F, D, RLQ pain/tenderness

1/3: involve only small bowel, 1/2 cases involved small bowel and colon.

Dx: usually endoscopic findings, image studies with compatible clinical history.
- colonoscopy is the most appropriate initial test for those presenting with diarrhea, imaging may be more appropriate for those presenting with abd pain.

Question 12

Ulcerative colitis

Answer 12

Diffuse mucosal inflammation involving only colon.
Sx: Abd pain + bloody diarrhea

Do not do a colonoscopy in patients with fulminant disease.

Comp: toxic megacolon

Question 13

Juvenile polyps

Answer 13

S/sx: little bright red blood with mucus BM

Abd pain rare

Question 14

Reye syndrome

Answer 14

AKA fatty liver with encephalopathy
Rapidly progressive encephalopathy with hepatic dysfunction, often several days after apparent recover from viral illness (varicella or influenza)
RF: salicylate / aspirin in febrile children
S/sx: vomiting, confusion, rapid evolution to seizure and coma
Dx: hypoglycemia, increased AST, blood NH4, prolonged PT time.
Tx: supportive, manage cerebral edema
Pt. ed: do not use aspirin when treating a virus, or kids period. <18

Question 15

DDx pediatric acute liver failure

Sx:

Answer 15

Infections: 
Inheritied/ Metabolic: wilsons dz, tyrosinemia, galactosemia, iron storage dz.
Ischemia: congenital heart disease
Drug: acetaminophen, valproate
Immune
Vascular: Budd-chiari...

Sx: acute onset, jaundice, fever, anorexia, v/ abd pain, hyper-relexia, positive extensor plantar response