Peds GI Flashcards
(70 cards)
What are the concerns if there are high pitched bowel sounds?
early peritonoits
gastroenteritis
intestinal obstruction
What are the concerns if there are absence of bowel sounds?
peritonitis
intestinal obstruction
Which areas should be dull to percussion vs tympany?
dull along right costal margin 1-3 cm below margin of liver
What are the 4 peritoneal signs?
rebound tenderness
obturator sign - flex hip w/ knee bent, internal hip rotation
psoas- lying on left side flex and extend right leg
Rovsing’s sign- palpation of LLQ causes RLQ pain
What is Dunphy’s sign?
Increased abd pain with cough, appendicitis
Markle sign?
stand on tip toes and fall onto heels
Murphy’s sign?
Have p breathe in and out to check for hepatomegaly, then have them breathe deeply in again, if gallbladder is inflamed they will c/o pain or stop inhaling due to pain of inflamed capsule
What are the pediatric risk factors for dehydration?
- increased extracellular fluid % and increase in body water compared to adults
- increased basal metabolic rate
- increased body surface area
- immature renal function
- increased insensible fluid loss through temp elevation
Cause of isotonic/isonatremic dehydration?
simple diarrhea
fluid loss not balanced by intake, sodium and water loss equal
Cause of hypotonic/hyponatremic diarrhea?
massive loss of water nad salt in stool, oral replacement with water only
-sodium loss greater than water
Cause of hypertonic/hypernatremic diarrhea?
vomiting and diarhea with decreased water intake
-greater water loss than salt loss
What are the steps to calculate daily maintenance fluid requirements?
- weight in kg
- allow 100ml/kg for 1st 10kg
- allow 50ml/kg for second 10kg
- allow 20ml/kg for remaining body weight
- total daily maintenance
What are the rates of rehydration for mild, moderate, and severe?
Mild 40-50 ml/kg over 4 hours
Moderate 60-100 ml/kg over 4-6 hours
Severe NS or LR, 20ml/kg bolus
How should you hydrate as out patient for each episode of stool or vomiting?
Slowly for vomiting
10ml/kg for each episode
What should you rehydrate with?
Breast feed more often and shorter periods
Avoid: plain water, apple juice, soda, milk sports drinks
Give: pedialyte, or recipe for water sugar and salt
-Reintroduce bland solids after 4-6 hours
What is the age of onset for pyloric stenosis? Who is most likely to have?
1-18 weeks (average 3 weeks)
-most common in white, first born males
What is the most common cause of intestinal obstruction in infancy?
pyloric stenosis
What is the clinical presentation of pyloric stenosis?
Non-bilious emesis, 70% becomes projectile
- still hungry after emesis
- occurs post feed
- dehydration, malnutrition, jaundice
What may you be able to palpate in a baby with pyloric stenosis?
1-2 cm olive shaped mass along lateral edge of rectus abdominus in RUQ
- best palpated after baby has vomited and is calm
- gastric peristaltic waves may be visible prior to vomiting
How do you diagnose pyloric stenosis?
U/s (gold standard)
-EGD if diagnosis is unclear
How do you treat pyloric stenosis?
electrolyte and fluid replacement
Surgery- pyloromyotomy
What is primary vs secondary peptic ulcer disease?
Primary- duodenal
Secondary- gastric
Who is more likely to have PUD?
Boys 12-18 yo familial predisposition critical illness some medications stress
How is PUD treated?
- Antacids
- GER meds
- H. Pylori treatment
