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Disciplines II, Final Exam > Peds GI Disorders > Flashcards

Peds GI Disorders Flashcards

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1
Q

What is Esophagreal atresia?

A

blind esophageal pouch w/ or w/o a fistulous connection between the proximal or distal esophagus & trachea

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2
Q

Clinical Presentation of Esophagreal Atreasia

A

Polyhydramnios (excess amniotic fluid)infants in the 1st few hrs of life w/ copious secretions, choking, cyanosis & respiratory distress

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3
Q

What imaging test is best used for Congenital Tracheoesophageal Fistulas and Esophageal Atresia

A

U/S followed by MRI

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4
Q

How does TE fistulas present on X-ray vs EA?

A

TE fistula distal to the esophagus = gas PRESENT in bowel

EA WITHOUT TE fistula = NO gas seen in bowel

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5
Q

Treatment of Congenital Tracheoesophageal Fistulas and Esophageal Atresia

A

NG tube in proximal pouch on low intermittent suction elevate head of bed to prevent reflux
IV glucose & fluids
O2
Surgery

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6
Q

What is the most common FB ingested? How do these present on CXR if in the esophagus or trachea?

A

CoinsSee slide 9

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7
Q

Treatment for button battery ingestion?

A

Requires endoscopic retrieval if lodged in the esophagusIf in stomach,

watch for 24-48 hours to see if it passes if not, must be removed endoscopically

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8
Q

What happens in magnets are ingested in a child and how is it treated?

A

multiple magnets can lead to fistula formation w/in bowel wall… these need surgical intervention!

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9
Q

Difference between GER vs GERD

A

GER: Reflux of gastric contents into the esophagus

GERD: present when reflux causes secondary sx or complications

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10
Q

What situations cause GER?

A

Occurs during relaxation of of LE sphincter small stomach capacity
large volume feedings
short esophageal length
supine positioning

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11
Q

Treatment for GER?

A

Usually benign expected to resolve by 12-18mo of life

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12
Q

What GER symptoms are concerning

A 
When infants develop sx like FTT, 
food refusal, 
pain, 
GI bleeding, 
upper or lower airway sx, etc. 
GER becomes GERD
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13
Q

What Symptoms are seen with GERD in older children?

A

Older children = heartburn, dysphagia

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14
Q

What are complications seen with GERD?

A

esophagitits recurrent pneumonia, recurrent cough dental erosions

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15
Q

How is GERD treated?

A

Reflux usually resolves 85% of time in infants by 12 mo
Can use thickened foods with oat cereal
Milk free and soy free diet
PPI medicines have shown better improvements

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16
Q

What risk is associated with given a PPI with infants?

A

risk for infection

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17
Q

What are the 2 most common complications of Eosinophillic Esophagitits (EoE)

A
  1. esophageal food impactions

2. esophageal stricture

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18
Q

How is EoE diagnosed?

A

Endoscopy

esophageal mucosa w/ thickening, mucosal fissures, strictures & ringsesophagus sprinkled w/ pinpoint white exudates (resembles candida)white spots composed of eosinophils

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19
Q

How is Eosinophilic Esophagitits treated?

A

elimination of food allergens

swallowed topical steroids (MDI)2 puffs of Fluticasone BID

Do NOT rinse mouth (unlike w/ asthma) & avoid eating for 30min to improve effectiveness

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20
Q

What is Pica?

A

Persistent eating of nonnutritive substances Animal feces, Clay, Dirt, Hairballs, Ice, Paint, SandAt least 1 month

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21
Q

What labs should be order to determine PICA?

What is the treatment?

A

CBC
Zinc levels
Lead levels

Tx: Address nutrient deficiency or lead poisoning
Behavioral therapy and family education

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22
Q

What is Rumination?

A

Repeated regurgitation and re-chewing of food At least 1 month

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23
Q

complications of Rumination?

A 
Associated with depression and eating disorders
Malnutrition
Failure to thrive
Weight loss
Bad breath
Tooth caries
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24
Q

Malabsorpion

A

slide 22

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25
Malabsorption
slie 23
26
What is the Most common inborn error of amino acid metabolism How is this caused?
Phenylketonuria (PKU) Decreased activity of phenylalanine hydroxylase (enzyme that converts phenylalanine to tyrosine)
27
Clinical Presentation of PKU Which is the MC finding?
Intellectual disability (the most common finding overall) ``` Fair skin and hair (impairment of melanin synthesis) Atopic dermatitis hyperactivity seizures Musty or mousy odor to body & urine Epilepsy (50%) ```
28
How can PKU be managed How much phenylalanine should be consumed ideally?
Dietary restriction of phenylalanine and aspartame Goal is <6mg/dL phenylalanine a day Tyrosine supplementation Elimination of all high-protein foods (meat, dairy, nuts, legumes)Restrict starches
29
MC food allergy in peds?
Cow's milk (12%)
30
What is the MC presentation of a Food allergy?
Skin: Urticaria and angioedema  (most common)
31
How are Food allergies diagnosed?
In vivo IgE against a specific food (skin testing) In vitro for specific IgE - RAST (radioallergosorbent testing ) -FEIA (fluorescent-enzyme immunoassay) Removal and re-challenge Clinical reactivity vs IgE antibodies
32
Treatment for Food allergies?
Avoidance and re-introduction annuallyEpinephrineH1 blockers
33
What is Celiac disease? | What are signs and symptoms?
Immune mediated enteropathy triggered by glutenabdominal pain, diarrhea, vomitingabdominal bloating or distention sometimes constipation
34
What are GI complications that occur with Celiac disease?
chronic diarrhea, abdominal distention, irritability, anorexia, vomiting, poor weight gain
35
What are non-GI complications that occur with Celiac disease?
delayed puberty or short staturedelayed menarche think CD w/ unexplained Fe def anemia
36
How is Celiac's Diagnosed? | How can it be treated?
Diagnosis: serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes) Tx: gluten restriction for life (wheat, rye & barley)
37
Essentially what is Omphalocele and Gastroschisis
Abdominal wall defects
38
What is Omphalocele?
Membrane covered herniation of the abdominal contents into the base of the umbilical cord
39
What is an GastroschisisWhat is the reason for incrased incidence of these?
Uncovered (no sac) intestine through small abdominal wall defect to the right of the umbilical cord Why?illicit drugs like meth & cocaine possible link w/ aspirin & ibuprofen use during pregnancy young maternal age
40
How does someone with Diaphramtatic Hernia present?
``` Respiratory distress - intestines poking through to the lungs Retractions, cyanosis, grunting respirations Scaphoid abdomen, barrel-shaped chest ```
41
How does someone with Diaphragmatic hernia present on CXR
bowel loops seen in chest w/ mediastinal shift to opposite side on CXR
42
How is a Diaphragmatic hernia treated?
intubation, mechanical ventilation & decompression of the GI tract w/ OG tube
43
What are Indirect hernia? Who are they most common in? What side is it most common?
Passes LATERAL to the deep epigastric vessels Follows tract THROUGH the inguinal canal (goes “IN” the “Inguinal canal”) Mostly male (9:1) More common than direct & most common in childrenMC on the right side
44
What is a Direct hernia? Where are these located?
Passes MEDIAL & INFERIOR to the deep epigastric vessels Does NOT go through the inguinal canal Hesselbach triangle RARE in children
45
What are Femoral hernias? Where are they located? Who are these most common?
Follows the tract below the inguinal ligament through the femoral canalMedial to the femoral vein and lateral to the lacunar ligamentMost common in females
46
Who are umbilical Hernias most common?
More common in full term, African American infants
47
What is Pyloric Stenosis?
Postnatal muscular hypertrophy of the pylorus | Progressive gastric outlet obstruction
48
What is the MC presenting symptom of Pyloric Stenosis?
projectile postprandial vomiting
49
What is a Hallmark sign on physical exam that indicates Pyloric Stenosis?
Hallmark sign: olive mass "stenosis" (mass in RUQ esp. after vomiting)
50
What imaging is best used to diagnose Pyloric Stenosis?
Ultrasound
51
What would be seen on Barium upper GI for pyloric Stenosis?
String sign- indicating the elongated narrowed pyloric canal
52
What is a genetic cause of Duodenal atresia?
Associated with Trisomy 21 (30%)
53
What findings will see on CXR with Duodenal atresia?
"Duodenal-Double bubble"Double-bubble sign (on abdominal xray) Dilated stomach & proximal duodenum
54
What is a sign that is seen right after birth in an infant with duodenal atresia?
Bilious vomiting hours after birth
55
What is Short Bowel syndrome?
A condition resulting from reduced intestinal absorptive surface
56
What is Intussusception?
Telescoping of one segment of the intestine into another segment
57
What are signs of Intussusception?
Passage of rectal blood and mucous“Red current jelly”- pathognomonicPalpable right-sided sausage-shaped massAbsent right-sided and cecal gas shadow on abdominal x-ray
58
What is seen on abdominal x-ray with Intussusception?What imagining test is most sensitive for Intuussusception?
“target sign” (2 concentric radiolucent circles superimposed)Ultrasound
59
What is the best therapeutic approach with Intussusception?
Air enema is the BEST therapeutic approach in the stable pt
60
What is Meckels Diverticulum?
Outpouching or bulge lower part of the small intestineLeftover umbilical cord
61
What is MC congenital anomaly of the GI?
Most common congenital anomaly of the GI tract
62
How do you treat Jaundice?
Treatment by exposure to bright lights – phototherapy
63
What affect does CF have on the pancrease?Intestine affects?
fat soluble vitamin deficiency intussception, rectal prolapse, carb intolerance
64
Cystic Fibrosis
Oral supplementation of pancreatic enzymes improves digestion
65
What is Pilonidial Cysts
Infection of the skin or subcutaneous tissue at or near the upper part of the natal cleft of the buttock
66
Treatment for Pilonidial cysts?
Soaking in warm water ease pain of pilonidal cystsSurgical opening and draining of the infected sinus
67
What signs and symptoms of Pinworms?
Worms in the stool or eggs on perianal skinintense anal pruritus - kids will scratch at the butt and contaminate fingers
68
Diagnosis for for Pinworms?Treatment for pinworms? What instructions need to be followed?
Scotch tape testOTC: Pyrantel pamoate Instructions: treat all household members at the same time to prevent reinfections repeat therapy after 2 weeks
69
What is Encopresis?
Repeated passage of feces into inappropriate places due to children not fully developing bowel control
70
How is Encopresis treated?
Behavioral-educational treatment of encopresis:1) Educating both child and parents about the disorder and its relation to regular bowel action2) Designing a feasible program of consistent toilet use3) Positive reinforcements for successful use of the toiletScheduled toileting shortly after meals- gastrocolic reflux
71
What pharmacotherapy can be used to treat Encopresis?
Initially – suppositories and enemasMiralax usually better
72
HOw is Constipation defined?
Chronic constipation is defined as 2 or more of the following characteristics for 2 months:1) < 3 BMs per wk2) > 1 episode of encopresis per wk3) impaction of the rectum w/ stool4) passage of stool so large it obstructs the toilet5) retentive posturing & fecal witholding6) pain w/ defecation
73
How is constipation treated?
diet changes “P” fruitsMedications:Miralax (polyethylene glycol) 0.8-1g/kg/dLactulose 1-2g/kg/dMilk of Magnesia

Disciplines II, Final Exam (4 decks)

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