Peds GI uworld Flashcards by william hennrikus

episodic crying, emesis, bloody stool, lethargy in young child think…

intussusception - reducing and recurring

How well did you know this?

Not at all

Perfectly

how will abdominal pain manifest in non-verbal child

crying and drawing legs to abdomen

How well did you know this?

Not at all

Perfectly

currant jelly stool suggests…

bowel ischemia

How well did you know this?

Not at all

Perfectly

dark and sticky loose stool with streaks of blood think…

currant jelly stool

bowel ischemia

How well did you know this?

Not at all

Perfectly

diagnosis
treatment
of intussusception

ultrasound-guided air contrast enema
(diagnostic and therapeutic… choice)

some places saline enema

if diagnosis less certain, can just ultrasound first

How well did you know this?

Not at all

Perfectly

peds intussusception
path
pres
dx
tx

telescoping bowel, periodic, ischemia, infarct

young child episodic crying, emesis, bloody stool (currant jelly), lethargy

ultrasound-guided air contrast enema
(diagnostic and therapeutic)
vs if dx uncertain can US for target sign, sausage sign

How well did you know this?

Not at all

Perfectly

why is abdominal CT with contrast not the study of choice for peds intussusception

time-consuming (compared to US)
radiation exposure

us guided air contrast enema is diagnostic and therapeutic

How well did you know this?

Not at all

Perfectly

anorectal manometry
what does it analyze
common use in peds

analyses motility and pressure in distal bowel

for Hirschsprung disease

How well did you know this?

Not at all

Perfectly

presentation of Hirschsprung disease

neonate with delayed meconium passage or bilious emesis

less commonly enterocolitis in older infant with chronic constipation

How well did you know this?

Not at all

Perfectly

risk with enema reduction of telescoped bowel

is the risk high or low

low risk of intestinal perforation

How well did you know this?

Not at all

Perfectly

why isn’t barium enema preferred to dx and tx intussusception

current preference

because if rare case of leak/perf barium can cause peritonitis

so air contrast enema preferred now

How well did you know this?

Not at all

Perfectly

technetium-99m scan
aka...
how does it work...
used to dx...
general presentation of that dx...

aka Meckel scan
identifies ectopic gastric tissue
used to dx Meckel diverticulum
which presents with painless rectal bleeding in child typically

How well did you know this?

Not at all

Perfectly

intussusception is a pediatric emergency

rapid dx and tx w ultrasound-guided air contrast enema is critical for avoiding ischemia and peritonitis

How well did you know this?

Not at all

Perfectly

ddx for neonate with delayed passage of meconium
and differentiation according to:
associated disorder
typical level of obstruction
meconium consistency
squirt sign

hirschsprung - downs, rectosigmoid obstruction, normal meconium, positive squirt sign

meconium ileus - cystic fibrosis, ileal obstruction, inspissated (thickened/congealed) meconium, negative squirt sign

How well did you know this?

Not at all

Perfectly

hirschsprung aka

congenital aganglionic megacolon

How well did you know this?

Not at all

Perfectly

what percent of healthy, full-term infants pass stool within 48 hours of birth

what to suspect if this is not happening

99%

suspect hirschprung or meconium ileus if no stool in 48 hours

How well did you know this?

Not at all

Perfectly

how to differentiate hirschsprung from meconium ileus

level of obstruction
hirschprung colon, meconium ileus ileum

meconium consistency
hirschsprung normal, meconium ileus inspissated (thickened/congealed)

squirt sign
positive hirschsprung, negative meconium ileus

How well did you know this?

Not at all

Perfectly

the earliest life-threatening manifestation of cystic fibrosis

meconium ileus

How well did you know this?

Not at all

Perfectly

meconium ileus is virtually diagnostic of CF

How well did you know this?

Not at all

Perfectly

basic 1-sentence pathophys of CF

mutation in CF transmembrane conductance regulator gene causes abnormal chloride and sodium transport and thick, viscous secretions in multiple organs

How well did you know this?

Not at all

Perfectly

pathophys of meconium ileus

CF
thick, inspissated meconium difficult to propel
ileal obstruction

How well did you know this?

Not at all

Perfectly

upright abdominal xr in meconium ileus

Study These Flashcards

multiple dilated loops of small bowel with paucity of air in narrow underdeveloped microcolon

baby pt has meconium ileus,
what comorbidity of underlying condition are they most likely to develop?
what likely treatment?

Study These Flashcards

chronic rhinosinusitis
(meconium ileus is virtually diagnostic of CF, and nearly all patients with CF develop sinopulmonary disease)
likely to need surgical debridement of sinuses when sx develop

what is “squirt sign”

what does it suggest in baby?

Study These Flashcards

forceful expulsion of stool after rectal exam

suggests hirschsprungs

hirschsprung underlying dz assoc comorbiditis to expect

alzheimer | hypothyroidism

% and pathophys of infertility in CF

men - almost all infertile from congenital absence of vas deferens women - 20% infertile from secondary amenorrhea from malnutrition and thick cervical mucus obstructing sperm entry

% and pathophys of sensorineural hearing loss in CF

20% sensorineural hearing loss from frequent treatment with aminoglycosides for gram-negative infections (e.g. pseudomonas aeruginosa)

inspissated means

thick/congealed

manage child who ingested battery

get xr if in esophagus, likely lodged, so immediate endoscopic removal to prevent esophageal erosion if in stomach, 90% pass uneventfully so observe to confirm excretion and/or follow with radiographs as necessary

normal CSF cell count

0-5 /mm^3

normal CSF glucose

40-70 mg/dL

normal CSF pressure

70-180 mm H2O

normal CSF protein

v40 mg/dL

``` normal CSF cell count glucose pressure protein ```

cell count 0-5 /mm^3 glucose 40-70 mg/dL pressure 70-180 mm H2O protein v40 mg/dL

``` Reye syndrome etiology presentation clinical features (what organs affected) lab findings treatment ```

aspirin (salicylates) to kid during influenza or varicella infection vomiting, abnormal behavior... then seizures, lethargy acute liver failure encephalopathy inc AST ALT PT INR PTT NH3 maybe dec glucose from use and depletion supportive tx

NH3 aka

ammoniA

is acute liver failure and encephalopathy in Reye syndrome rapid or slow onset?

rapid onset

major cause of death in Reye syndrome

encephalopathy --- elevated iCP

anticholinergic toxicity most common drug presentation

diphenhydramine overdose dry mouth and skin blurry vision hyperthermia urinary retention

hep A infection top 3 presenting symptoms top 3 labs

fever, vomiting, diarrhea elevated LFTs - AST ALT bilirubin

5 risk factors for celiac

``` first degree FH celiac down syndrome autoimmune thyroiditis type 1 diabetes selective IgA deficiency ```

celiac dz symptoms 4 GI 3 not GI

abdominal pain flatulence/boating diarrhea (rarely constipation) nausea/vomiting short stature / weight loss iron deficiency anemia dermatitis herpetiformis

diagnose celiac

inc tissue transglutaminase IgA inc anti-endomyseial antibodies inc intraepithelial lymphocytes and flattened villi on Duodenal biopsy

``` celiac disease path risk factors symptoms diagnosis ```

immune-mediated hypersensitivity to gluten - imparied nutrient absorption in proximal small intestine first degree FH celiac, down syndrome, autoimmune thyroiditis, type 1 diabetes, selective IgA deficiency abdominal pain, flatulence/boating, diarrhea (rarely constipation), nausea/vomiting, short stature / weight loss, iron deficiency anemia, dermatitis herpetiformis inc tissue transglutaminase IgA, anti-endomyseial antibodies, intraepithelial lymphocytes and flattened villi on Duodenal biopsy

labs consistent with iron deficiency anemia

``` microcytic anemia (low Hb, low MCV) low ferritin ```

how does celiac pt get iron deficiency anemia

impaired nutrient absorption from villous atrophy in Proximal Small Intestine aka DUODENUM where iron is absorbed I'm on faceBook Do join In (Iron abdorbed in Duodenum, B12 absorbed in Ileum?)

dermatitis herpetiformis describe food allergy association

pruritic papular or vesicular rash on knees, elbows, forearms, buttocks celiac disease

fatigue, weight loss, itchy papular/vesicular rash on knees, elbows, forearms, bottocks, iron deficiency anemia... think... next step in workup... and next step if that one is positive...

celiac disease (allergic duodenal inflammation and villous atrophy, poor iron and other nutrient absorption, dermatitis herpetiformis) anti-tissue transglutaminase antibody assay followed by endoscopic duodenal biopsy for confirmation

in general, what kinds of lab findings might make you consider a bone marrow biopsy

abnormal peripheral cell counts | e.g. pancytopenia, leukocytosis

confirm suspicion of iron deficiency

``` microcytic anemia (low Hb low MCV) low ferritin ```

when to consider hemoglobin electrophoresis for microcytic anemia

to exclude thalassemia and other hemoglobinopathies after iron deficiency anemia ruled out with a normal or elevated ferritin

what should be followed every 1-2 years in patients with type I diabetes

TSH for autoimmune thyroiditis

fatigue, anemia, hair loss, brittle nails, constipation in type I diabetic... think... 1st step in workup...

autoimmune hypothyroidism TSH

Peds GI uworld Flashcards

(53 cards)