Problems In Digestion Peds Flashcards
Cleft lip (CL) and palate (CLP)
May be partial, complete, unilateral, bilateral. Incomplete fusion of nasomedial and intermaxillaey processes, in fourth week of embryonic development. Feeding difficulties are most significant clinical manifestation, due to inability to generate negative pressure needed for sucking. Also may be swallowing difficulty. May require feeding and swallowing consultation with specialist, special bottles with nipples, breast-feeding may be possible. Orthodontic prosthesis for roof of mouth may help with sucking.
Esophageal malformations
Atresia is most common. Five types, varying connections or fistulas with trachea. Excess amniotic fluid may be seen on US if fetus cannot swallow in utero. At birth, drooling, inability to swallow secretions, choking with feeding, respiratory distress, in ability to pass OG tube may be present. Abdomen may fill with air and become distended. Trouble breathing and intermittent cyanosis may occur. Late complications can include stricture, reflux, dysphasia, chronic cough, dyspnea on exertion. Could also have recurrent aspiration, pneumonia, atelectasis. Need US, echo, vertebral and limb radiographs. Surgical repair usually needed.
Infantile hypertrophic pyloric stenosis
Most common cause of intestinal obstruction in infancy. More common in male infants. Acquired narrowing and distal obstruction of pylorus, common cause of postprandial vomiting. Occurs first few weeks or months after birth. May be genetic disposition. An infant who has fed well and gained weight begins to forcefully vomit nonbilious food after eating. Then demands to be refed due to hunger. Will be irritable due to hunger
Constipation can occur due to little food reaching intestine. In severe and untreated cases, can lead to fluid and electrolyte imbalances, malnutrition,
Weight loss. Can be fatal in 4-6 weeks. Are usually irritable due to hunger, may have esophageal discomfort due to repeat vomiting and esophagitis. Vomitus may be red streaked with blood. Vomiting is different than reflux vomiting, which is not as forceful and occurs ten or more minutes after feeding. Pylorus may be palpable, a hard olive in right upper quadrant, some infants may show a visible gastric peristaltic wave after eating, US will show hypertrophied pyloric muscles and narrowed pyloric channel. Needs corrective surgery-laparoscopic pylorotomy and needs fluid and electrolyte corrections. Can usually tolerate feeding several hours post op
Duodenum, jejunum , ileum obstructions
Persistent vomiting likely indicates high intestinal obstruction.
Duodenal obstruction will cause upper abdominal distention, visible peristaltic waves, decrease in size and frequency of meconium stools, progressive weight loss, persistent vomiting, dehydration. Vomiting may be bilious, feeding difficulties may be present. Double bubble” is seen on ultrasound. Larger bubble is air in dilated stomach, smaller bubble is dilated proximal duodenum. Needs NPO, gastric decompression, surgery
Intestinal malrotation
Most common congenital anomaly of small intestine. Small intestine lacks normal posterior fixation, is only attached near origin of superior mesenteric artery. Colon remains in right upper quadrant and may be compressed or obstructed. Intestines twist on themselves, can cause infarct and necrosis of entire midgut. Classic symptoms are intermittent or persistent bile-stained vomiting after feeding and epigastric distention. Dehydration and electrolyte imbalance can occur rapidly, fever can start with scant stools and pain. Diarrhea and blood stools are associated with progressive volvulus, vascular compression and infarction of intestine. Needs upper GI imaging, exploratory lap.
What is Hirschsprung disease?
A congenital condition characterized by the absence of nerve cells in the muscles of the colon, leading to severe constipation or intestinal obstruction. Dx with rectal biopsy showing a sense of ganglion cells in submucosa of colon. Surgery is treatment, taking out aganglionic segments and “pulling thru” proximal bowel to anus.
True or False: Hirschsprung disease primarily affects adults.
False: It primarily affects infants and young children.
Fill in the blank: The main symptom of Hirschsprung disease is __________.
severe constipation or inability to pass stool.
What is the primary treatment for Hirschsprung disease?
Surgical removal of the affected segment of the colon.
Which genetic mutation is commonly associated with Hirschsprung disease?
Mutations in the RET proto-oncogene.
Meconium syndromes
Meconium is what fills intestines before birth. Dark green, odorless mass of desquamated cells, mucus, free fatty acids, pancreatic phospholipases, and bile. Usually discharged 12-48 hours after birth.
Aspiration syndrome- contaminates lungs, predisposes to infection, respiratory distress, can cause persistent pulmonary hypertension with shunting thru patent ductus arteriosus and foramem ovale
Meconium Ileus-sticky meconium that causes ileus in neonate. Is simple or complex…complex is surgical emergency and is associated with bowel atresia, volvulus, necrosis, perforation. Peristalsis cannot propel this extra sticky goo so it becomes impacted. Mortality increases with peritonitis.
If simple, warm saline enemas can fix.
What does GER stand for in the context of infant health?
Gastroesophageal reflux
True or False: GER is a common condition in infants.
True
Fill in the blank: GER occurs when stomach contents flow back into the ______.
esophagus
Which of the following is a typical symptom of GER in infants? A) Excessive crying B) Persistent cough C) Arching of the back D) All of the above
D) All of the above
What is the primary treatment approach for mild cases of GER in infants?
Dietary changes and positioning techniques
What does GERD stand for?
Gastroesophageal Reflux Disease
True or False: GERD is common in infants and can resolve as they grow older.
True
Fill in the blank: Symptoms of GERD in children may include ________ and regurgitation.
heartburn
What is a common diagnostic test for GERD in children?
Upper gastrointestinal (GI) endoscopy
Which lifestyle modification can help manage GERD symptoms in children?
Avoiding large meals before bedtime
What is intussusception?
Intussusception is a medical condition where a part of the intestine telescopes into an adjacent segment, causing obstruction.
Symptoms are bile green vomit, colicky intermittent pain, irritability, knees drawn to chest (to reduce pressure on intussusception) abdominal mass, vomiting, bloody stools (late sign.) may fall into heavy sleep between pain periods due to endogenous morphine release. Needs US, xray, sometimes enema reduction works and prevents ischemia. Surgery is needed if ischemic, perforated. Is fatal if not treated. It also may spontaneously reduce.
True or False: Intussusception can occur in both adults and children.
True
Fill in the blank: The most common age group affected by intussusception is _____ years old.
6 months to 3 years
