Viral Gastroenteritis and Pyloric Stenosis Flashcards Preview

Pediatrics > Viral Gastroenteritis and Pyloric Stenosis > Flashcards

Flashcards in Viral Gastroenteritis and Pyloric Stenosis Deck (18):
1

Transmission of viral gastroenteritis

fecal to oral
best prevention: GOOD HANDWASHING
Young infants at greater risk of dehydration --> bring to medical attention promptly

2

Fluid therapy for dehydration?

IV Boluses with normal saline (isotonic)
- 20 mL/kg, up to 3 boluses before considering other therapies

3

Electrolyte abnormalities with pyloric stenosis

hypochloremic, hypokalemic metabolic alkalosis is the HALLMARK
- vomitting up all your chloride
- kidney tries to compensate for loss of H+ and sacrifices the K+ instead

4

Asses illness by telephone

Anyone else sick?
Significant abdominal pain?
What does emesis/diarrhea look like?
Fever?
Eating and drinking? How much?

5

Assess hydration status of kid by phone

Activity level?
Desire to intake fluids?

6

Determining degree of dehydration

weight loss in kg = water loss in L
weight loss in g = weight loss in mL
- also look at % loss

7

DDx for recurrent emesis in infant

GERD
Viral gastroenteritis
Malrotation +/- volvulus
Inborn Error of metabolism
Pyloric Stenosis
Intussusception
CNS disease
UTI

8

GERD

Regurg/spitting up may be the vomit
pain from reflux can lead to food aversion
FTT

9

Viral gastroenteritis

starts with isolated vomiting and progresses to watery stools
dehydration from fluid loss
bilious emesis not seen because above ligament of Treitz

10

Malrotation +/- volvulus

can lead to bowel obstruction
bilious emesis common and blood may be in stool
bowel ischemia can occur and cause significant abdominal pain
- can lead to shock and significant dehydration

11

Inborn error in metabolism

uncommon, can and should be considered
- can present with shock which may be seen as significant dehydration

12

Pyloric Stenosis

escalating pattern of projectile vomit (non-bilious)
- develop rapid dehydration due to inadequate fluid absorption (still have vigorous appetite)
- hypochloremic, hypokalemic metabolic alkalosis
- can lead to bloody emesis from Mallory-Weis tear
- visible peristaltic wave (palpable olive)

13

Intussusception

bilious emesis and crampy, severe abdominal pain
- currant jelly stools and pulling legs up to chest
- sausage mass due to telescoped bowel

14

CNS disease

hydrocephalus, intracranial neoplasm, and trauma should be considered but less common

15

UTI

important cuase of non-GI vomiting
- poor feeding, vomiting, fever --> dehydration

16

Work-up for Pyloric Stenosis

US - study of choice to confirm
upper GI study - demonstrate string sign in pyloric channel
- could also reveal malrotation/volvulus
Check electrolytes

17

Management of dehydration

ORT -> as effective if not safer than IV and less costly
- solutions (pedialyte, etc) typically have 45-50 mmol/L of sodium
- don't use gatorade, not enough sodium and too much glucose

18

Solid foods with vomiting and diarrhea

ok to eat if not dehydrated
- if dehydrated, wait to eat until rehydrated