Week 4.1 - GI Disorders

Question 1

Why are pediatric patients more susceptible to dehydration?

Answer 1

–> Larger body water content
–> Developmental communication barriers
–> Higher metabolic rates
–> Babies are unable to concentrate urine and are more prone to be affected by losses

Question 2

What might tachycardia be compensating for?

Answer 2

Lack of stroke volume - low blood volume

Question 3

Why might tachypnea occur with GI disorders?

Answer 3

To ensure adequate perfusion or compensate for metabolic acidosis

Question 4

What is a late sign of decompensation seen in children?

Answer 4

hypotension - often seen in state of shock when compensation is no longer possible

Question 5

What are some red flags with vitals for GI disorders?

Answer 5

Tachycardia and low BP

Question 6

What might be concerning in a child’s appearance with a GI disorder?

Answer 6

Pallor, lethargy, signs of poor perfusion (delayed cap refill, mottling, weak pulses)

Question 7

What are some red flags seen in children’s emesis?

Answer 7

Bilious (colour)
Hematemesis
Projectile

Question 8

What are some red flags in intake and output of children for GI disorders?

Answer 8

Weight loss (never normal)
Decreased output

Question 9

What might pale stool indicate in a peds patient?

Answer 9

biliary atresia

Question 10

What is a primary concern when a child has diarrhea?

Answer 10

Dehydration

Question 11

What four things are assessed in a modified Gorelick scale?

Answer 11

Cap refill more than 2 seconds
Absent tears
Dry mucous membranes
Ill general appearance

1 point each, assesses pediatric dehydration. 3+ points indicates fluid deficit of 5%.

Question 12

What is ORT?

Answer 12

Oral rehydration therapy - electrolyte solution

Question 13

When is ORT indicated?

Answer 13

Mild to moderate dehydration

Question 14

How much fluid should be given with ORT?

Answer 14

15 mL/kg/hr

(different than prof’s slides)

Question 15

What kind of fluid is given for IV bolus to children? Over what time period? At what rate?

Answer 15

RL or NS
–> 20 ml/kilo/hr

Question 16

What is the number one medical GI reason peds patients are in the hospital?

Answer 16

Acute gastroenteritis
–> Rotavirus, norovirus

Question 17

What is diarrhea?

Answer 17

3+ loose/liquid stools for 24 hours
–> Associated with cramping

Question 18

What is considered an acute case of diarrhea?

Answer 18

Lasting less than 14 days

Question 19

What history do we want to assess in a child with acute gastroenteritis?

Answer 19

Hx of recent travel, contact with source of infection

Question 20

What could bilious emesis indicate?

Answer 20

Volvulus - emergency

Question 21

What is biliary atresia? What are the S/S?

Answer 21

A rare newborn condition wherein bile cannot get from the liver to stool cause acholic stool
–> Results in buildup of bile in the liver, causing damage and failure.

Newborns will have jaundice and hepatomegaly

Question 22

What are causes of biliary atresia?

Answer 22

Congenital or environmental (inflammation)

Question 23

How is congenital biliary atresia treated?

Answer 23

Surgically

Question 24

What is acholic stool?

Answer 24

Pale stool

Question 25

What is the difference between GERD vs GER?

Answer 25

Presence of breath holding spells (BRUE- Brief resolved unexplained event), poor weight gain, and feeding issues.

Question 26

How does the presentation of IBD differ in children and adults?

Answer 26

Children generally have more significant disease involvement

Question 27

ABD pain, diarrhea, rectal bleeding, weight loss, fatigue and pallor are all associated with what disease?

Answer 27

IBD

Question 28

What might cause IBD?

Answer 28

Cause not known May be genetic predisposition, gut microbiome, immune system, environmental exposures.

Question 29

How is IBD treated pharmacologically?

Answer 29

Immune modulators (infliximab) Corticosteroids Enteral nutrition Methotrexate

Question 30

What are the two kinds of hematemesis and their potential causes?

Answer 30

Frank Red --> Maternal blood from nipple laceration --> Small intestine - ligament of Treitz birth defect resulting in malrotation Coffee Ground: Upper GI (stomach, GI)

Question 31

What is hematochezia?

Answer 31

Frank red blood in stool, suggestive of bleeding in colon

Question 32

What is a concern when an exclusively breastfed baby is spitting up red blood?

Answer 32

Whether is it maternal from breastmilk or from the baby

Question 33

When is the peak age of occurrence for appendicitis?

Answer 33

10-17

Question 34

What is the first symptom of appendicitis? How does it progress?

Answer 34

peri-umbilical pain that migrates to the RLQ. Accompanied by anorexia, N&V, low grade fever, rebound tenderness, guarding

Question 35

How is appendicitis managed?

Answer 35

IV bolus Analgesia NG tube if peritonitis or obstruction Antibiotics NPO Surgical consult

Question 36

What antibiotics are used for appendicitis?

Answer 36

Ampicillin, tobramycin, flagyl

Question 37

What is pyloric stenosis? What is a sign of it? What are more clinical manifestations?

Answer 37

Narrowing of the outlet from stomach to small intestine that occurs in infants Non bilious, non projectile vomiting in babies under 2-8 weeks who demonstrate hunger but cannot tolerate eating. Dehydration, and weight loss. Will also present with diminished or absent bowel sounds and visible gastric peristalsis left-right following feeding

Question 38

What is intussusception?

Answer 38

When a loop of bowel slips into another section (telescoping) - reduces blood flow, obstruction, tissue damage

Question 39

What age group and sex is most effected by intussusception?

Answer 39

Peaks ages 5-9 months (up to 3 years) --> More common in males, can be fatal

Question 40

What is the classic presentation of intussusception?

Answer 40

Vomiting Bloody-mucoid stools Intermittent colicky abdominal pain

Question 41

What treatment is available for intussusception?

Answer 41

Air enema might be attempted, if not effective an emergency surgery is necessary

Question 42

What is a volvulus? What kind is most common in infants and toddlers? What complications will be seen?

Answer 42

Malrotation of bowel results in small bowel obstruction - mid gut most common in infants and toddlers. Results in bilious emesis. Medical emergency --> Dehydration, electrolyte imbalance, prolonged vomiting can lead to shock

Question 43

What are signs of splenic injury?

Answer 43

LUQ pain and referred pain to left shoulder

Question 44

What kind of IBS is characterized by affecting only the superficial mucosa, beginning with the rectum and limited to the colon?

Answer 44

UC

Question 45

What kind of IBD is characterized by transmural inflammation that affects any part of the GI tract?

Answer 45

Crohn's

Question 46

What is the ligament of Treitz?

Answer 46

A ligament that anchors the duodenum - birth defect can results in intestinal torsion.

Question 47

What is the most common solid organ injury in children?

Answer 47

Splenic injury

Question 48

Why should we opt for conservative treatment of splenic injury?

Answer 48

The spleen filters blood and removed old/damaged cells Destroys pneumococcal bacteria - considered immunocompromised without it Stores platelets

Question 49

What is the pathophyiosology of acute gastroenteritis?

Answer 49

Irritation of mucosa by toxins results in excretion of water and electrolytes --> Metabolic acidosis, dehydration, electrolyte imbalance Inflammation + destruction of mucosal lining + increased motility = decreased absorption

Question 50

Peritonitis is a possible complication of appendicitis. What are the S&S?

Answer 50

Sudden relief of pain indicates rupture --> Peritonitis can lead to fever, abd rigidity/distention, ischemic bowel, sepsis, shock

Question 51

What demographic is most affected by pyloric stenosis/when does it become apparent?

Answer 51

Caucasians, Males --> 2-8 weeks of age

Question 52

What is meant by a "pyloric olive"?

Answer 52

Palpable stenotic pyloric sphincter

Question 53

What are some complications of intussusception?

Answer 53

Necrotic bowel Perforation of Bowel Shock Sepsis Recurrent intussussception

Question 54

When is splenic injury suspected?

Answer 54

Anyone with blunt abd trauma

Question 55

How is splenic injury confirmed? Managed?

Answer 55

Admit for observation of VS + CBC + obtain T&C --> Mange with IV boluses, analgesia