PED- TEST 3 > GI Lecture > Flashcards

GI Lecture Flashcards

(49 cards)

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1
Q

What is included in a history for GI disorders?

A
  1. fam h/o GI disorders (celiac disease, gallbladder, ulcers, H. Pylori
  2. past medical history of GI tract (illness surgery, celiac, IBS, cleft lip palate, esophageal problems.
  3. feeding habits
  4. appetite/thrist
  5. pain OLDCARTs
  6. bowel habits- constipation vs. diarrhea
  7. food intolerance/allergy
  8. nausea, vomitting, belching flatulance, heartburn
  9. apnea, asthma, odorous breath
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2
Q

Pain characteristics for GI can be?

A

-Pain characteristics (OLD CARTS)
- Epigastric
- Periumbilical
- Colonic,
- Suprapubic
Referred (shoulder, back, neck, groin)

Acute, Secondary ANS stimulation can cause s/s N/V, diaphoresis, pallor, anxiety

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3
Q

GI history good to?

A

Develop a rapport between parent & child
assess general appearance sick vs not sick appearing

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4
Q

What is included for a physical Exam for GI assessment?

A

Head to toe examination Height/Weight/BMI on growth charts General appearance

HEENT, Neck CV/Resp

Abdominal:
Inspect for visible peristalsis, rash/lesions, asymmetry, masses, pulsations
Auscultate BSs, abdominal bruits Percuss for masses, HSM
Palpate lightly then deeply for masses, HSM, CVA tenderness, rebound tenderness/Rosving’s sign, guarding, obturator/psoas signs Rectal exam when indicated

Gynecological exam when indicated (usually referred)
Skin: inspect hydration status

Have the child jump on one foot

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5
Q

DX Testing for GI?

A

Performed as indicated: Urinalysis
CBC w/ diff
CMP (includes LFTs), lipid profile, ESR, CRP, TSH, Free T4, H.Pylori IgG/IgM, EBV Panel Food intolerance/allergy testing
Stool Studies (O&P, WBC, culture, cryptosporidium, giardia, rotavirus, c. diff) Fecal fat collection
Pregnancy test Urine PCR for STIs

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6
Q

DX for GI radiology?

A

Radiological evaluation: Abdominal X-ray (KUB) Upper/Lower GI series Air contrast enema Bone Age
CXR
Ultrasound HIDA scan CT scan MRI

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7
Q

Think about things that can be
done in the office such as UA, blood glucose, CBC

A

DX testing for GI

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8
Q

For GI DX testing?

A

Special testing: barium swallow, pH probe, endoscopy, breath hydrogen test, sweat chloride test

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9
Q

What can be done to manage GI disorders?

A

Antibiotics Antifungals
Anthelmintics Antiemetics
Antidiarrheals (rarely used)
Stool softeners/laxatives
Antispasmodics
Corticosteroids

Reduction of pain Reduction of acidity Probiotics/Prebiotics Diet changes

Anti-reflux measures

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10
Q

What are some GI disorders?

A
  • Dysphagia
  • Vomiting/Dehydration
  • Cyclic Vomiting Syndrome
  • GERD
  • PUD
  • Colic
  • Appendicitis
  • Intussusception
  • Abdominal Pain/Migraine
  • IBS/Cohn’s/Ulcerative colitis
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11
Q

What are some types of malabsorption syndromes?

A
  • Malabsorption syndrome (Celiac disease, Lactose intolerance, Cow’s milk protein intolerance/allergy)
  • Polyps
  • Anal Fissure
  • Failure to Thrive (FTT)
  • Acute/Chronic Diarrhea
  • Parasite infection
  • H. Pylori infection
  • Constipation (w/ or w/o encopresis)
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12
Q

What is the most common cause of abdominal pain in children?

(Know!)

A
  • Abd pain of unknown cause
  • Gastroenteritis
  • Appendicitis
  • Constipation
  • UTI
  • Viral infection
  • Strep Pharyngitis
  • Sinusitis/Pharyngitis
  • Pneumonia
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13
Q

What is the most common GI complaint?

A

Constipation

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14
Q
  • Second most commonly referred condition in pediatric gastroenterology ?
A

Constipation

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15
Q

What is the rest common pediatric gastroenterology complaint?

A

generalized abd pain

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16
Q

What is constipation?

A
  • Decreased frequency of bowel movements or difficulty having a bowel movement for more than two weeks with associated distress the child.
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17
Q

Difficult to define by actual frequency of BMs alone because of factors such as?

A

passage of stool, consistency of stool, and volume of stool

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18
Q

What is some history info for constipation?

A
  • Age/Circumstance of onset
  • Meconium passage
  • Bowel pattern
  • Pain/bleeding with defecation
  • Withholding behaviors
  • Soiling
  • Abdominal pain
  • Diet
  • Weight loss
  • Vomiting
  • Medications
  • Toilet training history
  • Neurological problems
  • Urinary problems
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19
Q

Know the Bristol stool chart!

A
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20
Q

What should the physical exam be like to assess for constipation?

Study These Flashcards
A
  • General Exam: growth and development
  • Neurological Assessment: tone, strength, DTR’s
  • Abdominal Exam: palpable stool, percussion
  • Perianal Exam: anal position, fissures, skin tags, hemorrhoids, anal wink, rash
  • Digital Rectal Exam: tone, size of rectum, fecal mass, stool occult
  • Spine: sacral dimple, tuft
21
Q

What are some red flags of constipation?

Study These Flashcards
A
  • Anal stenosis
  • Blood mixed in stool/bloody diarrhea
  • Failure to thrive
  • Tight empty rectum
  • Sacral dimple
  • Atypical perianal exam
  • Prolapse of rectum
22
Q

When is functional constipation most commonly seen?

Study These Flashcards
A

between 6 months and 4 years of age

23
Q

Functional constipation?

Study These Flashcards
A
  • > 2 weeks of < 2 bowel movement s per week with hard, large or small stools in the absence of:

structural, endocrine, or metabolic abnormalities.

24
Q

Functional constipation?

Study These Flashcards
A
  • Normal meconium passage
  • Onset during transition periods
  • No overtly distended abdomen
  • Normal growth
  • Overflow soiling
  • Improved with medical therapy
25
Encopresis
26
Encopresis
27
What is the treatment for encopresis?
* Diet: fiber and water! * Fiber * Whole grains, fruits, and vegetables * Rule of Thumb: age in years + 5 = goal of number of grams of fiber needed each day. * Water/fluid intake * About 2 oz per gram of fiber * Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass
28
Rule of Thumb: age in years + 5 = goal of number of grams of fiber needed each day.
treatment for encopresis
29
Encopresis treatment?
* Clean out (2-3 days) * Maintenance medication (6 months-2 years) * Sitting on toilet regularly – reward system * Diet * Keys to success: adequate clean-out, consistent use of medications, regularly scheduled toileting and improved diet.
30
Encopresis Treatment continued (Medications)?
* Stool softeners: * Miralax * Lactulose * Milk of magnesia * Colace * Stimulant Laxatives: * Senna syrup, tablets * Ex lax * Dulcolax * Enemas: * Milk and Molasses * Saline * Soap suds
31
Hypertrophied Pyloric Stenosis What is it?
Caused from hypertrophy of the pylorus muscle
32
* The lumen becomes obstructed by mucosa, resulting in a blockage of the lumen that extends from the stomach to the duodenum
Hypertrophied Pyloric Stenosis
33
* Unknown cause, associated with a failure of nitric oxide synthetase and decrease nitric oxide and an inability of the smooth muscle of the pylorus to relax
Hypertrophied Pyloric Stenosis
34
Leads to several metabolic abnormalities, including metabolic alkalosis, hypochloremia and hypokalemia
Hypertrophied Pyloric Stenosis
35
Hypertrophied Pyloric Stenosis?
* Occurs between1.4 and 4 per 10000 live births * More common in males than females * Possible genetic predisposition * Typical case is a first born male presenting with recurrent vomiting between 3-5 weeks of age
36
* Infant between 2-8 weeks * Presents with nonbilious projectile vomiting * Infant remains hungry after feedings * Generally not febrile or ill appearing unless the onset of dehydration produces lethargy What is this clinical condition? (Know)
Hypertrophied Pyloric Stenosis
37
Hypertrophied Pyloric Stenosis * Physical Examination?
* Peristaltic wave in the RUQ * Pylorus palpable as a small, hard mass or “olive” * Weight loss and possible dehydration * Characteristic facies with furrowed brow, wrinkled appearance and prominent sucking pattern
38
Hypertrophied Pyloric Stenosis * Diagnosis?
* Abdominal ultrasound has become the gold standard for diagnosis * Upper GI barium study can also be useful
39
Treatment for Hypertrophied pyloric stenosis?
* Treatment is correction of metabolic alkalosis and dehydration and then surgical correction
40
Upper Gastrointestinal Disorder? Dysphagia?
* Difficulty or discomfort in swallowing
41
Symptoms of Dysphagia may be?
be oral, pharyngeal or esophageal
42
* Structural Defects:? for dysphagia?
* Esophageal narrowing * Extrinsic obstruction
43
What are some nonstructural causes of dysphagia?
* Motility disorders of oropharynx/esophagus * Prematurity/neurologic impairment from CP or other disorders * Mucosal injury – GERD, eosinophilic, esophagitis
44
What history should you do for dysphagia?
* Progressive dysfunction * Persistent drooling/cough * Pain * Picky or food refusal * Heartburn * Halitosis * Weight loss * Regurgitation
45
What physical exam should you do for dysphagia?
* Observe feeding * PE may appear normal * Diagnostic Studies * Lateral neck films * Barium swallow * Fiberoptic endoscopy/videofluroscopy * Manometry – measure of esophageal tone * MRI * Electromyography – evaluates sphincter tone
46
* Electromyography
evaluates sphincter tone
47
* Manometry
* Manometry – measure of esophageal tone
48
In dysphagia the physical exam may appear?
normal
49
What are some differential dx for dysphagia?
* Obstructive/compressive lesions – difficulty with solids * Physiologic dysfunction – systemic disorder * Psychological – dysfunctional feeding relationship * Management * Multidisciplinary Approach * Depends on source of disorder: * Physical * Cognitive * Developmental * Behavioral
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