Gastrointestinal disorders in children
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Created by:
AZNPStudent on June 10, 2011
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46 terms
Terms | Definitions |
|---|---|
 Gastroenteritis definition (AGE) | - nonspecific -acute nausea, vomiting, diarrhea caused by inflammation/irritation of gastric mucosa |
| Causes | - mostly viral (rota- [50%], adeno-) - bacterial (salmonella, campyhlobacter [very malodorous], shigella [fever spikes, bloody stools, febrile siezures], E coli [mild loose stools]) - parasitic - inorganic food contents - emotional stress - parasitic |
| Signs and sxs | - N/V/D - hyperactive bowel sounds - watery stools - malaise - fever - anorexia - crampy abdominal pain - abdominal distention |
| Incubation period for various bacterial causes of AGE | - E coli 2-3d - Campylobacter 2-5d - staphylococcus 1-6h - shigella/salmonella 8-24h - botulism 12-36 - giardia 7-12d |
| Physical findings in AGE | - variable fever - tachycardia - signs of dehydration - hypotension in severe cases - initially tachycardia, bradycardia in severe cases - prolonged capillary refill more than 3 sec in severe - decreased skin turgor - sunken fontanelle in moderate to severe cases - oliguria in severe |
| When are diagnostic studies warranted, and what should be tested? | - test if sxs longer than 72hr or if bloody stools present - stool for guaiac (likely bacterial in positive) - stool WBC - stool culture - stool O&P |
| Management of AGE in children (nonpharmacologic) | - oral rehydration based on % dehydration (normal wt minus current weight all devided by normal weight X 100 In mild dehydration, 50ml/kg replacement over 4 hours In moderate dehydration, 100ml/kg over 4 hr - continue breast milk or their regular formula - BRAT diet when rehydrated (bananas, rice, applesauce, toast)--complex carbohydrates, soups, yogurt, vegetables, fresh fruits - bed rest during acute phase |
| What fluids should be avoided? | - undiluted juices, cola, gatorade, ginger ale, milk (because they are hyperosmolar) - water (hypoosmolar) as sole replacement source |
| What foods should be minimized? | - high fat and simple sugar foods |
| Symptomatic pharmacologic treatment of AGE in children | - judicious use of antimotility agents (can prolong diarrhea, never give when bloody diarrhea or if febrile) |
| When should antibiotics be considered? | - identified bacterial source - not usually helpful in Salmonella, but consider in toxic infant or immunocompromised - - in dysentery (more than 8-10 stools a day, bloody stools) - if immune compromised host - if leukocytes in stool |
| What is the appropriate antibiotic for each enteropath? | - Salmonella: cefotaxime (Claforan) or ceftriaxone (Rocephin) for 10-14 days - Shigella: Bactrim or cefixime (Suprax) - E coli: usually self-limiting, Bactrim may shorten course - Yrsinia: Bactrim, aminoglycosides, cefotaxime, tetracycline (over age 8) only if becteremia or extra-intestinal infections or if immunocompromised - giardia: metronidazole |
| What is the pharmacologic prophylaxis for traveler's diarrhea? | - bismuth susalicylate |
| What are other preventive measures AGE? | - cook food thoroughly - thorough cleaning of cooking surfaces - handwashing - bottled water - exclude those infected with roatvirus, E coli, Shigella from day care (require 2 negative stools for E coli/Shigella) |
| 3 types of gastroesophageal reflux in infants | - physiological: infrequent, episodic vomiting - functional: painless, effortless vomiting with no sequelae - pathological: frequent vomiting with sequelae such as FTT, aspiration |
| What is the prevalence of GERD in infants and when should it resolve? | - 85% in premature - 70% in infants weighing less than 1700g (3 1/2#) - 40% resolve by 3 mo - 70% resolve by 18 mo |
| Symptoms of GERD in infants/children (11 items) | - choking - coughing/wheezing - wt loss - irritability - dysphagia - recurrent vomiting - heartburn painful belching/abdominal pain - stool pattern changes - sore throat - otitis - dental errosions |
| GERD diagnositics | - CBC with diff to rule out anemia, infections - UA and UC - stool for occult blood - abdominal US to r/o pyloric stenosis - esophageal pH monitoring (+ for GERD if higher than 4) - endoscopy to r/o esophagitis |
| Management of GERD in infants | - freq small feedings - burp well - keep head elevated after feeding - 1 tbsp rice cereal in each oz formula - avoid formula changes - older children should avoid chocolate, caffeine, fatty foods, spicy foods, alcohol, bedtime snacks |
| Classes of medication used in GERD | - H2 blockers: famotidine (Pepcid), ranitidine (Zantac) - protein pump inhibitors: omeprazole (Prilosec) - promotility agent: metoclopramide (Reglan)--can cause tardive dyskenesia |
| Incidence and epidemiology of pyloric stenosis (muscular gastric outlet obstruction) | - 1:500 infants - males more often affected - familial predisposition - Caucasians more often affected - breast feeding delays occurence |
| Signs and sxs pyloric stenosis | - presents at 3-4 weeks of age - projectile nonbilious emesis after eating - hungry after vomiting - poor weight gain our weight loss - eventual dehydration - visible peristaltic waves - palpable mass after vomiting |
| Diagnostics for pyloric stenosis | - Abdominal US - UGI if US equivocal |
| Management of pyloric stenosis | - surgery required |
| Speculated causes of introduction intussusception | - adenoviral infection - celiac disease - cystic fibrosis |
| Epidemiology of intussusception | - more common in males - most before age 2yr |
| Signs and sxs of intussusception | - Acute colicky pain in previously healthy child - nonbilious vomiting - progressive lethargy - currant jelly stools (late) - sausage shaped mass RUQ - progressive distension/tenderness - (very late) perforation and shock |
| Mnemonic for intussusception | A abdominal mass B bloody (currant jelly) stool C colic D dissension/dehydration E edema F face pallor |
| Diagnostics for intussusception | - KUB - barium enema (often curative) |
| Management of imtussusception | - barium enema will often reduce the telescoping of the bowel -emergency surgery if BE doesn't work by |
| Within how many hours will appendicitis lead to perforation a gangrene and death? | - 36 hours |
| Epidemiology of appendicitis | - more common in males - more common ages 10-30yr - affects 10% of the population |
| Signs and sxs appendicitis | - vague periumbilical colicky pain that progresses over a few hours to the RLQ - RLQ guarding and rebound tenderness - localized abdominal tenderness - + psoas/obturator signs - coughing and jumping worsens the pain - nausea with 1-2 episodes of vomiting - sense of constipation, infrequently diarrhea - lowgrade fever -rectal tenderness on digital rxam |
| Diagnostics findings in appendicitis | - WBC 10,000-20,000 - elevated sed rate - 25% has microscopic hematuria/pyuria - US is diagnostic in 85% (usually unnecessary), CT scan if inconclusive |
| Management of appendicitis | - surgery |
| Causes of malabsorption | - infection - enzymatic deficiency (eg cystic fibrosis) - abnormality of intestinal mucosa - celiac disease (rare) |
| Signs and sxs of malabsorption | - failure to thrive - severe, chronic diarrhea - bulky, foul stool - vomiting - abdominal pain - abdominal distension - signs of malnutrition (pallor, fatigue, dry hair and skin, cheilosis, peripheral neuropathy) |
| Diagnostic workup in malabsorption | - stool for occult blood, C&S, O&P, WBC, microscopic - serum Ca++, phos, alk phos, total protein, ferritin, folate, LFTs |
| Differential dx for malabsorption | - failure to thrive - short stature - chronic diarrhea - cystic fibrosis - immune deficiency - hepatic disease - inflammatory bowel disease - celiac disease |
| Management malabsorption | - treat persistent infection - avoid offending foods - refer to GI - if celiac, no wheat, oats, rye, barley |
| Types of viral hepatitis and how they are transmitted | A- fecal/oral, often contaminated water and food B- borne by blood and body fluids, often transmitted from IV drug abuse (IVDA), vertical transmission mother to infant C- blood borne, source often uncertain, 50% related to IVDA, some from blood transfusions, rare sexual or vertical transmisison D- can only cause hepatitis in conjunction with hepB, primarily assoc w/ IVDA, rare vertical transmission E- fecal/oral, waterborne, 10-20% mortality in pregnant women G...no info NonAnonB |
| Incubation period and main clinical features of hepatitis | A- incubation 2-6wk, infectious during this period, many children asymptomatic, no chronic carrier stae, rarely becomes fulminant, low mortality B- incubation 6wk-6mo, the younger the child the more chance of chronic state, less than 1% become fulminant but if it does carries 60% mortality rate C- variable incubation (range 4-12wk), most affected children anicteric D- superinfection with D in a hep B patient greatly increases fulminance and mortality E- mild infection in children (like A) no carrier state, rare in U.S. |
| Signs and sxs of hepatitis | - Pre-icteric: fatigue, malaise, anorexia, n/v headache, acersion to smoking and alcohol - Icteric: weight loss, jaundice, pruritis, RUQ pain, clay-colored stools, dark urine - wide range of severity from mild to severe - low grade fever - hepatosplenomegaly - cough, pharyingitis - in hep B can have nonspecific macular rash and arthralgias (early) |
| Diagnostics findings in hepatitis | -WBC low to normal - UA protein,bilirubin - elevated AST/ALT 500-2000 IU/L (begins to fall after jaundice develops) - slightly elevated serum LDH, bilirubin, alk phos, PT |
| What antigen/antibody tests will be elevated in each type of hepatitis? | - active A: anti-HAV, IgM - recovered A: antiv HAV, IgG - active B: HBsAg, HBeAg, anti-HBc, IgM - chronic B: HBsAg, anti-HBc, anti-HBe, IgM, IgG - recovered B: anti-HBc, anti-HBsAg - acute C: anti HCV< HCV RNA - chronic C: anti-HCV, HCV RNA - D: anti-HDV, IgM, HDV RNA - E: no test available - G: HGV RNA - NANB all tests negativeb |
| Management of hepatitis | - supportive - push fluids (3-4L/day) - Vit K of PT higher than 15 sec - avoid alcohol and meds that are cleared by liver - non-protein diet - Rebetron (interferon and ribavirin) for hep C - hep B immune globulin in infants with infected moms - hep B immunization, 3 doses. Up to 3 additional doses at 1-2mo intervals if no serologic evidence of immunity |
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