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PEDS- GIT - Uworld

Terms in this set (57)

failure to pass meconium after 48hrs of life.

2 ddx?
Meconium Ileus [Cystic Fibrosis]

vs.
Hirshsprung Disease [congential aganglionic megacolon]
Chronic reccurent rhinosinusitis in infant.

dx?
Cystic FIbrosis

- AS EARLY AS AGE 8: CT-Scan of sinuses --> opacification --> requiring Surgical debridement

TREATMENT w/ AMINOGLYCOSIDES for GM-ve infections [Pseudomonas] --> 10-15% get SENSORINEURAL HEARING LOSS
Abd x-ray in CF neonate?
Multiple DILATED LOOPS OF SMALL** BOWEL with paucity of air in large intestine & rectum


NB:
Inspissated Meconium + Obstruction at ILEUM *
vs. Hirschsprung -
Normal meconium + Obstruction at RECTOSIGMOID *
Tx - meconium ileus?
GASTROGRAFFIN ENEMA [Dx & Tx]
Ulcerative colitis +
Sunburn that burns on distal arms/legs & TTP
+ beefy red tongue
+ watery diarrhea

what Vitamin deficiency?
NIACIN [B3]

Tx: niacin replacement
Cheilosis
+ glossitis
+ seborrheic dermatitis [genital area]
+ pharyngitis
+ edema/erythema of mouth


vit def?
B2 [RIBOFLAVIN]
Irritable, depressed,
+ dermatitis
+ stomatitis
+ VTE / atherosclerosis [d/t elevated homocystien]

vit def?
B6 def
pyridoxine
Macrocytic anemai + peripheral neuropathy.

vit def?
B12 - Cyanocobalamin def
DM-type 1
+ red spots on arms & legs that itch and burn, fill with clear fluid and crust over.

he lost 8lbs in past 4 months. He has iron def anemia.
FOBT negative x3.
NExt step?
Anti-tissue transglutaminase AB assay

He has CELIACS [MC site = DUODENAL villuus atrophy]
[seen w/ Autoimmune THYROID, DM-type 1, Down's, Selective IgA deficiency]

Extraintestinal manifestations =
- DEmatitis Herpetiformis
- Iron def anemia - no Duodenum**
- Short stature + Weight loss
tx - GERD in infants?
- Thickened feeds
- Antacid Therapy
[if severe --< pH probe monitor & Upper endoscopy]
Infant 2-8 weeks
+ regurgitation
+/- eczema
+/- bloody stools.

dx?

tx?
Milk Protein allergy

Tx:
- eliminate dairy and soy protein from Diet

- initiate HYDROLYZED formula in formula-fed infants
infant w/ FTT, significant irritability when feeding
+ ARching head and back [Sandifer syndrome] on every feed.

dx?
GERD in infant
"Happy Spitter"

esophagus - short.long?
LES?
Time spent suppine ?
Short Eso
incomplete closure of LES
longer time SUPINE

BUT ADEQUATE WEIGHT GAIN = OK!
Hold INfant UPRIGHT after FEED
8 yo boy w. abd pain + dark urine. began weeks ago. Scleral icterus & mild abd tenderness. Abdominal mass palpable in RUQ.
BR, total - 6.5
BR, direct 3.4
Amylase 91 [wnl]
Lipase 152 [nl = 0-160]
US -RUQ = extrahepatic Cystic mass + normal GB.

Dx?
BILIARY CYST
aka. choledochal cyst
[congenital dilation of biliary tree]


[too old for biliary atresia]

<10yo
TRIAD: Abd pain, jaundice + palpable mass

Dx: US visualize or ERCP

Tx: surgical resection' prevent malig transformation

*NB: older children may have PANCREATITIS *
Reye;s syndrome on liver bx?
MICROVESICULAR FATTY INFILTRATION
can use ASPIRIN for children wiht?
KAWASAKI
and
Juvenile idiopathic arthritis
Alpha-1-AT def liver bx?
cirrhosis + periportal Eosinophilic infiltrate
Bile plugs in bile/canalicular ducts
+ portal tract edema
+ fibrosis

dx?
BILIARY ATRESA
[infancy + direct hyper BR]
Alcholic hepatitits And Obese pt w/ NASH

liver bx?
MACROVESICULAR fatty change
Premee <32 wks, @ 3 wks old in NICU
starts Vomtiing w/ increased gastric residual volume.
T 35.6 F
BP 85/45
P 142
RR 34
SpO2 - 97%
Lethargic neonate w/ abdominal distention
+ increased WBC and metabolic acidosis.

dx ?
what would abd x-ray show?
NECROTIZING ENTEROCOLITIS

- riskS =
premature
& VERY LOW BIRTH WEIGHT

[gut immaturity + bacteria exposure]

Abd xray:
Air in Bowle wall and Portal Veins
--> risk of perforation/pneumoperitoneum

[esp with metabolic acidosis and leukocytosis]
Tx - Gastroschisis at delivery?
- Exposed bowel covered with sterile saline dressings & plastic wrap
+NG tube + ABx

+ ER Surgery in SINGLE-STAGE CLOSURE **

NB: this is >90% of the time - ISOLATED DEFECT
Tx - Omphalocele ?
ER surgery at BIRTH
with
STAGED CLOSURe w SILASTIC SILO ** [slowly]

NB: associated with other malformations !- wide variety - cardiac/trisomies
Reyes:
- Increased Intracranial Pressure [LP opening pressure increased]
- elevated BR, AST, ALT, PT
- elevated LDH levels
- Elevated AMMONIA
- LOW GLUCOSE
infant +
+ hypoglycemia
+ hyperammonemia
+ low prothrombin
+ acute episdoe of encephalopathy
+ elevated Acyl-carnitine ***

[looks like REYES ]
Systemic Carnitine Deficiency [SCD]
- defect in FATTY ACID OXIDATION
Breastfeeding fail
vs. Breast Milk Jaundice


[both UNCONJUGATED]
FEEDING Fail:
*Time: 1st wk of life
*Pathophys: Lactation failure [decreased BR elimination; Increased enterohepatic cycling]
*clinical: signs of dehydration + loss of birth weight
[4 days --> 4 wet diapers/day]
+ BRICK-RED urate crystals [sign of dehydration]

vs.
MILK:
*Time: starts age 3-5 days; PEAK AT 2 WEEKS
* Pathophys: high beta-glucuronidase in breast milk deconjugateed BR & increased enterohepatic Circulation
*Clinical SIgns: NORMAL exam + adequate diapers!
REGULAR FEEDING for neonate
8-12 times a day
q2-3 hrs]
for 10-20mins PER BREAST
When do u phototherapy?
Total BR =/> 20

Exhange when TBili =/> 25 or Neuro sx
Foreign body in Esophagus vs. trachea.

tx?
IN esophagus + Sx or
TIME OF INGESTION is UNKNOWN
--> FLEXIBLE ENDOSCOPY

vs. In esophagus + NO SX -->
observe for 24 hrs


in trachea
--> RIGID BRONCHOSCOPY
3-5wks after birth
+ projective non-bilious vomiting.

what is diagnostic step?
dx?
Hypertrophic Pyloric Stenosis

Abdominal ULTRASOUND!

- COMMON in FIRST BORN BOYS***
3 hr old baby is cyanotic but gets pink when he cries.
- Cyanosis worsens when he attempts to feed

dx?
associated sydnrome?
CHOANAL ATRESIA b/l
NB: unilateral may go undiagnosed until first URTI

*CHARGE syndrome
C - coloboma/CNS
Heart
Atresia of choana
REtard of growth.devo
GU anomaly
Ear abnormal/deafness

**FAIlure to PASs CATHETER through nose into OROPHARYNX = suggest Dx
COnfirm w/ CT - narrow PTERYGOID plate in POSTerior NASAL CAVATY
Risks for NEcrotizing Enterocolitis ?
- Prematuriry
- Verylow birth weight {<1.5kg]
- Reduced mesenteric perfusion [HYPOTESION, CONGENITAL HEART DISEASE]
- Enteral feeding [Formulas worse than BREAST]]
Cause of intussusception < age 2yo?
follow viral illness; Hypertrophied Peyer's Patches
cause of intussussception in age >2yo, especially IF RECURRENT episode.
?
Diverticulum [TRUE diverticulum]

ie: MECKEL'S
Next step after recurrent intussusception age 5?
Technetium-99m pertechnetate scanning -- looking for MECKEL's

tx: surgical resection
Palpable purpura
+ joint pain
+ colicky abdominal pain

cause of abdominal pain?
intussusception caused by
Small-bowel hematoma formation
[autoimmune vasculitis]

THIS IS HSP
henoch-schnolein-purpura
Causes of Intussessception?
1. Burkitt's Lymphoma - sporadic variant in GIT [- rapidly growing B-cell tumor ]
2. HSP [small bowel hematoma]
3. Meckels - recurrent or children >2yo [diverticulum]
4. Cystic Fibrosis - Inspissated stool ;
Recent viral illness
ROTAVIRUS VACCINE***
- Celiac's Disease
- Polyps
Tx - Intussusception?
- Air ENema [safer, cleaner, faster] > contrast

+ Surgical removal of Lead point
Breastfed infant born to strict vegetarian mom.

tx?
B12 supplement
Breastfed exclusively.

what supplemens?
1. Vit D 400 IU daily [starting w/in 1st month]
2. Iron supplement daily for first 1 yr [esp if preamture/maternal iron deficiency]
macroglossia
+ enlarged R. UE and R. LE

next step?
Abdominal US

This is : BECWITH-WIEDMANN SYNDROME
- deregulation of IMPRENTED GENE in chromosome 11p15 [encodes INSULIN-LIKE GROWTH FACTOR 2]

SX: hyperhemiplasia
+ macroglossia
+ umbilical hernia OR omphalocele
+ fetal macrosomia/rapid groth until late childhood

COMPLICATIONS -
**WILMs or HEPATOBLASTOMA

**Surveillance = serum AFP, + abdominal/renal Ultrasounds
Surveillance in Beckwith-wiedmann
AFP q3mos Birth - age 4
Abd US q3 months: birth - Age 8
Renal US q3mos: > age 8 - adolescenets
Contraindications to breast feeding in infant?
GALACTOSEMIA
[only one!]
Benefits for INFANT of breastfeeding?
- improved immunity
- improved GI fnc
- Prevents ID: Otitis Media, GE, URTI, UTI
- Decreased risk of childhood cancer, DM type 1 and necrotizing Enterocolitis
Benefits for MOM of breastfeed ?
- More rapid uterine involution & decreased post-partum bleeding
- Faster return to prepartum weight
- Improved child spacing
- Improved maternal-infant bonding
- REDUCED RISK OF BREAST AND OVARIAN CANCER
Maternal ContraIndications to breast feeding?
1. active untreated TB [after 2 wks of TB therapy --> can breast feed]
2. HIV infection in countries where formula is availbale
3. Herpetic breast lesions
4. Varicella infection <5 days prior or w/in 2 day of delivery
5. Medications
6. CHEMO or RADIATION
7. Active abuse of STREET DRUGS or alcohol
2-3 yo w/ impaired adaptation to darkness, photophobia, dry skin, xerosis conjunctiva or cornea [dry eyes], keratomalacia ..

BITOT spots and follicular hyperkeratosis of shoulder ,butt, extensor surfaces!

dx?
Vit A deficiency
Batteries lodged in esophagus .
tx?
Endoscopic remova
Battery distal to esophagus. tx ?
OBSERVATION with stool exam
and f/u X-rays to confirm excretion
Prenatal exposure to cocaine or other VASOCONSTRICTIV drugs...

risk for?
[GIT]
Jejunal Atresia or Ileal Atresia
[Triple bubble or gasless colon]

Tx: surgeyr
Jaundice that appears in day 2-4 of life.

dx?
Physiologic Jaundice
Unconjugated HyperBR

REasons:
1. High Hgb turnover
2. hepatic UDP-glycuronyl transferase does not reach adult level until 2 weeks **COMMON IN ASIAN newborn]
3. Increased Enterohepatic recycling d/t immature sterile gut [can not break down BR to Urobilinogen for fecal excretion]; therefore more reabsorbed
Tx - constipation in children.
- increased dietary fiber
- Limit cow milk intake <24 oz
- Oral Laxatives [polyethylene glycol or mineral oil] - PREFERRED

+/- Suppositories, enema
Cyclical vomiting syndrome:
criteria:
- 3+ episodes in 6 mos period
- Familial
- Lasts 1-10 days
- vomit 4+ times/hr at peak
- No sx in between episodes
Tx - cyclical vomiting syndrome?
IVF
ANTIEMETICS [odansetron]
Reassure

*they will grow out of it in 5-10 yrs
and
ADD SUMATRIPTAN if co-existant MIGRAINES!!!
Human milk protein absorbs better and improves gastric emptying.
True/False?
TRUTH

Human milk = 70% whey; 30% casein

Whey is more easily digested than casein; Contains:
- latoferrin
- lysosyme
- secretory IgA
to improved immunity!

MAIN CARB = LACTOSE

*Ca+ and PO4 are low, but better absorbed from HUMAN MILK
Normocytic anemia
Seborrheic dermatitis
Angular cheilosis + stomatitis

deficiency?
B2 [RIBOVIRAN]
Chelosis
Stomatitis
Glossitis
Irritability, confusion, depression

deficiency?
B6 - PYRIDOXINE
intussessception in a 2 yo boy.

what is best MODALITY to CONFIRM diagnosis...
Tectinum 99 pertechnate scan
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