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Children's Health: Gastrointestinal

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Color: Yellow orange or green
Consistency: Runny to curdy
Frequency: With each feeding - 1x each 3-4 days
What is the normal color, consistency, and frequency of stool for breast-fed babies?
Color: Brownish
Consistency: Loosely formed to solid
Frequency: 3x per day - 1 every 3-5 days
What is the normal color, consistency, and ffrequency of stool for formula fed babies?
2-8 billion
The annual international incidence of diarrheal illness is....
1. Dry mouth
2. Fewer than half the usual number of diapers
3. No urine output in 12 days
4. No tears
5. Dizziness
6. Weakness
7. Headache
8. Muscle cramps
9. Sunken eyes and fontanelles
10. Skin tenting
List as many as you can of the signs of diarrhea.
1. Breast feeding
2. Chicken/vegetable broth (carrots reduce diarrheal tendencies)
3. Pedialyte pediapops, lyte solution
How do we re-hydrate a baby?
1. Gastroenteritis
2. Overfeeding
3. Infection
4. Antibiotics
5. Food poisoning
6. Toxic ingestion
Give acute causes of diarrhea.
1. Food intolerance
2. Irritable colon syndrome/chron's
3. Cystic fibrosis
*4. Celiacs
5. Short bowel syndrome
6. Giardiasis
Give chronic causes of diarrhea.
BRAT diet.

Increase bananas, rice, apple, and toast. (Carrots and cheese).
What diet should a child with diarrhea be on?
Rotavirus
What is the most common cause of acute gastroenteritis?
Common in winter months. Acute onset. Vomiting is first symptom. Low grade fever and voluminous watery diarrhea.
Tell me about Rotavirus.
2nd most common cause of acute gastroenteritis. Year round.

Signs/symptoms are similar to rotavirus. Duration is 1 week.
Tell me about adenovirus.
Gran negative bacterial rod. Fecal-oral route. Almost never infects adults but 20,000 cases per year in US of children. Serious illness with children.

Incubation is 2-4 days. Abrupt onset with chills, abdominal cramps, fever, BLOODY DIARRHEA.
Tell me about Shigella.
Gram negative bacterial rod. Susceptible to gastric acidity so infants and elderly at risk.

12-24 hour incubation. Fever, vomiting, watery diarrhea containing mucous or bood, abdominal cramping, etc. Subsides in 4-5 days.
Tell me about Salmonella
Normally found in gut flora. Commonly spread via daycare and undercooked beef.

Can be acute or progressive in onset. Mild diarrhea. Abdominal cramping, fever, blood and mucus in stool.
Tell me about E Coli
A protozoa. Infection through contaminated water, swimming pools, fecal-oral route, etc.

Signs/symptoms, 1-2 week incubation. Acute onset of greasy malodorous diarrhea. Bloating, flatulence, weight loss, malabsorption, etc.
Tell me about Giardia Lamblia
Itchy anus, restless sleep, intermittent nausea/abdominal pain.
What is the presentation of pinworm?
Voluntary withholding: fear, pain, punishment, anal stenosis, or stricture.

Hirschsprung disease, medications, dehydrations, tumors, etc.
Give some general causes of constipation?
CRAB diet. We AVOID carrots, rice, apples, and bananas.

We should give them plums, prunes, apricots, pears, raw spinach, and green grapes.
What diet do we give for constipation?
1. Stool softeners/laxitives
2. Spinal adjustments
3. Dietary modifications
4. Supplementing with magnesium or calcium
5. Abdominal reflex points.
How do we treat constipation?
1. Esophageal dysfunction: early GERD
2. Achalasia
3. Food intolerance
4. Overfeeding
What are the causes of regurgitation?
Eliminate irritating foods, sit upright for 20 minutes after feeding, burp often, spinal adjustments, and diaphragm releases.
What are the treatments for regurgitation?
1. Decreased LES pressure
2. Decreased gastric emptying
3. Hiatal hernia
4. Inappropriate LES relaxation
5. Development predispositions (short esophagus)
What is the etiology of GERD?
Cough, vomiting, regurgitation, irritability with feeding.

Unusual symptoms include mouthing, discomfort in supine positions, gagging.

Severe Symptoms: Wheezing, aspiration pneumonia, failure to thrive, esophageal bleeding, anemia
What are the symptoms of GERD?
Antacids, Spinal adjustments, hiatal hernia release, avoid peppermint/chocolate/caffeine/alcohol, elevate head of bed, hypoallergenic diet.
How do we treat GERD?
Weight loss, vomiting progresses to projectile, palpation of olive shaped lump RUQ/right of umbilicus.

Marked peristalsis from LUQ to epigastrum.
What are the symptoms of pyloric stenosis?
Pyloromyotomy
What is the treatment of pyloric stenosis?
Telescoping bowel (usually just proximal to ileocecal valve).

Males more common. typical at 6-18 months (MC bowel obstruction under 3yo). Signs/symptoms include colicky type pain, child draws knees up, may vomit, current jelly stools, palpable sausage shaped mass.
What is intussusception?
Enema is diagnostic and therapeutic.

Fatal if not treated.
How do we treat intussusception?
Aspirin or URI trigger it.

Signs/symptoms: Intractable vomiting after URI, confused, combative, agitative, comatose, dilated pupils, kussmaul's respirations, no fever.

If under 2 yoa, diarrhea and rapid respiration.
Reyes syndrome is triggered by... What are the symptoms?
Hospitalization, fluids, steroids.

brain damage. 20% mortality within 2-3 days.
How do we treat Reyes syndrome? What are the complications?
GI and lymph cancers, osteoporosis, neurological symptoms, peripheral neuropathy, myopathy, seizures, optic myopathy, dementia
What are the complications of Celiacs disease?
Crying for 3+ hours per day, for 3+ days per week, for 3+ consecutive weeks.
What is the standard definition of colic?
Unknown. Thought to be gastrointestinal in origin.
What is the etiology of colic?
Crying paroxysms, facial grimace, flenched fists, knees/hips flexed, distended abdomen, and poor response to soothing intervention.
What are the signs/symptoms of colic?
Chiropractic adjustments are >90% effective in reducing or eliminating crying behavior.
How effective is chiropractic in treating colic?
Swaddling, swinging, shushing, side/stomach, sucking.
What are the 5 Ss to treat colic
Zantac and Prevacid
What medicine can we use to treat a colicy baby?
It is self limiting most commonly by 3 months of age. Research even shows colicky infants might have a higher IQ.

But, it is a risk factor for abuse. It can also indicate underlying disease.
What is the prognosis for colic?
E Coli
Most common organism to infect a urinary tract?
1. Fever
2. Irritability
3. Poor feeding
4. Vomiting
5. Strong smelling urine
6. Abdominal pain
7. >7yo might have uregency, frequency, enuresis, flank/back pain
What are the symptoms/signs of a UTI in a child?
10-15% of five year olds. 5% of 10 year olds.

Boys are more common than girls.

Much more likely (3-4 times) with family history.
How common is nocturnal enuresis?
Primary: A child older than 5 who has never been consistently dry for 6 months or longer.
Secondary: A child who reverts to uncontrolled urinary discharge after previously establishing urinary control for 6 months or more.
Compare and contrast primary vs secondary nocturnal enuresis.
True. Which is why a full bladder doesn't wake them.
T/F: Children with enuresis are typically deep sleepers.
Lack of antidiuretic pituitary hormone, vasopressin.

Detrusor hyperactivity or over-stimulation.
What are the mechanisms of enuresis?