Flashcards in Pediatric Gastrointestinal Disorders (Part 2) - Unit 2 Deck (74)
What is hirschsprung's disease? What does it result in?
Congenital aganglionic megacolon - essentially an absence of autonomic parasympathetic ganglion cells in the mucosal and muscular layers of the colon. IN LAYMAN'S TERMS, it means that they have no nerve cells down there so they can't pass the stool.
It results in obstruction and dilation of the proximal bowel.
Hirschsprung's Disease - peristalsis is normal above the affected area. T/F?
What are some clinical findings for Hirschsprung's Disease?
Long & ribbon like stools, typically symptoms appear once they start solid foods...
Failure to pass meconium, enlarged/distended abdomen, vomiting, fecal mass, rectum that is empty of stool
How do we test for hirschsprung's disease?
Anorectal manometry (tests the sphincter's reaction to rectal distention (if stimulated, they should poop), biopsy
How do we manage hirschprung's?
monitor F&E balance, may need regular rectal irrigation, surgical removal of the aganglionic portion of the bowel, may need temporary ostomy proximal to the aganglionic segment, complete correction (pull through)
Hirschprung's Disease - may be too malnourished to withstand immediate surgery. T/F?
What diet should a hirschprung's patient be on?
High calorie, high protein, LOW FIBER diet
What is enterocolitis?
Inflammation of the small bowel and colon, leads to ischemia and ulceration of bowel wall - - - - it is a surgical emergency is perforation occurs.
Entercolitis - can cause death in kids with Hirschprung's. T/F?
What are signs of perforation?
Distended + hard abdomen, pain, shocky (rapid HR, 1000 mile stare)
What is gastroesophageal reflux?
Retrograde flow of gastric contents in the esophagus - it is normal.
What causes gastroesophageal reflux?
Failure of the sphincter mechanism at the junction of the esophagus and the stomach.
GER - normal for children and adults after meals and may randomly improve in kids at age 6-9 months. T/F?
What are some manifestations of GI reflux?
Spitting up, vomiting, weight loss (something isn't right), gagging/choking at the end of feedings, respiratory problems, heartburn/irritability...
Heartburn and GI reflux - what is the problem with this?
Babies can't tell you they have heartburn!
What are some diagnostic tests for GI reflux?
Barium swallow, UGI, scintiscan, flexible endoscopy
How do we manage reflux?
Change to soy forumla, frequent burping, small feedings (not anything over 30 minutes), elevate HOB (wedge under mattress), lay on right side after feeding, thicken feeding with rice cereal
What meds manage reflux?
H2 Blockers (cimetidine), suppression of gastric acid (prilosec), increase gastric emptying (reglan - metaclopramide), azithromycin, etc.
What is a surgery for management of GI reflux?
Nissen fundoplication (wraps fundus around end of esophagus to make it tight) or a G-tube
What is enterobliasis?
What are some signs of pinworms? How are they transmitted? How do we test for them?
Signs = intense perianal itching.
transmitted fecal-oral route. :(
Tested with scotch tape test - we stick tape in their undies or diaper and later should find the worms...ewwww!
How do we treat pinworms? Do we treat the whole fucking family? Do we treat 1-2 weeks later?
We treat the whole family, also 1-2 weeks later!
What is colic?
Complex of symptoms which include paroxysmal severe crying episodes - apparent abdominal pain and irritability in healthy infants.
When does colic typically happen? What are some clinical findings for colic?
presents at 2-4 weeks and resolves by 3-4 moths, face may be flushed, circumoral pallor, abdomen may be distened, legs may be drawn up to the abdomen, episodes are rhythmic, usually occuring evening/lasting 3-5 hours or longer, normal physical exam.
How do we manage colic?
Reassure parents, discuss factors that trigger or increase (new bottle? Breast milk? etc), teach soothing techniques, WATCH FOR SBS
What are the inflammatory disorders? Difference?
UC and Crohn's.
UC - inflammation in colitis is limited to the colon and rectum - limited to the mucosa and involves continuous segments. T/F?
UC - produces what kind of diarrhea? Is there abdominal pain?
yes for abdominal pain.
Crohn's disease - chronic inflammation. T/F?