Pediatric GI Disease
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Transcript of Pediatric GI Disease
Pediatric GIDisease
Tory Davis, PA-C
Table of Contents Esophagus Stomach
– Pyloric stenosis, foreign bodies Intestine/Colon
– Abd wall defects, intestinal atresia, intussusception
Infectious/Inflammatory
Abd Pain Red Flags Awakening at night with belly pain Pain localizing away from umbilicus Wt loss, growth deceleration Extraintestinal symptoms (fever, joint pain,
dysuria) Blood in stool Anemia, elevated ESR + FHx PUD, IBD
Esophagus Tracheoesophageal fistula- faulty
separation of trach and esoph Cough, cyanosis, choking after first
feed. Recurrent pneumonia, wheezing 40% with other abnormalities VATER syndrome- vertebral defects,
anal atresia, TEF, radial limb dysplasia
Pyloric stenosis Hypertrophic pyloric stenosis Males 1:150, females 1:750 Postprandial nonbilious projectile
vomiting, ages 4-6 weeks Hypokalemic metabolic alkalosis,
dehydration Olive-shaped mass, R of midline Marked peristaltic waves postprandial Dx: US TX: Pyloromyotomy
Foreign Bodies My personal favorite: Bezoar- mass of ingested material that
fails to pass stomach– Trichobezoar– Phytobezoar– Lactobezoar
Abd pain, anorexia, vomiting, weight loss
Foreign bodies Coins, marbles, button batteries, legos…you
name it, they eat it Lodge in esophagus at cricopharyngeal
muscle, level of aortic arch, LES Sx: cough, choking, stridor, odynophagia,
drooling, or asymptomatic If in esoph, needs removal (endo, foley)
– Prevent ulceration/bleeding/perforation If in stomach, this too will pass
– Manage conservatively, monitor
Abd Wall Defects Omphalocele- herniation of abd
viscera (covered with peritoneum) thru abd wall at umbilicus. Not covered with skin.
Primary closure of small defects, staged surgeries for large defects
High incidence of associated malformations
Abd wall defects Umbilical hernia- incomplete closure
of fascia of umbilical ring Herniated omentum/bowel covered
with skin Spontaneous healing with small
defects– Surgical repair if defect is >1.5 cm at 2
years– Manual reduction ineffective
Intestinal Atresia Failure of a portion of the intestinal
tract to completely form Bilious vomiting within hours to 2 days
after birth Duodenal- xray “double bubble” Jejeunal/ileal atresia- more common
than duodenal
Anorectal malformation 1:5000 Careful perianal exam in newborn Rectal or anal agenesis Rectal atresia Anal stenosis Imperforate anus
Meckel’s Diverticulum Vestigial remnant of omphalomesenteric
duct Rule of 2s
– Most often presents clinically at 2 years old– 2% of population– Males 2x females– 2 feet from ileocecal valve– 2% symptomatic– 2 inches long
Meckel’s Diverticulum Most common presenting symptom is
painless rectal bleeding Also:
– Intussusception– Volvulus– Diverticulitis (can resemble acute
appendicitis)
Hirschsprung Disease Congenital aganglionic megacolon Absence of normal enteric nerves in a
segment of large intestine Suspect in infant failing to pass meconium
in 1st 24 hours Chronic constipation Failure to thrive, abd distention, anemia,
undernourished PE: Palpable stool in abd with empty
rectum
Hirschsprung Disease Dx- barium studies, aganglionic rectal
bx Tx: “pull through” surgery
Midgut Volvulus Emergent bowel obstruction in which loop of
bowel has twisted on itself Caused by congenital intestinal malrotation Presents 0-30 days Bilious vomiting (from obstruction), severe
pain (from bowel ischemia) Dx: UGI Tx: Surgical (Ladd’s procedure)
Inguinal hernia Abdominal contents in patent
processus vaginalis (thru which the testicle descends into scrotum, 50% remain patent)
More common in preemies and boys Painless swelling, manually reducible
Incarcerated Hernia Age 0-12 months Hard, painful non-reducible groin
mass Fussy, anorexia, +/- emesis Dx by exam Tx surgical (hernioplasty) to avoid
bowel necrosis
Intussusception Section of bowel telescopes into distal
segment Idiopathic
– CF, lymphoid hyperplasia patches, Meckel diverticulum
Ages 6-18 months Acute onset colicky, intermittent abd
pain
Intussusception Fetal position, vomiting Sausage-shaped mass in upper abd Current jelly-colored stools Dx: Barium enema (bonus- may also
reduce the intussusception) Tx: if barium enema failed, or if clinical
signs of perforation or peritonitis: surgical reduction
Colic Periods of unexplained paroxysmal bouts of
crying Rule of 3s
– >3 hours/day, >3 days/week, >3 weeks in healthy, well-fed infant between age 3 weeks and 3 months
Typical late afternoon, early evening bouts 15-25% of infants Multifactorial etiology-infant, parent, and
environmental factors– Not necessarily GI
Colic Listen to the parents! Reassure the parents! Teach the parents! Emphasize that this is self-limited Changing formula?
– “The art of medicine is to amuse the patient while nature cures the disease.”
• Voltaire
Probiotics
Phenylketonuria Autosomal recessive genetic disorder Deficiency in the enzyme phenylalamine
hydroxylase (PAH)– Metabolizes phenylalamine (PA) to tyrosine
Untx’d accumulation of PA leads to irreversible brain damage, MR, seizures. Screen at birth.
No cure Tx by diet low in PA, high in tyrosine
Yes, kids also have: IBD Crohn’s Ulcerative colitis Lactase deficiency Celiac disease Appendicitis Peptic ulcer disease GERD
But you already know about those…
And I know you didn’t forget it all already….
And if you did, you’ll be sure to go review….