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Transcript
Pediatric GI
Disease
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….