Peds GI Problems
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| Upper Abdomen | Peptic, Non-ulcer dyspepsia, pancreatitis, GB
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| NUD | respond to blockers, but no evidence on scope of inflammation
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| Mid abdomen | Small bowel, IBD, appendix, right colon lesions, functional
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| Lower Abdomen | Constipation, IBS,IBD, renal, GU, appendix
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| Most common mid-abdominal pain | functional abdominal pain
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| Quality of abdominal pain | crampy, burning, bloating, stabbing, steady vs intermittent, intensity
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| crampy | spasms of the visceral tract
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| burning | acid problems
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| stabbing | non-specific common complaint
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| Pain modifiers | meals (PUD gets better when you eat, pancreatitis, gallbladder dz gets worse), bowel movements, response to tx, sleep, stress, distractions
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| Pain that wakes a child from sleep | may suggest that the problem is organic instead of functional
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| Functional (nonorganic) abdominal Pain | 10% of kids, pain is poorly characterized and poorly localized. May be modeled after a transient illness of a family member's sx, exacerbated by stress, often have sx for years, but good growth and overall health
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| GI causes of pain include: constipation, lactose intolerance, PUD, sorbital (also in apple juice!), parasites, IBD, and | pacreatitis, cholelithiasis, postviral gastroparesis, congenital anomalies: GI,GB, pancreas. GI polyps
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| Non-GI Causes of Pain include: Functional, nonulcer dyspepsia, irritable bowel syndrome, sexual abuse; Renal: pyelonephritis, hydronephrosis, renal stones (severe pain), Medications (ADHD meds, Abdominal migraine, and | sickle cell crisis, PID, HSP, FMF, Vertebral discitis or tumor, SLE, Angioedema, Porphyria, Pneumonia
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| Presentations of constipation | infrequent large hard stools, painful BM +/- blood (may be from tearing.. so take a good hx of frequency and size), fecal soiling, abd. pain, poor appetite, lethargy, chronic diarrhea (really overflow soiling from constipation)
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| Most common cause of fecal soiling | constipation
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| Causes of Constipation: Functional, developmental, Hirschsprung's, Medications (e.g. narcotics, anticholinergics, chemotherapy), Hypothyroidism, Spina bifida, tethered cord, AND | anterior displacement of the anus, perianal disease, intestinal pseudo-obstruction, CF, Lead intoxication, botulism
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| Hirchsprung's dz and constipation | colon not innervated normally, doesn't relax properly which leads to a functional obstruction
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| some sx of hypothyroidism | constipation, slow heart rate, dry thick hair, sensitivity to cold, and other sx
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| Causes of fecal soiling | constipation with overflow, neurogenic: spina bifida, tethered cord, spinal cord tumor. Anal anomaly: imperferate with fistula, secondary destruction of the anal muscle (Hirschprung's repair, Crohn's perianal dz), Psychogenic (5%)
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| History for Constipation work up: Stool pattern, age at onset, toilet trained? Meconium (in 1st day of life, kids with Hirchsprung's may not have), stool holding, fecal soiling, perianal dz, previous tx and response, AND | How well will the child take meds? Sensitivity to cold, coarse hair, etc (hypothyroid), developmental and psychosocial hx. Recurrent UTI's?
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| PE for Constipation work up: Abd mass/disten, rectal exam: perianal soiling, tags, erythema, position of the anus, anus lax (like in chronic constipation) or tight? mass of stool in ampulla, gush of stool. AND | pilonidal sinus/tuft of hair, spina bifida, Neuro: LE DTRs, anal wink; Stigmata of hypothyroidism, Developmental delays/autism
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| Tests for constipation work up (when indicated) | KUB, Barium or water soluble enemia, rectal bx, anorectal manometrics, MRI of spine, Culture for a Group A Strep, Blood tests: thyroid, Ca, lead, celiac; sweat test, UGI-SI x-rays, US of urinary bladder, colonic manometry
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| Problems associated with chronic rectal distention | decreases strength of rectosignmoid contraction, increases threshold for conscious need to defecate, promotes relaxation of the internal anal sphincter - soiling, Sx: abdominal pain, decreased appetite, vomiting, irritability
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| Habit Constipation Tx: | cleanout (disimpaction), maintenance - stool softener, behavior modification, diet
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| GER in infants | regurgitation is normal, Pathologic reflux is defined by: feeding difficulty, FTT; Pulm sx - apnea, aspir, RAD; Esophagitis. Medical Tx: thickening 1Tbs cereal/2oz, acid blockers, prokinetic: reglan, erythromycin
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| FTT | fails to thrive (can occur as a result of over emesis)
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| RAD | reactive airway disease (may be associated with reflux)
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| Developmental GER usually subsides by | age of 18 months
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| Complications of GER | esophageal stricture, Barrett’s esophagus, asthma, sinusitis, feeding disorder, tooth enamel erosion, etc.
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| Reglan AE | chronic use can cause movement disorders
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