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Pedia- gi problems
med22
| Question | Answer |
|---|---|
| What is the most common cause of diarrhea in healthy, growing infants? | Cow milk protein intolerance (CMPI). |
| What is the typical presentation ("Procto-colitis") of non-IgE mediated Cow Milk Protein Intolerance (CMPI) in an infant? | Diarrhea, bloody/mucusy stool, and foul smelling gas. |
| Case: A 2-month-old is diagnosed with Cow Milk Protein Intolerance. What is the management if the infant is breastfed and supplemented with formula? | For the breastfeeding mother, protein elimination diet (eliminating cow milk protein, and often soy protein, from her diet). If formula-fed, use a Protein Hydrolyzed based formula. |
| What are the clinical characteristics of Functional Abdominal Pain (FAP) regarding its relationship to meals and defecation? | Not related to meals or defecation. |
| What is a common presentation of FAP regarding timing and school attendance? | The pain is often worst in the morning and frequently prevents or delays children from attending school. |
| What are the key differentiating features of Irritable Bowel Syndrome (IBS) (a subset of FAP)? | Pain with change in bowel habits (fluctuating between diarrhea & constipation) and pain relief with defecation. |
| What is the management approach for FAP and IBS after ruling out warning signs with a detailed history and physical exam? | Focus on returning to normal activities, fiber supplements, probiotics, and Cognitive Behavioral Therapy (CBT)/Psychological support. Medications like Amitriptyline may also be used. |
| List at least five "Warning Signs" in a child with recurrent abdominal pain that should prompt further workup for an underlying organic illness. | Vomiting (especially bilious emesis), Growth failure or Weight loss, Pain awakening child from sleep, Blood in stool, Location away from periumbilical region, and Abnormal screening laboratory study (anemia, hypoalbuminemia, inflammatory markers). |
| Case: A 2-month-old with recurrent regurgitation after every feed, with no blood or bile, who is otherwise gaining weight and meeting milestones. What is the next step in management? | Reassurance, as this is physiological Gastroesophageal Reflux (GER) ("spitting up"). |
| List three non-invasive (non-endoscopic) diagnostic tests for Gastroesophageal Reflux Disease (GERD). | Barium upper gastrointestinal (GI) series (to rule out gastric outlet obstruction), 24-hour esophageal pH probe monitoring, and Esophageal impedance monitoring. |
| What is the role of Endoscopy in the diagnosis of GER? | It is useful to evaluate for esophagitis, esophageal stricture, and mucosal disease. |
| List three conservative (non-medical, non-surgical) therapies for GER. | Thickened feedings, Smaller, more frequent feedings, Positional therapy (upright in seat; elevate), and Avoidance of tobacco smoke, alcohol, and caffeine. |
| Case: A 6-week-old male with new-onset projectile, nonbilious, nonbloody vomiting after every feed who is lethargic and has Hypochloremic, hypokalemic metabolic alkalosis. What is the immediate next step in management? | IV fluids to correct the dehydration and acid-base balance. |
| What are the clinical and physical exam findings highly suggestive of Pyloric Stenosis? | Projectile emesis (vomitus never contains bile), Very hungry early in the course, Visible gastric peristaltic waves in the left upper quadrant, and a hypertrophied pylorus (the "olive") may be palpated. |
| What is the definitive treatment for Pyloric Stenosis? | Surgical pyloromyotomy. |
| Case: A 1-month-old with worsening vomiting that is now nonprojectile bilious emesis, accompanied by abdominal distension and failure to thrive. What is the most likely diagnosis? | Intestinal Malrotation (often with midgut volvulus). |
| What is the clinical significance of a midgut volvulus secondary to Intestinal Malrotation? | It causes intestinal obstruction or mesenteric artery occlusion leading to intestinal infarction. |
| What is the key finding on an Upper GI series that suggests Intestinal Malrotation? | Absence of a typical duodenal "C-loop," with the duodenum instead remaining on the right side of the abdomen. |
| Case: A 7-year-old with a history of asthma and eczema (atopy) presents with vomiting after meals, dysphagia (food gets stuck, requiring water to swallow), and undigested food vomiting. What is the next step to confirm the diagnosis? | Upper endoscopy with biopsy (Gold standard). |
| What are the histological findings required to diagnose Eosinophilic Esophagitis (EoE)? | $\ge 15$ eosinophils per high-power field in the esophageal biopsy. |
| What is the definition of Constipation? | Defined as $\le 2$ stools per week or passage of hard, pellet-like stools for at least 2 weeks. |
| What is the most common cause of constipation in children and what is the associated finding that can complicate it? | Functional Constipation, which is commonly associated with fecal incontinence caused by leakage of retained stool (encopresis). |
| Case: A 7-year-old with recurrent fecal soiling (encopresis) and passing large-caliber, hard, painful stools every 3 days. Exam shows fecal soiling and hard stool in the rectum. What is the most appropriate management? | Increase fiber and fluids in the diet, use stool softeners (Polyethylene glycol and milk of magnesia), and initiate a routine scheduled toilet sitting program. |
| Case: A 4-month-old with constipation, passes stool once every 4 days, has ribbon-shaped stool, is bloated, and had a delayed meconium passage (after 72 hours of birth). What is the suspected diagnosis? | Hirschsprung disease. |
| What is the underlying cause of Hirschsprung disease? | A motility defect caused by failure of ganglion cells to migrate into the distal bowel during fetal life, leading to a functionally obstructed aganglionic segment. |
| What are the two most definitive tests to confirm the diagnosis of Hirschsprung Disease? | Rectal suction biopsy (shows absence of ganglion cells) and Anorectal manometry (shows absent relaxation of the internal sphincter). |
| What is the characteristic finding on a physical exam in a child with Hirschsprung Disease (classic triad)? | Failure to pass meconium in the first 24 hours of life, abdominal distension, and a tight anal sphincter with an empty, contracted rectum. |
| What is the definitive management for Hirschsprung Disease? | Surgical correction via Primary colorectal anastomosis. |
Created by:
MeanHeem