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Peds GI

Pediatrics

QuestionAnswer
Most common site of intussusception ileocecal valve (part of ileum into ascending colon)
Intussusception s/s 3 months-1 year. Colicky, abd pain, N/V, drawing up legs. Early: sausage-like abdominal mass. In 48 hrs lethargy, tachypnea, fever, hypotension, currant jelly stools (late)
Intussusception mgmt NGT, telemetry, IVF. CMP, coag, CBC. US or xray (looks like inverted cap). Barium or air enema both dx/tx
Introduce solid foods (cereal, fruits) 4 – 6 mo; after 6 mo add meat, eggs, starchy foods
Rule of 3s in colic Prolonged episodes of crying for >3 hrs / day, for >3 days / week, for >3 weeks in a previously well infant
Contraindications to reduction of Intussusception by barium Free intraperitoneal air or peritoneal & systemic sxs of compromised intestine: need surgical reduction
Volvulus (malrotation) presentation In 1st 1-3 weeks of life. Recurrent bilious vomiting. Acute SBO.
Volvulus on imaging Abdominal xray shows double bubble sign. Barium enema shows malposition of cecum. Upper GI series shows ligament of Treitz malposition
Diagnostic procedure of choice in pt with volvulus and without obstruction Upper GI series
Volvulus mgmt Surgical emergency (due to bowel necrosis from SMA occlusion). May require second-look surgery at 24-48h
Constipation mgmt PRN disimpaction. High fiber diet. Short term laxatives. Low dose PEG x6 months.
Projectile vomiting in infant within 2h of feeding suggests: pyloric stenosis
Pyloric stenosis presentation 4:1 M:F. 2-12 weeks old. Nonbilious emesis, wt loss. Olive shaped RUQ mass. Hypochloremic alkalosis with potassium depletion
Pyloric stenosis mgmt NGT. Surgery
Viral gastroenteritis etiologies rotavirus; caliciviruses (includes noroviruses); astroviruses ; adenoviruses
Bacterial gastroenteritis etiologies nontyphoidal Salmonella; Shigella; Campylobacter; E. coli (EPEC, 0157-H7)
Viral gastro: explosive, watery diarrhea, N/V, fever, 2-8 days rotavirus
Gastroenteritis: Abx recommended for Shigella or EPEC if <3 mos old; NOT for Salmonella or 0157:H7
Giardia may cause this condition: vulvovaginitis in prepubescent girls
Created by: Abarnard