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