Pediatric Gastrointestinal and GU Disorders Questions and Answers
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Course
GU Peds
Institution
GU Peds
Refers to recurrent postprandial spitting and vomiting in healthy infants that resolve spontaneously Uncomplicated GERD
Is present when reflux causes secondary symptoms or complications GERD
If emesis contain bile: requires immediate evaluation as this may be a symptom of intestinal obstruction
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Pediatric Gastrointestinal and GU
Disorders Questions and Answers
Refers to recurrent postprandial spitting and vomiting in healthy infants that resolve
spontaneously ✅Uncomplicated GERD
Is present when reflux causes secondary symptoms or complications ✅GERD
If emesis contain bile: ✅requires immediate evaluation as this may be a symptom of
intestinal obstruction
Warning signs that are associated with GERD that may lead to other serious conditions
include: ✅bilious emesis, GI bleeding, onset of vomiting after 6 months, failure to
thrive, diarrhea, fever, hepatoesplenomegaly, abdominal tenderness or distension, or
neurologic changes.
Reflux usually resolves in 85% of affected infants by what age? ✅12 months of age.
Postnatal muscular hypertrophy of the pylorus. Progressive gastric outlet obstruction,
nonbilious vomiting, dehydration, and alkalosis in infants younger than 12 weeks. Upper
GI contrast radiographs or abdominal ultrasound are diagnostic. Projectile vomiting
usually occurs between 2-4weeks. Hypochloremic alkalosis with potassium depletion is
the classic metabolic finding. Also elvated H&D secondary to dehydration. ✅Pyloric
Stenosis
TX: ramstedt pyloromyotomy is the the treatment of choice. Also treat dehydration.
A peritoneal sac precedes the testicle as it descends from the genital ridge of the
scrotum. Usually no other symptoms are present. Can happen in both boys and girls
✅Inguinal Hernia
Tx: Manual Reduction (trendelenburg position with an ice bag on the affected side).
Manual reduction is contraindicated if hernia has been present for more than 12 hours
or if bloody stools are noted. Surgery is then necessary.
Disease that results from the absence of ganglion cells in the mucosal and muscular
layers of the colon. This leads to failure of the colonic muscles to relax in front of the
advancing bolus of stool. ✅Hirschsprung Disease
TX: Surgical
Clinical findings of Hirschsprung Disease ✅Failure of the newborn to pass meconium.
Vomiting, abdominal distention. Reluctance to feed. Most of these children do not pass
stool for the first 24 hours of their life. On rectal exam, the anal canal and rectum are
devoid of fecal material despite obvious retained stool on abd exam and radiographs.
Constipations with ribbon like stool in older children.
, Chronic constipation in childhood is defined as two or more of what characteristics:
✅Fever than three bowel movements per week. More than one episode of encopresis
(involuntary deification) per week. Impaction of the rectum with stool. Passage of stool
so large it obstructs the toilet. Retentive posturing and fecal withholding. Pain with
defecation.
Infants younger than 3 months often grunt, strain, and turn red with this condition.
✅Normal stools. Educated not to use laxatives or enemas.
Treatment of Constipation. ✅Obtain careful diet history. Dietary fiber is important along
with fluid intake. Miralax (1g/kg/day), magnesia (1-2mg/kg/day), lactulose, mineral oil (2-
3 ml/kg/day dont give to nonambulatory patient, also a multivitamin supplement is
recommended with this medication).
An otherwise healthy infant aged 2-3 months seems to be in pain, cries for more than 3
hours a day, for more than 3 days a week, for more than 3 weeks. Occurs mainly in the
late afternoon. Knees are drawn up and fist are clenched. Minimal response in attempt
to soothing. ✅Colic
TX: Rhythmic stimulation such as gentle swinging or rocking, soft music, car rides,
walking around the block with stroller. Also, can change feeding habits such as more
frequent feedings as to decrease gastric distention.
Repeated urination into the clothing during the day and into the bed at night by a child
who is chronologically and developmentally older than 5 years. This pattern must occur
twice a week for 3 months. ✅Enuresis.
TX: goal is to help child not feel ashamed, and help them build their confidence. Limit
liquids before sleep. Awakening the child at night so that they can go toilet. Bed wetting
alarms (alarms set that make the child wake up and use the restroom). Desmopressin
acetate is an antidiuretic hormone analogue that has prove to have some success.
Imipramine (tricyclic antidepressent) should be used as a last resort. Daytime enuresis,
look for underlying pathology (i.e. Diabetes Insipidus, neurogenic bladder, constipation.)
Abdominal pain, diarrhea, bloody stools, fever, anorexia, fatigue, and weight loss.
Is................what? ✅Inflammatory Bowel Disease (Chrons and ulcerative colitis).
Diet: High protein, High carb, normal fat, low-lactose.
Meds: ASA dderivatives (balsalazide and sulfasalazine)
Steroids: Methylprednisolone (1mg/kg/day)
Immunomodulator to maintain remission (azathioprine, 6-mercaptopurine, and
methotrexate.)
ABX: Metronidazole 15-30 mg/kg/day in 3 divided doses. Ciprofloxacin
Biologicals: Infliximab used in fistualizing disease.
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