GI 1

hemolytic uremic syndrome: cause? triad?

E. coli; bleeding, low PLT, kidney damage

chronic nonspecific diarrhea

idiopathic, noninfectious, non bloody stool, no developmental delay >2 weeks

diarrhea treatment

fluid replacement, IV, oral rehydration therapy

using antibiotics with what infection can make it worse?

E. coli

antibiotics used to treat C. diff

metronidazole, vancomycin

how long can C. diff live on hard surfaces?

3 days

what to avoid in diarrhea patients?

caffeine, fruit juice, carbonated sodas, gelatin, meat broths (too much Na), BRAT diet (low nutrition)

most common cause of diarrhea in children <5

rotavirus

C. diff causes..

leukocytosis (elevated WBC) and hypoalbuminemia

what to avoid with E. coli

anti-motility agents (Imodium AD) and opioids (slow GI; bacteria stays in body longer)

avoid antibiotics in which 2 GI infections?

E. coli (make it worse) and salmonella (prolong GI transit)

hirschsprung disease is also known as…

congenital aganglionic megacolon

hirschsprung disease: pathophysiology? cause?

no ganglion cells (for peristalsis) commonly in rectosigmoid colon, skip lesions, whole colon→ bowel inflammation; congenital defect

hirschsprung disease symptoms

failure to pass meconium within 24-48 h after birth, refusal to feed, bilious vomiting, abdominal distention, FTT, constipation, foul-smelling ribbon-like stools, dilated loops of bowel on x-ray

how is hirschsprung disease confirmed?

rectal biopsy

hirschsprung disease surgery: procedure? postop?

primary pull-through/staged repair with temporary colostomy; NPO, NG to low INT suction (gastric decompression), I/O, abdominal assessment (girth), IVF, ostomy care, measure girth at umbilicus

peak incidence of GER is at…

4 months

symptoms of GER

passive regurgitation*, after meals/at night, poor weight gain, respiratory problems, abdominal pain, dysphagia, irritability

medications to treat GER

H2 blockers (famotidine), PPIs (omeprazole)

GER surgery & procedure

nissen fundoplication; wrap fundus around distal esophagus (tightens esophageal sphincter and prevents backflow)

GER treatment

small frequent meals, thickened feeds with rice cereal (bottle- allow room for rice to come through), upright feeding position NO <45 degrees

most common cause of emergency surgery in kids

appendicitis

meckel diverticulum

omphalomesenteric duct (connects yolk sac to fetal midgut; leaves after placenta takes over) remains

meckel’s diverticulum: rule of 2’s

2% population, 2x more common in males, 2 in, 2 ft proximal to ileocecal valve, 2 yr at dx, 2 cm diameter, 2 types of mucosa (pancreatic, gastric)

meckel’s diverticulum symptoms

painless rectal bleeding (bright red, INT, tarry, etc.), ulceration

meckel’s diverticulum: diagnosis? treatment? postop?

meckel’s scan (with radioactive dye); surgical removal; assess for hypovolemic shock, blood replacement, O2, IV fluids, NG to low INT suction