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Meconium should be passed by __ hrs of age
Stools are unformed, seedy, oatmeal-like; yellow, brown or green
breast milk stools
Breast fed: infants may stool up to ___ x/day
10 to 12; or once a wk
Stools are formed; yellow, green, or brown and pasty in consistency in consistency
Formula stools
Infrequent passage of hard or pellet-like stools
T/F: \\\"straining\\\" behavior in infants can be normal as long as stools soft
__% children 1-2 yo have fxnal constipation
Medical causes of constipation (4)
Hirschprungs Dz, hypothyroidism, Spinal cord defects (SB), imperforate anus/anal stenosis
Tx: constipation
education, Meds: miralax, MOM, Colace, enemas
Involuntary fecal soiling in children who have already been potty trained
Forceful ejection of gastric contents that may occur w/GI & non-GI Dz in childhood
Loss of urge to defecate and \\\"force\\\" of contractions is lost
Passive, nonforceful ejection of gastric contents resulting from reflux through a relaxed LES
Tx: vomiting
Tx underlying disorder; prevent dehydration
hypertrophic muscle around pyloric valve
Pyloric stenosis
Dx: pyloric stenosis
palpation of olive-shaped mass to right of umbilicus, epigastrium; confirmed by US/barium swallow
Tx: pyloric stenosis
S/Sx: sandifer sign, vomiting, regurg, asthma, aspiration PNA, SIDS, FTT, esophagitis
Gastroesophageal reflux (chalasia)
Etiology: GERD (4)
dec LES pressure, over-feeding, dec gastric motility, hiatal hernia
Hx & upper GI barium swallow
meds (reglan, H2 blockers), surgery (nissen fundoplication)
blood stained emesis or coffee ground emesis that results from bleeding proximal to the ligament of Treitz
Dark, black tarry looking stools suggestive of bleeding from the oropharynx to the proximal small intestine
Bright red/maroon colored stools
BRB per mouth/rectum --> test performed to determine if blood baby or mom\\\'s
Apt test
Eval: UGI bleed
NGT w/gastric lavage, CBC, may need endoscopy or barium swallow
Eval: LGI bleed
FOB test, barium enema, endo
Tx: GI bleeding
correct hypovolemia/anemia, stop bleeding, meds (antacids, anion pump inhibitors, H2 blockers), modify diet
Umbilical hernia: will close spontaneously if < __cm
2 cm
____hernia will NOT close and needs repair
supraumbilical hernia
S/Sx: gastric distension & bilious emesis; \\\"double bubble\\\" appearance on US & polyhydraminos
Duodenal atresia
30% of babies w/DA have ____ syndrome
Down Syndrome
S/Sx: acute colicky INT abd pain & currant jelly stools, sausage-shaped mass
Occurs when one segment of bowel telescopes into a distal segment
Intussusception: occurs most b/w __-__ months
Dx: intussusception
barium, gastrografin or air-contrast enema
Tx: intussusception
Surgery if perforation, peritonitis or shock
Vestigial remnant of the omphalomesenteric duct & is most frequent anomaly of GI tract
Meckel diverticulum
Rule of 2\\\'s: peak 2 yo, 2% pop, 2 cm long, 2 ft from ileocecal valve, 2 types of tissue (gastric & pancreatic), 2x MC in males
Meckel diverticulum
Yellow discoloration of the skin, mucus membranes & sclera caused by inc serum bili conc
Jaundice (icterus)
Unconjugated hyperbilirubinemia: Hemolysis Coombs + (3)
ABO & RH incombatibility, drug induced
Unconjugated hyper.: Hemolysis coombs - (3)
G6PD Def, Sickle cell, Sperocytosis
Unconjugated hyper.: No hemolysis (5)
breast milk jaundice, physiologic jaundice of newborn, hypothyroid, gilbert syndrome, crigler-najar syndrome
S/Sx: jaundice, hepatomegaly, dark urine & acholic (white) stools
Neonatal cholestasis
Neonatal is an example of ____ hyperbilirubinemia
Biliary scan shows absent extrahepatic bile ducts
biliary atresia
Tx: biliary atresia
kasai procedure then liver transplantation
S/Sx: severe perianal itching or vaginal itching
Pin worms
Most common worm infestation in the U.S.
Pin worms (enterobius vermicularis)
Tx: pinworms
Vermox (mebendazole)
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