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What are the common GI d/o\\\'s in peds?
1. Acute gastroenteritis (AGE) 2. Chronic diarrhea 3. Constipation 4. Reflux 5. Esophagitis 6. Celiac dz 7. Allergic colitis
What are the functional GI disoders of childhood?
1. Functional dyspepsia 2. IBS 3. Functional abd pn 4. Abd migraine 5. Aerophagia
What is the def of diarrhea?
3+ loose; water stools/day
Describe the sx of AGE?
**Rapid onset** diarrhea w/or w/out fever; abd pn; nausea; and vomiting
What is the most common viral cause of AGE?
What are the top two bacterial causes of AGE?
1. Campylobacter jejuni (**most common**) 2. Shigella (2nd most common)
What is the top cause of AGE?
What is the most common parasitic cause of AGE?
**Giardia lamblia** // MOST labs will only look for this unless you specify a different parasite
Daycare outbreak indicates what etiology of AGE?
Shigella (not always but associate it in your head)
Bloody AGE indicates what type of etiology?
Ab use can lead to what type of AGE?
Pseudomembranous colitis
Is BP or Pulse more beneficial for AGE?
**Pulse is most sensitive**
Do PE findings equate accurately w/level of dehydration?
No. Unless you know the weight of the child before they were sick and after. That\\\'s your best physical correlation.
What is fluid bolus for a ped? A neonate?
**20cc/kg IV** Neonate 10cc/kg IV
When should we use IV therapy for dehydration?
1. Severe dehydration 2. Unable to take oral fluids
\\\"What is the normal range for \\\"\\\"pooping frequency\\\"\\\"?\\\"
3/day to 3/week
Children <5y/o usually get AGE how many times/yr?
What are the 2 most common viral causes of AGE?
1. Rotavirus 2. Norwalk
\\\"What are the \\\"\\\"other\\\"\\\" causes of diarrhea (important to know)?\\\"
1. Ab\\\'s 2. Meds 3. **Excess carb intake** (Crystal light; etc.)
What is the most important aspect of pt hx to obtain in AGE?
**Assess severity of dehydration**
What test do we order if we suspect G. Lamblia?
Stool for O&P
What test could we order if we suspected a malabsorptive problem?
Stool pH (<6.0 = +)
What drug can help prevent vomiting if we are trying to use oral rehydration therapy?
What is a great ratio for Gatorade for oral rehydration therapy?
What is the formula for maintenance therapy for a ped?
**4/2/1cc/kg/hr** (1st 10kg x 4; 2nd 10kg x 2; the rest of the kg x 1)
What is the formula for a bolus for a neonate?
What is tx for a kid that is afebrile and has non-bloody diarrhea?
Just rehydrate
If pt is afebrile and has bloody diarrhea; what things should we consider?
1. HUS 2. Intussusception 3. IBD
Chronic diarrhea is how long?
**> 4 wks**
What are the concepts of etiology of chronic diarrhea?
1. Decreased absorption (osmotic) 2. Increased intestinal permeability (secretory) 3. Increased intestinal motility
Delayed stooling since birth = ?
Hirschsprung\\\'s dz (lack of nerves to stimulate colon)
Chronic diarrhea w/hx of resp. infections should make us think what?
Chronic bloody diarrhea should make us think what?
What etiology of chronic diarrhea is more likely to cause abd pn?
What are the general screening labs that we should get for chronic diarrhea?
1. CBC; Chem 7 2. Stool O&P and culture 3. Stool pH and reducing substance
What are the most common times for constipation to occur?
1. Intro of solid foods (6 mo) 2. Toilet training (2-3 y/o) 3. Start of school (4-5 y/o)
What are the two types of constipation?
1. Functional (95%) 2. Organic (5%)
What are the causes of constipation that we CANNOT miss?
1. Infantile botulism 2. CF 3. Spinal dysraphism (spina bifida) 4. Lead poisoning 5. Hirschsprung\\\'s Dz 6. Hypothyroidism
How many poops should a 2 y/o have per day?
How many times should a 4 y/o defecate/day?
How many times should a 1 wk old defecate/day?
What is an easy test to do to see that there\\\'s poop in a constipated pt?
What is the tx for constipation in infants?
1. Add sorbital (sugar) 2. Rectal stimulation 3. Glycerine suppositories
What are the tx options for constipation for children/adolescents?
1. Increase fiber/water 2. Decrease milk 3. **Osmotic laxatives** (lactulose or Miralax)
What is the def of GER?
Regurge of stomach contents that does NOT cause the infant harm
What is the def of GERD?
Pathologic regurge
What are the sx of pediatric GERD?
1. Wt loss 2. Esophagitis 3. Respiratory sx 4. Neck tilting (Sandifer\\\'s syndrome)
GERD in kids increases risk of what 3 things?
1. Esophageal stricture 2 Barrett\\\'s esophagus 3. Asthma
What is a common presenting systemic sx of GERD in kids?
What is the best test for evaluating GERD progression or differentiating from PUD?
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