Pediatric GIDisease

Tory Davis, PA-C

Table of Contents Esophagus Stomach

– Pyloric stenosis, foreign bodies Intestine/Colon

– Abd wall defects, intestinal atresia, intussusception

Infectious/Inflammatory

Abd Pain Red Flags Awakening at night with belly pain Pain localizing away from umbilicus Wt loss, growth deceleration Extraintestinal symptoms (fever, joint pain,

dysuria) Blood in stool Anemia, elevated ESR + FHx PUD, IBD

Esophagus Tracheoesophageal fistula- faulty

separation of trach and esoph Cough, cyanosis, choking after first

feed. Recurrent pneumonia, wheezing 40% with other abnormalities VATER syndrome- vertebral defects,

anal atresia, TEF, radial limb dysplasia

Pyloric stenosis Hypertrophic pyloric stenosis Males 1:150, females 1:750 Postprandial nonbilious projectile

vomiting, ages 4-6 weeks Hypokalemic metabolic alkalosis,

dehydration Olive-shaped mass, R of midline Marked peristaltic waves postprandial Dx: US TX: Pyloromyotomy

Foreign Bodies My personal favorite: Bezoar- mass of ingested material that

fails to pass stomach– Trichobezoar– Phytobezoar– Lactobezoar

Abd pain, anorexia, vomiting, weight loss

Foreign bodies Coins, marbles, button batteries, legos…you

name it, they eat it Lodge in esophagus at cricopharyngeal

muscle, level of aortic arch, LES Sx: cough, choking, stridor, odynophagia,

drooling, or asymptomatic If in esoph, needs removal (endo, foley)

– Prevent ulceration/bleeding/perforation If in stomach, this too will pass

– Manage conservatively, monitor

Abd Wall Defects Omphalocele- herniation of abd

viscera (covered with peritoneum) thru abd wall at umbilicus. Not covered with skin.

Primary closure of small defects, staged surgeries for large defects

High incidence of associated malformations

Abd wall defects Umbilical hernia- incomplete closure

of fascia of umbilical ring Herniated omentum/bowel covered

with skin Spontaneous healing with small

defects– Surgical repair if defect is >1.5 cm at 2

years– Manual reduction ineffective

Intestinal Atresia Failure of a portion of the intestinal

tract to completely form Bilious vomiting within hours to 2 days

after birth Duodenal- xray “double bubble” Jejeunal/ileal atresia- more common

than duodenal

Anorectal malformation 1:5000 Careful perianal exam in newborn Rectal or anal agenesis Rectal atresia Anal stenosis Imperforate anus

Meckel’s Diverticulum Vestigial remnant of omphalomesenteric

duct Rule of 2s

– Most often presents clinically at 2 years old– 2% of population– Males 2x females– 2 feet from ileocecal valve– 2% symptomatic– 2 inches long

Meckel’s Diverticulum Most common presenting symptom is

painless rectal bleeding Also:

– Intussusception– Volvulus– Diverticulitis (can resemble acute

appendicitis)

Hirschsprung Disease Congenital aganglionic megacolon Absence of normal enteric nerves in a

segment of large intestine Suspect in infant failing to pass meconium

in 1st 24 hours Chronic constipation Failure to thrive, abd distention, anemia,

undernourished PE: Palpable stool in abd with empty

rectum

Hirschsprung Disease Dx- barium studies, aganglionic rectal

bx Tx: “pull through” surgery

Midgut Volvulus Emergent bowel obstruction in which loop of

bowel has twisted on itself Caused by congenital intestinal malrotation Presents 0-30 days Bilious vomiting (from obstruction), severe

pain (from bowel ischemia) Dx: UGI Tx: Surgical (Ladd’s procedure)

Inguinal hernia Abdominal contents in patent

processus vaginalis (thru which the testicle descends into scrotum, 50% remain patent)

More common in preemies and boys Painless swelling, manually reducible

Incarcerated Hernia Age 0-12 months Hard, painful non-reducible groin

mass Fussy, anorexia, +/- emesis Dx by exam Tx surgical (hernioplasty) to avoid

bowel necrosis

Intussusception Section of bowel telescopes into distal

segment Idiopathic

– CF, lymphoid hyperplasia patches, Meckel diverticulum

Ages 6-18 months Acute onset colicky, intermittent abd

pain

Intussusception Fetal position, vomiting Sausage-shaped mass in upper abd Current jelly-colored stools Dx: Barium enema (bonus- may also

reduce the intussusception) Tx: if barium enema failed, or if clinical

signs of perforation or peritonitis: surgical reduction

Colic Periods of unexplained paroxysmal bouts of

crying Rule of 3s

– >3 hours/day, >3 days/week, >3 weeks in healthy, well-fed infant between age 3 weeks and 3 months

Typical late afternoon, early evening bouts 15-25% of infants Multifactorial etiology-infant, parent, and

environmental factors– Not necessarily GI

Colic Listen to the parents! Reassure the parents! Teach the parents! Emphasize that this is self-limited Changing formula?

– “The art of medicine is to amuse the patient while nature cures the disease.”

• Voltaire

Probiotics

Phenylketonuria Autosomal recessive genetic disorder Deficiency in the enzyme phenylalamine

hydroxylase (PAH)– Metabolizes phenylalamine (PA) to tyrosine

Untx’d accumulation of PA leads to irreversible brain damage, MR, seizures. Screen at birth.

No cure Tx by diet low in PA, high in tyrosine

Yes, kids also have: IBD Crohn’s Ulcerative colitis Lactase deficiency Celiac disease Appendicitis Peptic ulcer disease GERD

But you already know about those…

And I know you didn’t forget it all already….

And if you did, you’ll be sure to go review….