tailieunhanh - THE PEDIATRICS CLERKSHIP - PART 4

Chẩn đoán Upper GI nội soi. Bari bữa ăn không nhạy cảm. Đồng bằng x-quang có thể chẩn đoán thủng loét cấp tính. Angiography có thể chứng minh trang web chảy máu. ĐIỀU TRỊ Thuốc kháng acid, sucralfate, và misoprostol. Thuốc chẹn H2 và PPI. Cung cấp cho dự phòng loét dạ dày khi trẻ em là tổ chức phi lợi nhuận | Diagnosis Upper GI endoscopy. Barium meal not sensitive. Plain x-rays may diagnose perforation of acute ulcers. Angiography can demonstrate bleeding site. Treatment Antacids sucralfate and misoprostol. H2 blockers and PPIs. Give prophylaxis for peptic ulcer when child is NPO or is receiving steroids. Endoscopic cautery. Surgery vagotomy pyloroplasty or antrectomy for extreme cases. COLIC Parents and caretakers of children with colic are often very stressed out putting the child at risk for child abuse. Definition Frequent complex of paroxysmal abdominal pain severe crying Usually in infants 3 months old Etiology unknown Signs and Symptoms Sudden-onset loud crying paroxysms may persist for several hours Facial flushing Circumoral pallor Distended tense abdomen Legs drawn up on abdomen Feet often cold Temporary relief apparent with passage of feces or flatus Treatment No single treatment provides satisfactory relief. Careful exam is important to rule out other causes. Passage of flatus or fecal material by aid of enema or suppository may work. Improve feeding techniques burping . Avoid over- or underfeeding. I PYLORIC STENOSIS Definition Most common etiology is idiopathic. Not usually present at birth. Associated with exogenous administration of erythromycin eosinophilic gastroenteritis epidermolysis bullosa trisomy 18 and Turner s syndrome. Signs and Symptoms Nonbilious vomiting projectile or not Usually progressive after feeding Usually after 3 weeks of age may be as late as 5 months 128 FIGURE 11-3. Abdominal x-ray on the left demonstrates a dilated air-filled stomach with normal caliber bowel consistent with gastric outlet obstruction. Barium meal figure on the right confirms diagnosis of pyloric stenosis. The dilated duodenal bulb is the olive felt on physical exam. Note how there is a paucity of contrast traveling through the duodenum. Photo courtesy of Drs. Julia Rosekrans and James E. Colletti. Hypochloremic hypokalemic metabolic alkalosis rare these days due