Term
| what study is diagnostic for acute appendicitis |
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Definition
ABD CT after rectal instillation of contrast with thin cuts in the area of the appendix
(most cost-effective: if appendicits suscepted --> ABD U/S followed by CT scan for neg studies) |
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Term
| after a period of close observation of a pt, and acute appendicitis is unable to be ruled out, what procedure is indicated |
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Definition
| exploratory laparotomy or laparoscopy is indicated when the dx of acute appendicitis cannot be ruled out after a period of close observation |
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Term
| what is given to a pt with acute appendicitis to prevent postoperative infection |
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Definition
| a single intraoperative dose of cefoxitin or cefotetan is recommened for ALL pts to prevent postoperative infection |
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Term
| postoperative antibiotic therapy is reserved for what instances of acute appendicitis (aka - it isn't given to every acute appendicitis pt, only for certain cases) |
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Definition
| reserved for pts with gangrenous or perforated appendix |
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Term
| what special examination is found in all Hirschsprung disease pts |
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Definition
| rectal manometric testing revealing a failure of reflex relaxation of the internal anal sphincter after distention of the rectum; this occurs in all pts regardless of the length of the aganglionic segment |
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|
Term
| how is hirschsprung disease differentiated from small left colon syndrome (common in infants of diabetic mothers) |
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Definition
| hirschspring disease is differentiated from small left colon syndrome by biopsy |
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Term
| treatment for an unstable infant with hirschsprung disease |
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Definition
| diverting colostomy or ileostomy proximal to the aganglionic segment, with resection of the aganglionic segment postponed |
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Term
| treatment for a stable infant with hirschsprung disease |
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Definition
| primary resection of the aganglionic segment with a pull-through of the ganglionated bowel all performed in one operation |
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Term
| what tx could be done for a pt with ultrashort hirschsprung disease that is capable of controlling symptoms |
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Definition
| internal anal sphincter myotomy or botulinum toxin injection of the internal anal sphincter |
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|
Term
| treatment of mild constipation |
|
Definition
for first line, does not require medication initially
increase intake of high-residue foods: bran, whole wheat, fruits, veggies
increased fluid intake only increase urination and typically has little effect on defecation |
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Term
| treatment of constipation if diet change alone is ineffective |
|
Definition
barley malt extract (Maltsupex) or polyethylene glycol solution (Mirolax) are safe stool softeners in infants and children
give regularly in doses sufficient to induce 2 - 3 loose BMs/day
after weeks - months of regular loose stool and begint to taper and eventually stop |
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Term
| tx of a fecal impaction in a child |
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Definition
stimulant laxatives (ExLax) can be used for short periods to relieve fecal impaction
if fecal impaction is present with encopresis, should start with relieving the fecal impaction |
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|
Term
|
Definition
tx with a stool softener
anal dilation relieves sphincter spasm
warm sitx bath after defecation
rarely - silver nitrate cauterization or surgery
avoid surgery in Crohn's disease pt - bc of high risk of recurrence |
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Term
| what procedure is diagnostic of intussusception |
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Definition
| barium enema and air enema are both diagnostic and therapeutic |
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|
Term
what tx is preferred for an intussusception pt who has signs of strangulated bowel, perforation, or toxicty
what is the alternative |
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Definition
reduction of the intussusception by barium enema should not be attempted
air insufflation of the colon under fluoroscopic guidance is a safe alternative to barium enema |
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|
Term
| for an intussesception pt, when is surgery indicated |
|
Definition
surgery is required in:
extremely ill pts
pts with evidence of bowel perforation
or those in whom hydrostatic or pneumatic reduction has been unsuccessful |
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|
Term
| dx of acute diarrhea due to rotavirus |
|
Definition
rotavirus cannot be definitively diagnosed on clinical grounds alone. rotavirus antigens can be IDed in stool or virus can be seen by scanning electron micrograph
however the specific ID of rotavirus is not required in every case, as tx is nonspecific |
|
|
Term
tx of acute diarrhea due to rotavirus
(including what additional for immunocompromised pt) |
|
Definition
nonspecific and supportive:
replace fluid and electrolyte deficits (oral rehydration solutions is appropriate)
early initiation of refeeding is recommended - with a reduction of fat intake (may decrease N/V)
antidiarrheals are ineffective, possible dangerous
if immunocompromised: oral immunoglobulin or specific antiviral agents - limit duration of dz |
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|
Term
| the definitive cure for alpha1-antitrypsin liver diseae |
|
Definition
| liver transplantation, performed for development of end stage liver disease, cures the deficiency and prevents the development of pulmonary disease |
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|
Term
| what vaccines should a pt with alpha1-antitrypsin liver diseae receive |
|
Definition
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|
Term
| alpha1-antitrypsin liver diseae pt who has the associated neonatal cholestatic condition is treated with what |
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Definition
| choleretics, medium chain tryglyceride containing formula, and water soluble perparations of fat soluble vitamins |
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|
Term
| contraindications to Hep B vaccine |
|
Definition
serious allergic rxn to yeast or vaccine components
anaphylaxis to Hep B vaccine in the past
Hx of Guillain-Barre
MS
Autoimmune disease
pregnancy is NOT a contraindication |
|
|
Term
contraindications to Hep A vaccine
and precautions |
|
Definition
contraindications:
prior severe allergic rxn to previous Hep A vaccine
hypersensitivity to neomycin (Harvix brand)
hypersensitivity to aluminum (both brands: Harvix and Vaqta)
Precautions:
pregnancy
moderate - acute illness
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|
Term
| contraindications for rotavirus vaccine |
|
Definition
hypersensitivity to previous dose
pt with latex allergy - do NOT give RV1 brand
pt with moderate - severe gastroenteritis - defer vaccination |
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|
Term
contraindications to DTaP
precautions |
|
Definition
contraindications:
anaphylaxis to previous vaccine
children who developed encephalopathy after previous vaccine w/in 7 days
children with: infantile spasms, epilepsy, encephalopathy
precautions:
persistant inconsolable crying
seizures w/in 3 days of previous dose
guillian-barre less than 6 weeks after previous dose
(these contraindications and precautions are very similar for Tdap) |
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|
Term
| contraindications for Hib vaccine |
|
Definition
severe allergic rxn to previous dose
never before 6 weeks of age - causes immune tolerance |
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|
Term
| contraindications for pneumococcal vaccine |
|
Definition
severe allergic rxn to previous dose
moderate - severe acute illness w/ or w/o fever - defer |
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|
Term
contraindications for poliomyelitis vaccine
precautions |
|
Definition
contraindications:
severe allergic rxn to previous dose
moderate - severe acute illness w/ or w/o fever - defer
precautions:
pregnancy |
|
|
Term
| contraindications for MMR/MMRV vaccine |
|
Definition
contraindications:
pregnancy
woman planning to become pregnant w/in next 28 days
immunocompromised pt
anaphylactic egg allergy or neomycin allergy
high dose corticosteroid therapy
leukemic pt - unless they are in remission and off chemo for > 3 months |
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|
Term
| contraindications for varicella vaccine |
|
Definition
allergic rxn to previous dose
children who have cellular immunodeficiencies (leukemia, lymphoma)
children on steroid therapy
pregnancy |
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|
Term
| contraindications for meningococcal vaccine |
|
Definition
severe allergy to vaccine component including diptheria toxoid or rubber/latex
prior history of gullaine barre syndrome |
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