Paediatrics Marrow Pg 91-100 (GIT)
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Questions and Answers

Which of the following imaging techniques can visualize only radio-opaque foreign bodies in the esophagus?

  • Ultrasound
  • X-ray (correct)
  • CT scan
  • MRI

    • A contrast study of the esophagus can reveal filling defects.

    True

    What is the recommended observation period for a child with an asymptomatic blunt object in the esophagus?

    24 hours

    If a foreign object is __________ for more than 24 hours, esophagoscopy is indicated.

    <p>impacted</p> Signup and view all the answers

    Match the following indications with their corresponding actions:

    <p>Symptomatic = Esophagoscopy needed Impact &gt; 24 hrs = Esophagoscopy needed Blunt object &amp; asymptomatic = Observe for 24 hours Batteries/magnets/sharp objects = Esophagoscopy needed</p> Signup and view all the answers

    Which of the following is a symptom commonly associated with the Omicron variant of COVID-19 in children?

    <p>Rhinorrhoea</p> Signup and view all the answers

    Vaccination for COVID-19 is recommended for children aged 5 and under.

    <p>False</p> Signup and view all the answers

    What are the 3Ws and 2Vs for COVID-19 appropriate behavior?

    <p>Watch your distance, Wear a mask, Wash your hands frequently, Ventilation, Vaccination</p> Signup and view all the answers

    In children with COVID-19, a respiratory rate greater than ___ is considered severe.

    <p>60/min</p> Signup and view all the answers

    Match the COVID-19 symptoms with their variants:

    <p>Omicron = Sore throat/Throat irritation Delta = Loss of sense of smell &gt; taste Both = Fever, cough None = Severe chest retractions</p> Signup and view all the answers

    What is the purpose of zinc in the gastrointestinal system?

    <p>It plays a role in GI re-epithelialisation.</p> Signup and view all the answers

    A dose of 10 mg of zinc is recommended for individuals older than 6 months.

    <p>False</p> Signup and view all the answers

    What are the two probiotics mentioned that can be prescribed based on cost-benefit analysis?

    <p>Lactobacillus rhamanosus and Saccharomyces boulardii</p> Signup and view all the answers

    Persistent diarrhea is associated with risk factors such as malnutrition and __________.

    <p>immunodeficiency</p> Signup and view all the answers

    Match the following risks of convulsions with diarrhea to their causes:

    <p>Hyponatremia = Electrolyte and metabolic imbalance Febrile seizures = Infections Cerebral venous thrombosis = Dehydration Meningitis = Infections</p> Signup and view all the answers

    What is the most common defect associated with esophageal atresia?

    <p>Tracheo-esophageal fistula (TEF)</p> Signup and view all the answers

    Which investigation is NOT required for asymptomatic childhood infections?

    <p>Not required</p> Signup and view all the answers

    Type E/H of esophageal atresia refers to TEF without esophageal atresia.

    <p>True</p> Signup and view all the answers

    Name one of the components of the VACTERL association.

    <p>Vertebral anomalies</p> Signup and view all the answers

    Corticosteroids should be administered immediately after the onset of symptoms in severe COVID-19 cases.

    <p>False</p> Signup and view all the answers

    What is the primary treatment for moderate childhood COVID-19 infections?

    <p>O2 inhalation and fluid &amp; electrolyte balance correction</p> Signup and view all the answers

    Esophageal atresia is characterized by __________ in the esophagus.

    <p>discontinuity</p> Signup and view all the answers

    Match the following types of esophageal atresia with their descriptions:

    <p>Type A = Isolated Esophageal Atresia (EA) Type C = Proximal EA with distal TEF Type D = Proximal and distal TEF Type F = Esophageal stenosis</p> Signup and view all the answers

    In mild COVID-19 cases, __________ can be used for fever management.

    <p>Paracetamol</p> Signup and view all the answers

    Match the following severity of disease with its corresponding treatment site:

    <p>Asymptomatic = Home isolation Mild = Home isolation ± Teleconsultation Moderate = Ward of a COVID 19 hospital Severe = High Dependency Unit of COVID-19 hospital</p> Signup and view all the answers

    What is the recommended treatment for no dehydration?

    <p>Low osmolarity ORS</p> Signup and view all the answers

    Salted fruit juice is a recommended alternative to ORS at home.

    <p>False</p> Signup and view all the answers

    What is the daily fluid requirement for a child weighing 15 kg?

    <p>1250 mL</p> Signup and view all the answers

    In severe dehydration (Plan C), the initial fluid replacement is ______ mL/kg.

    <p>100</p> Signup and view all the answers

    Match the following components with their respective osmolarity:

    <p>Glucose = 75 mosm/L Na = 75 mosm/L K = 20 mosm/L Cl = 65 mosm/L</p> Signup and view all the answers

    What is a common treatment strategy for managing GERD in children?

    <p>Diet &amp; lifestyle modifications</p> Signup and view all the answers

    The majority of foreign bodies in the esophagus will not pass through and must be removed surgically.

    <p>False</p> Signup and view all the answers

    Name two symptoms that might indicate a child has ingested a foreign body.

    <p>Drooling of saliva and refusal of feeds</p> Signup and view all the answers

    _______ fundoplication is a surgical option for refractory GERD.

    <p>Nissen</p> Signup and view all the answers

    Match the following foreign body types with their potential risks:

    <p>Coins = Common foreign body Batteries = Coagulative necrosis risk Magnets = Bowel obstruction risk Sharp objects = Perforation risk</p> Signup and view all the answers

    What is the recommended dosage of low molecular weight heparin (LMWH) like Enoxaparin for children with confirmed thrombosis?

    <p>1 mg/kg twice daily</p> Signup and view all the answers

    Multisystem Inflammatory Syndrome in Children (MIS-C) can present immediately after acute COVID-19 infection.

    <p>False</p> Signup and view all the answers

    Which of the following is a common clinical feature of esophageal disorders in children?

    <p>Antenatal polyhydramnios</p> Signup and view all the answers

    List one risk factor for developing Multisystem Inflammatory Syndrome in Children (MIS-C).

    <p>Age &lt; 1 year</p> Signup and view all the answers

    What is the most common cause of acute diarrhea in children?

    <p>Rotavirus</p> Signup and view all the answers

    Excessive frothy salivation is not a clinical feature of esophageal disorders in children.

    <p>False</p> Signup and view all the answers

    Hospitalization in the ________ is a critical part of managing Multisystem Inflammatory Syndrome in Children (MIS-C).

    <p>ICU</p> Signup and view all the answers

    Severe dehydration is indicated by the presence of lethargy and absent tears.

    <p>True</p> Signup and view all the answers

    What surgical procedures are commonly performed for treating esophageal disorders?

    <p>Anastomosis of esophageal ends and division &amp; ligation of TEF.</p> Signup and view all the answers

    Match the following medications with their intended use in the management of COVID-19 in children:

    <p>Methylprednisolone = Management of MIS-C IV Immunoglobulin (IVIG) = Treatment of severe COVID-19 symptoms Remdesivir = Antiviral (not recommended in children) Enoxaparin = Thrombosis management</p> Signup and view all the answers

    Name the diarrhea type associated with non-infectious causes, especially malabsorption.

    <p>Chronic</p> Signup and view all the answers

    A chest X-ray can show resistance during __________ insertion.

    <p>nasogastric tube</p> Signup and view all the answers

    Match the clinical features with their descriptions:

    <p>Vomiting = Multiple episodes of throwing up Aspiration pneumonitis = Lung inflammation due to inhaled material Excessive frothy salivation = Increased production of frothy saliva Antenatal Polyhydramnios = Excess amniotic fluid due to inability to swallow</p> Signup and view all the answers

    In the skin pinch test, if the skin returns to normal in more than 2 seconds, it indicates __________ dehydration.

    <p>severe</p> Signup and view all the answers

    Match the following conditions with their corresponding dehydration assessment:

    <p>No dehydration = Active &amp; alert Some dehydration = Irritable Severe dehydration = Lethargy (Cannot be aroused)</p> Signup and view all the answers

    Study Notes

    Disorders of Esophagus in Children

    • Investigations:
      • X-ray visualization of radio-opaque foreign bodies
      • Contrast study of esophagus/esophagogram: Identifies filling defects
    • Management:
      • Conservative for blunt objects and asymptomatic cases: Observation for 24 hours
      • Indications for removal by esophagoscopy: Symptomatic, Impacted for more than 24 hours, Batteries, magnets, sharp objects

    COVID-19 in Children

    • COVID Appropriate Behaviour:
      • 3Ws & 2Vs: Watch your distance (>2 metres), wear mask, wash your hands frequently, ventilation (open space ventilation decreases transmission), vaccination (for 15-18 years of age)

    COVID-19 Features in Children

    • Symptoms:
      • Mild/asymptomatic (most common; incidental detection or history of contact)
      • Fever, cough, rhinorrhea
      • Sore throat/throat irritation: Omicron variant (most common)
      • Myalgia/headache/malaise
      • Diarrhoea
      • Loss of sense of smell > taste: Delta variant (most common)
    • Severity Table:
      • Asymptomatic: Normal respiratory rate, SPO2 > 94%
      • Mild (URTI): Normal respiratory rate, SPO2 90-93%
      • Moderate: Increased respiratory rate, SPO2 90-93%
      • Severe: Increased respiratory rate, SPO2 < 90%, Respiratory rate: > 50/min (2-12 months), > 40/min (1-5 years), > 30/min (> 5 years)
    • Danger signs & symptoms:
      • Grunting
      • Lethargy
      • Seizures, somnolence
      • Severe chest retractions

    Childhood Infections Management

    • Investigations:
      • Asymptomatic: Not required
      • Mild: CBC, ESR, Chest X-ray, Blood glucose, CRP/ferritin (markers of inflammation), D-Dimer assays (for thrombosis), LFT/RFT (for multi-organ dysfunction)
      • Moderate: CBC, ESR, Chest X-ray, Blood glucose, CRP/ferritin (markers of inflammation), D-Dimer assays (for thrombosis), LFT/RFT (for multi-organ dysfunction)
      • Severe: CBC, ESR, Chest X-ray, Blood glucose, CRP/ferritin (markers of inflammation), D-Dimer assays (for thrombosis), LFT/RFT (for multi-organ dysfunction)
    • CT chest: Not indicated in paediatric COVID except if terminally ill.

    Treatment

    • Asymptomatic: Home isolation, No specific Rx
    • Mild: Home isolation ± Teleconsultation (sos), Covid care centre, Symptomatic Rx: Paracetamol for fever, Warm saline gargles for sore throat
    • Moderate: Ward of a COVID 19 hospital, DCHC (Dedicated COVID Health Centre), O2 inhalation (target Spo2: 94-96%), Fluid & electrolyte balance correction, Steroids: in progressive disease course, Antimicrobials: If needed
    • Severe: High Dependency Unit (HDU) of COVID-19 hospital, O2 support (SpO2: 94-96%), Fluid & electrolytes balance correction, Corticosteroids (most useful drug indicated in all severe cases)
    • Steroid administration: Avoided in first 3 – 5 days, after onset of symptoms (prolongs the viral shedding)
      • Right dose:
        • Dexamethasone : 0.15 – 6mg/kg once daily.
        • Methylprednisolone: 0.75 – 30mg/kg once daily
      • Right duration: 5-7 days → tapered over 10-14 days

    Gastrointestinal System

    • Zinc:
      • Plays a role in GI re-epithelialisation
      • Lowers the risk of persistent diarrhea (14 days)
    • Age-Specific Dosage for Zinc:
      • < 6 months: 10 mg/day

      • 6 months: 20 mg/day

    • Additional Drugs:
      • Dysentry: 3rd generation cephalosporin
      • Vomiting: Antiemetics (Ondansetron 0.15 mg/kg/dose orally)
      • Probiotics: Prescribed based on cost-benefit analysis (e.g., Lactobacillus rhamanosus and Saccharomyces boulardii)
    • Convulsions with Diarrhea (Etiology):
      • Electrolyte and Metabolic Imbalance: Hyponatremia, Hypernatremia, Hypoglycemia
      • Infections: Febrile seizures, Meningitis/encephalitis
      • Dehydration: Cerebral venous thrombosis, sagittal sinus thrombosis
    • Persistent Diarrhea - Risk Factors:
      • Malnutrition (causes decreased immunity)
      • Immunodeficiency
    • Management:
      • Fluids: Oral Rehydration Solution (ORS) or intravenous (IV) fluids, depending on the degree of dehydration
      • Zinc
      • Vitamin A
    • Single Dose Based on Weight for Vitamin A:
      • < 8 kg: 1 lakh LU

      • 8 kg: 2 lakh LU

    Management of Dehydration

    • In no dehydration (Plan A):
      • Use low osmolarity ORS
      • ORS Composition: Glucose (75), Na (75), K (20), Cl (65), Citrate (10), Total (245) mosm/L
      • Amount of ORS/Stool: Ad lib for 10 years
      • Replace ongoing losses
      • Alternatives to ORS (at home): Salted rice water, Salted yogurt, Soup with salt, Fresh fruit juice (no sugar), Tender coconut water
    • In some dehydration (Plan B):
      • ORS use to correct dehydration
      • Steps:
        • Rehydration: 75 mL/kg ORS over 4 hrs.
        • Replacement of ongoing losses: Same as Plan A (above).
        • Daily fluid requirements: Holliday–Segar formula
    • Daily Fluid Requirements (Maintenance):
      • First 10 kg: 1000 mL
      • 10 - 20 kg: 1000 mL (first 10 kg) + 50 mL/kg after 10 kg

      • 20 kg: 1500 mL (first 20 kg)+ 20 mL/kg after 20 kg

    • In severe dehydration (Plan C):
      • IV fluids: RL + 5% dextrose
      • Rehydration: 100 mL/kg for replacement
      • Rehydration Schedule:
        • 1 year: 30 minutes initial time, 2.5 hours time over 70 mL/kg, 3 hours total time

    COVID-19 in Children

    • Anticoagulants:
      • Indication: thrombosis confirmed by imaging/ ↑D-dimer levels
      • Low molecular weight heparin/LMWH (Enoxaparin): 1 mg/kg BD
    • Antimicrobials:
      • Indications: Clinical evidence/Suspicion of bacterial infection
    • Antivirals:
      • Remdesivir, Favipiravir/monoclonal antibodies: Not recommended (efficacy unknown in children)

    Multisystem Inflammatory Syndrome in Children (MIS-C)

    • Time of presentation: 2-4 weeks after acute COVID
    • Risk factors:
      • Age < 1 year
      • Co-morbidities: Asthma, Chronic lung disease
      • Obesity
      • Children with immunodeficiency
    • Diagnostic criteria (WHO) for MIS-C:
      • Children and adolescents with fever (≥38°C) for ≥ 3 days.
      • Any 2 of the following:
        • Mucocutaneous inflammation: Rash/Bilateral non purulent conjunctivitis
        • Hypotension or shock
        • Myocardial dysfunction, myocarditis, valvulitis, Coronary aneurysms, ↑ troponin
        • Coagulopathy (elevated D-dimers)
        • Severe GI involvement (uncontrolled abdominal pain/diarrhoea)
      • Additional findings:
        • ↑ Inflammatory markers: ESR > 40 mm/hr, CRP > 5 mg/dl, Procalcitonin
        • Recent COVID-19 (RTPCR +ve)/contact with confirmed COVID-19 case
        • No evidence of serious bacterial infection/Alternative diagnosis
    • Management of MIS-C:
      • Hospitalization in ICU
      • Methylprednisolone (mg/kg/day): tapered over 2-3 weeks
      • IV Immunoglobulin (IVIG):
        • Dose: 2 g/kg as slow IV infusion
        • Maximum dosage: 100 g

    Esophageal Atresia

    • Discontinuity in the esophagus.
    • Associated Anomalies:
      • Tracheo-esophageal Fistula (TEF): Most common defect in mesenchymal separation between trachea and esophagus
      • Gross Classification:
        • Type A: Isolated Esophageal Atresia (EA)
        • Type B: Proximal TEF with distal EA
        • Type C: Proximal EA with distal TEF
        • Type D: Proximal and distal TEF
        • Type E/H: TEF without EA
        • Type F: Esophageal stenosis
    • VACTERL Association:
      • Vertebral anomalies
      • Imperforate Anus
      • Cardiac defects
      • Tracheo-esophageal fistula
      • Renal anomalies
      • Limb anomalies

    TREATMENT

    • Diet & lifestyle modifications:
      • Small, frequent feeds
      • Thickening of feeds
      • Avoid caffeine, spicy foods
      • Avoid chocolates (In older children)
    • Pharmacological:
      • PPIs: Omeprazole, Lanzoprazole
      • Duration of Rx: 3 months (To prevent recurrence)
    • Surgery:
      • Done for refractory GERD
      • Nissen fundoplication

    Foreign Bodies in Esophagus

    • Features:
      • Age: ≤ 3 years
      • Common foreign bodies: Coins, nuts, small toys
      • Dangerous foreign bodies:
        • Button/batteries → Coagulative necrosis of esophagus
        • Multiple magnets → Stick to each other across bowel loops → Obstruction → perforation
        • Sharp objects
    • Natural Course:
      • Most of foreign bodies (> 95%) will pass through & get excreted
      • Sites of impaction:
        • Cricopharynx
        • Mid-esophagus (At level of tracheal bifurcation)
        • Right above LES
    • Clinical Features:
      • History of ingestion of foreign body may be absent
      • May be asymptomatic
        • If symptomatic: Drooling of saliva, Refusal of feeds, Chest discomfort/pointing towards discomfort, Respiratory complaints: Recurrent cough/wheeze (D/t pressure effect on trachea)

    Clinical Features for Esophageal Atresia

    • Vomiting (multiple episodes)
    • Aspiration pneumonitis
    • Excessive frothy salivation
    • Antenatal Polyhydramnios (Inability to swallow amniotic fluid)

    Investigations for Esophageal Atresia

    • Chest X-ray: Resistance encountered during nasogastric (NG) tube insertion

    TREATMENT for Esophageal Atresia

    • Surgery: Anastomosis of esophageal ends + Division & ligation of TEF

    Gastro Esophageal Reflux Disorder (GERD)

    Clinical Features for GERD

    • Age of onset:

    Diarrheal Disorders in Children

    • Diarrheal disorders are major contributors of under-5 mortality.
    • Types:
      • Acute: < 7 days, Infections
      • Persistent: > 14 days, Prolonged infection
      • Chronic: > 14 days (upto months), Non-infectious Causes (Especially malabsorption)

    Acute Diarrhea

    • Most common cause: Rotavirus
    • Other viral causes: Norwalk, adeno, astro and calicivirus
    • Most common bacteria: ETEC (Enterotoxigenic & coli)
    • Dysentery: Diarrhea + blood in stool
    • Most common cause: Shigella flexneri

    Dehydration

    • Primary concern in diarrhea

    Assessment

    • No dehydration: Active & alert eyes, Normal tears, Normal mouth & tongue, Normal thirst, Fast skin pinch test (< 1 sec)

    • Some dehydration: Irritable eyes, Normal tears, Normal mouth & tongue, Dry thirst, Slow skin pinch test (≤ 2 sec)

    • Severe dehydration: Lethargy (Cannot be aroused) eyes, Very sunken tears, Absent mouth & tongue, Very dry thirst, Very slow skin pinch test (> 2 sec)

    • Skin pinch testing:

      • Pinching the skin – Let go – Evaluate time taken for skin to go back to normal
      • Testing for skin turgor/elasticity
      • Skin turgor depends on interstitial fluid
      • In dehydration: ↓ fluid level → ↓ turgor

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    This quiz covers two critical topics related to children's health: disorders of the esophagus and COVID-19. Understand the investigations and management of esophageal conditions and explore COVID-19 symptoms and appropriate behavior for children. Ideal for healthcare professionals and students in pediatrics or child health programs.

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