Foreign body, PUD and IBD

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Questions and Answers

What is the typical fate of ingested foreign bodies in the gastrointestinal tract?

They usually cause immediate perforation.

They must be monitored radiologically.

95% pass through without difficulty. (correct)

They always need surgical removal.

What size of objects typically does not pass through the pylorus in infants and toddlers?

Objects <3 cm in length

Objects >2 cm in length

Objects >3 cm in length or >20 mm in diameter (correct)

Objects that are rounded in shape

What should be monitored if a patient ingests a sharp foreign body?

The color of the stool

Weekly assessments of symptoms (correct)

Blood pressure levels

Gastrointestinal pH levels

What is the recommended action if a magnetic object is ingested?

Surgical removal may be necessary due to the risk of perforation. Signup and view all the answers

If a foreign body is not progressing within 3-4 weeks, what does this indicate?

This indicates a potential congenital or acquired anomaly. Signup and view all the answers

What is the primary symptom that should prompt immediate medical attention after foreign body ingestion?

Persistent fever or abdominal pain Signup and view all the answers

Which of the following objects generally should be surgically removed if ingestion occurs?

Razor blades Signup and view all the answers

What is the appropriate initial management for drug-related foreign body ingestion?

Oral polyethylene glycol lavage. Signup and view all the answers

What should not be used in the treatment of ingested foreign bodies?

Cathartics Signup and view all the answers

What should be done if symptoms recur after discontinuing antisecretory therapy in children with idiopathic ulcers?

Start antisecretory therapy again Signup and view all the answers

What genetic risk is higher among relatives of patients with Crohn disease compared to those with ulcerative colitis?

Risk of developing Crohn disease Signup and view all the answers

What is the concordance rate for Crohn disease in monozygotic twins?

36% Signup and view all the answers

Which condition is NOT mentioned as a possible cause of idiopathic ulcers?

Glycogen storage disease type Ib Signup and view all the answers

What percentage of patients with ulcerative colitis typically have a perinuclear antineutrophil cytoplasmic antibody?

70% Signup and view all the answers

What breakthrough occurred in the field of genetic research for IBD in 2001?

Identification of the first IBD gene, NOD2 Signup and view all the answers

What is the pediatric dosage recommendation for Famotidine?

1-2 mg/kg/day Signup and view all the answers

For a child weighing more than 20 kg, what is the approved maximum daily dosage of Omeprazole?

20 mg Signup and view all the answers

Which medication is approved for use in children older than 2 years?

Omeprazole Signup and view all the answers

What is the pediatric dosage range for Rabeprazole for a child weighing more than 15 kg?

5-10 mg/day Signup and view all the answers

What is the pediatric dosing recommendation for Pantoprazole in children older than 5 years weighing more than 40 kg?

40 mg/day Signup and view all the answers

Which of the following medications is dosed according to the patient's weight and has a maximum dosage of 30 mg for children older than 1 year?

Lansoprazole Signup and view all the answers

What is the pediatric dosage range for Nizatidine?

5-10 mg/kg/day Signup and view all the answers

Which cytoprotective agent is dosed at 40-80 mg/kg/day?

Sucralfate Signup and view all the answers

What is the dosage of Esomeprazole for a child weighing between 3 kg and 5 kg?

2.5 mg Signup and view all the answers

What is the primary risk associated with the ingestion of multiple magnets by children?

Obstruction and perforation Signup and view all the answers

In asymptomatic children, what is the recommended approach for managing the ingestion of a single magnet?

Observation without intervention Signup and view all the answers

What should be done if a lithium battery is ingested?

Immediate endoscopic removal Signup and view all the answers

What complication is likely if multiple coins are ingested?

Bowel obstruction from decomposition Signup and view all the answers

When should endoscopic retrieval be performed for ingested magnets?

If the patient is symptomatic and has ingested two or more magnets Signup and view all the answers

What can occur as a result of battery leakage after ingestion?

Bowel perforation Signup and view all the answers

What is true regarding the duration of retention for batteries larger than 15 mm?

They are unlikely to pass spontaneously if retained for more than 48 hours Signup and view all the answers

What is indicated when abdominal pain or peritoneal signs are present after ingestion of a foreign body?

Surgical intervention Signup and view all the answers

What critical factor impacts the management of ingested magnets?

The number of magnets ingested Signup and view all the answers

What is a significant complication that can arise from the ingestion of toy medallions containing lead?

Lead toxicity Signup and view all the answers

What size of batteries is unlikely to pass spontaneously in children younger than 6 years of age?

Larger than 15 mm Signup and view all the answers

What action should be taken if a patient develops peritoneal signs after battery ingestion?

Surgical removal is required Signup and view all the answers

How long does it typically take for a battery that is beyond the duodenum to pass per rectum?

Within 72 hours Signup and view all the answers

What is the recommended action for lead-based foreign bodies if lead intoxication is suspected?

Remove them endoscopically Signup and view all the answers

What is a bezoar primarily composed of?

Food or fiber Signup and view all the answers

If objects are placed in the rectum, what size typically passes spontaneously?

Small and blunt objects Signup and view all the answers

What should be done to assist in removing an object from the rectum?

Administer sedation to relax the anal sphincter Signup and view all the answers

What is a potential risk if water-absorbing polymer balls are ingested?

They expand and cause intestinal obstruction Signup and view all the answers

Which hotline can be contacted for help in identifying batteries?

National Button Battery Ingestion Hotline Signup and view all the answers

What is the first step if an object is proximal to the rectum?

Observation for 12-24 hours Signup and view all the answers

Study Notes

Foreign Bodies in the Stomach and Intestine

95% of ingested objects pass through the gastrointestinal tract without difficulty
Objects longer than 6 cm or wider than 20 mm in diameter often fail to pass through the pylorus
Open safety pins require urgent endoscopic removal
Small magnets should be removed if in the esophagus
Multiple magnets can cause bowel perforation
Lead-based foreign bodies can cause lead poisoning
Water-absorbing polymer balls can expand in the small intestine and cause obstruction
Objects inserted into the rectum typically need to be retrieved
Batteries larger than 15 mm are less likely to pass spontaneously

Bezoars

A bezoar is an accumulation of matter in the stomach or intestine
They are primarily composed of food or fiber

Antisecretory Therapy With Pediatric Dosages

H2 Receptor Antagonists
- Ranitidine: 4-10 mg/kg/day divided 2 or 3 times a day
- Famotidine: 1-2 mg/kg/day divided twice a day
- Nizatidine: 5-10 mg/kg/day divided twice a day
Proton Pump Inhibitors
- Omeprazole: 1.0-3.3 mg/kg/day
- Lansoprazole: 0.8-4 mg/kg/day
- Rabeprazole: 5-10 mg/day
- Pantoprazole: 0.3-1.2 mg/kg/day (limited data)
- Esomeprazole: 2.5-10 mg (depending on weight)
- Dexlansoprazole: 30-60 mg
- Omeprazole sodium bicarbonate: Not approved for use < 18 years
Cytoprotective Agents
- Sucralfate: 40-80 mg/kg/day

IBD (Inflammatory Bowel Disease)

Ulcerative colitis and Crohn disease have a higher prevalence among relatives of patients with the same disorder
The concordance rate for twins is higher for Crohn disease (36%) than for ulcerative colitis (16%)
The first IBD gene, NOD2, was identified in 2001
Since 2006, there has been an exponential growth in the set of validated genetic risk factors for IBD

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Description

This quiz covers essential concepts in pediatric gastroenterology, focusing on foreign bodies in the stomach and intestine, identification of bezoars, and antisecretory therapy with pediatric dosages. Test your knowledge on critical symptoms and treatment approaches relevant to young patients.