Pediatrics GI

banannie's version from 2016-02-21 23:02

Congenital malformations

Question Answer
TE fistula presentationpolyhydramnios in utero, increased oral secretions, inability to feed
diagnosis of TE fistulaCXR showing an NG tube coiled in the esophagus idenitifies esophageal atresia.
Presentation of CDHbowel sounds over left hemithorax
GI tract is exposedgastroschisis
billious emesiswithin hours after the first feeding


Question Answer
most common cause of bowel obstruction in the first two years of lifeintussuception
classic triad of intussuceptionabdominal pain, vomiting, and bloody mucus currant jelly stool
"sausage-shaped" RUQ abdominal massintussuception
test of choice for intussusceptionultrasound: target sign
diagnosis and treatment of intussusceptionair enema
lead points for intussusceptionMeckels, HSP, polyps, celiac disease and CF
trigger of intussusceptionadenovirus or rotavirus, due to swollen LN ... also old rotavirus vaccine!
Meckels rule of 2smore common in children under 2, 2 times more common in males, 2 types of tissue (pancreatic and gastric), 2 inches long, 2 feet of ileocecal valve, 2% of the population
diagnostic test for Meckel'stechnetium-99m pertechnate scan
congenital cause for painless GI bleedmeckel's diverticulum
treatment for Meckel'ssurgical excision of the diverticulum together w/adjacent ileal segment
failure to pass meconium within first 48 hours of lifehirschsprung's, meconium ileus, meconium plug, imperforate anus
imaging study of choice for Hirschsprungbarium enema
narrowed distal colon w/proximal dilationHirschsprung's
definitive diagnosis of Hirschsprung'srectal suction biopsy
GI obstruction plus Down syndromeHirschsprung's or Duodenal atresia
Meconium ileus is caused byCystic fibrosis
diagnosis and treatment for meconium ileusgastrographin enema aka water-soluble contrast enema
what not to do in a baby with failure to pass meconiumrectal temperature
VACTERLVertebral, Anal atresia, Cardiac defect, TE fistula, Renal malformation, Limb abnormalities
causes of meconium plugmaternal opiate use or Mg
treatment of meconium plugsuppository or enema
MC cause of neonatal GI bleedanal fissure
mc cause of constipation in a childfunctional constipation
differentiate late hirschsprung from functional constipationmanometry
causes of encoparesisfunctional constipation, sexual abuse
last resort treatment for functional constipationdisimpaction in OR with anesthesia


Question Answer
causes of bilious vomitingDuodenal atresia, annular pancreas, intestinal atresia, malrotation, volvulus
intrauterine sign of intestinal obstructionpolyhydramnios
imaging of choice if expect malrotation with volvulusupper GI series
x-ray finding with bilious vomitingdouble bubble
when does duodenal atresia present?day 1
cause of duodenal atresiafailure to recanalize
associated with Duodenal atresiaDown syndrome with other anomalies!
what presents exactly like duodenal atresiaannular pancreas
cause of annular pancreasfailure of apoptosis
no gas beyond double bubbleduodenal atresia, or annular pancreas
pathology of intestinal atresiavascular compromise in utero
causes of intestinal atresiamom smoked cigarettes or crack
triple bubblejejunal atresia
associated with malrotation?other abdominal developmental defects, such as diaphragmatic hernia, omphalocele
when does malrotation present?week 1
when does volvulus present?1 month - 1 year
bird beakvolvulus or malrotation
ligament of treitz above stomachmalrotation or volvulus
bowel obstruction with indication for emergent surgerymalrotation and volvulus, due to risk of ischemia
classic metabolic derangement in pyloric stenosishypochloremic hypokalemic metabolic alkalosis
treatment for pyloric stenosisfirst correct electrolyte/acid base abnormalties. then surgical correction with pyloromyotomy
causes of nonbilious vomitingesophageal atresia, pyloric stenosis, GERD
choking plus vomiting in a neonateesophageal atresia + TE fistula (bubbly, aspiration)
coiled NGT in blind pouchsign of esophageal atresia
who gets pyloric stenosis?first born white boys
projectile vomitingpyloric stenosis
how does pyloric stenosis presentprojectile vomit, peristaltic wave, olive mass
when does pyloric stenosis present1 week to 5 months
target in cross section on ultrasoundpyloric stenosis (upper GI), intussusception (lower GI)
mc cause of nonbilious vomitingGERD, due to weak LES in babies
"my baby is having a seizure and foaming at the mouth"GERD: can present with tetany due to chest pain
symptoms associated with neonatal GERD?esophagitis, apnea, stridor, failure to thrive
tetany, could be mistaken for seizure
diagnose neonatal GERDesophageal pH test
treatment for neonatal GERD?thick food, vertical feeding position ... resolves by 2 years!
most common GI emergency in neonatesNEC
indications for surgery in NECperforation (free air under the diaphragm) or worsening radiographc signs
hallmark findings on X-ray for NECpneumatosis intestinalis (double line appearance) and portal venous air
complications of NECintestinal strictures and short-bowel syndrome

What is the initial test

Question Answer
a 7 day old preemie now has grossly bloody stoolabdominal series (worry about NEC)

Vitamin Deficiencies

Question Answer
thiamine (vitamin B1)Wernicke-Korsakoff
riboflavin (vitamin B2)cheliosis, glossitis, dermaitits, pharyngitis
pyroxidine (vitamin B6)irritability, depression, dermatitis, and stomatitis
B12macrocytic anemia
niacin (B2)pellagra (diarrhea, dermatitis, dementia and possibly death)
vitamin Aimpaired adaptation to darkness, photophobia, dry scaly skin
hemorrhagic disease of the newbornvitamin K. classically presents with hematemesis, hematuria, umbilical stump and circumcision oozing
vitamin D deficiencyrickets.
cow's milk has an insufficient amount ofiron
ricketsfailure of bone mineralization

Inflammatory bowel disease

Question Answer
DIsordered response to intestinal bacteriaCrohn's
Any portion of GI tractCrohn's
Discontinuous lesionsCrohn's
Spares the rectumCrohn's
Cobblestone mucosaCrohn's
Creeping fatCrohn's
"string sign" on barium swallow x-rayCrohn's
Linear ulcers, fissures, fistulasCrohn's
Noncaseating granulomasCrohn's
Lymphoid aggregates (Th1 mediated)Crohn's
Strictures, fistulas, perianal disease, malabsorption, nutritional depletionCrohn's
Diarrhea may or may not be bloodyCrohn's
Migratory polyarthritisCrohn's
Erythema nodosumCrohn's
Kidney stonesCrohn's
disrupts tight junctions between lumen of GI tract and rest of the bodyCrohn's
Ankylosing spondylitisboth
Tx of chron'sCorticosteroids, azathioprine, methotrexate, infliximab, adalimumab
Tx of ulcerative colitisASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy
AutoimmuneUlcerative colitis
Continuous colonic lesionsUlcerative colitis
ALWAYS Rectal involvementUlcerative colitis
Mucosal and submucosal inflammation onlyUlcerative colitis
Friable mucosal pseudopolyps with freely hanging mesenteryUlcerative colitis
Loss of haustra → lead-pipe appearanceUlcerative colitis
Crypt abscesses and ulcersUlcerative colitis
No granulomas (Th2 mediated)Ulcerative colitis
Bloody diarrheaUlcerative colitis
MalnutritionUlcerative colitis
Sclerosing cholangitisUlcerative colitis
Toxic megacolonUlcerative colitis
greater risk of colorectal cancerUlcerative colitis
Pyoderma gangrenosumUlcerative colitis
1° sclerosing cholangitisUlcerative colitis