Pediatrics GI

eesohbel's version from 2015-12-05 23:24

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, vomitting, and bloody mucus currant jelly stool
"sausage-shaped" RUQ abdominal massintussuception
test of choice for intussusceptionultrasound
in setting of high clinical suspuscion test aka see target sign on ultrasoundair-contrast barium enema. both diagnostic and therapeutic.
risk factors for intussusceptionconditions w/potential leads points including Meckels, HSP, polyps, celiac disease and CF
classic metabolic derangement in pyloric stenosishypocholremic hypokalemic metabolic alkalosis
treatment for pyloric stenosisfirst correct electrolyte/acid base abnormalties. then surgical correction with pyloromyotomy
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
treatment for Meckel'ssurgical excision of the diverticulum together w/adjacent ileal segment
failure to pass meconium within first 48 hours of lifehirschsprung's or meconium ileus
imaging study of choice for Hirschsprungbarium enema
narrowed distal colon w/proximal dilationHirschsprung's
imaging of choice if expect malrotation with volvulusupper GI series
definitive diagnosis of Hirschsprung'srectal biopsy
often presents in the first month of life with bilious emesisvolvulus
bird beak appearancevolvulus
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-boweled 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