1 Abd GI

Question 1

Blood or mucus in diarrhea?

Do what test

Think what diagnosis

Answer 1

Send a culture

Think bacterial, think HUS

Question 2

Appendicitis: what percentage perforate?

Answer 2

33%

Under 4 years old: >80%

adolescents 10-20%

Question 3

Appendicitis

get what labs

Answer 3

CRP, Procal

Question 4

Intussusception

mnemonic

Answer 4

ARENA

Abdominal pain

Rash–palpable purpura

Edema

Nephritis

Arthralgia

Question 5

intususception

air enema vs contrast enema

Answer 5

Air enema is rapid, less radiation, easier to perform, perforation is better than contrast perf

However, contrast enema has better visualization

Question 6

Painless rectal bleeding, think what

Answer 6

Meckel’s diverticulum

do the meckel’s scan

Question 7

NEC

do what

Answer 7

IVF, resuscitate

NG tube

surgery consult

abx

Question 8

neonatal jaundice:

-What are different types of neonatal jaundice? (5 main types)

Answer 8

Remember: conjugated vs unconjugated bilirubin

Conjugated is always pathologic

• physiologic–enzyme immaturity, increased breakdown of hgb. normal days 2-4 (NOT day 1)
• (lack of) breast feeding– dehydration causes bili to return to body
• breast milk–inhibitors in milk (day 3 - week 3)
• Infection
• Hemolysis–congenital defects, g6pd, etc

Question 9

neonatal jaundice, with elevated unconjugated hyperbilirubinemia:

inpatient treatment?

Answer 9

phototherapy for indirect hyperbilirubinemia

-exchange transfusion

Question 10

omphalitis:

• what to do if you suspect it but aren’t sure if redness is just from diaper rash
• tx

Answer 10

Wait in the ED while working up

Redness will stay if it is omphalitis.

omphalitis will get worse quickly

-tx: iv abx, surgery consult, sepsis workup, transfer