3/24 Pediatric GI - Rosenthal Flashcards
cleft lip/palate
congenital midline facial defects (together or alone, unilat or bilat) involving one or more clefts in upper lip, hard palate, and/or soft palate
cleft lip: 6wk
cleft palate: 9wk
tx: surgical repair
tracheoesophageal atresia or fistula
esoph ending in blind pouch and/or abnl fistula connection with trachea
occurs at 4-5wk gestation
most common: esoph atresia with distal TEF
- polyhydramnios (gestation)
- 3 Cs: coughing, choking, cyanosis
- excess oral mucus, bubbles, drooling
- can’t insert nasogastric tube
tx: airway, IV fluids, NG tube, surgery
GER vs GERD
eosinophilic esophagitis
eosinophilic esophagitis: rings and white exudate (?)
ingestions
drooling, vomiting, stridor, dysphagia, abd pain
can lead to perforation
- pill esoph: tetracycline, doxycycline, NSAIDs, aspirin
- foreign bodies: coins, etc
- coins_coronal = esoph
- coins_sagittal = trachea
achalasia
incomplete relaxation of LES/lack of normal esoph peristalsis due to damage of myenteric plexus
- dysphagia, regurg, recurrent pneumonia, wt loss, chest discomfort
rx: surgical or balloon myotomy, botox
pyloric stenosis
2:1 males:females
presents between 3wk-2mo
seasonality & genetic component: NOS1 (nitric oxide synthetase 1)
- non-bilious projectile vomiting
- hypochloremic alkalosis (if not picked up early)
- hyperbilirubinemia
- palpable “olive” in stomach
tx: abd U/S, pyloromyotomy
omphalocele
protrusion of abd contents through abd wall at jx of abdomen and umbilicus
etiology: failure of abd contents to return to abd by time of closure of abd wall (10 wk gestation)
- umbilical cord inserts into sac
- sac contains organs
dx: elevated maternal AFP (alpha serum fetoprotein)
many associated defects (cardiac, trisomy, midline defects)
sac rupture results in evisceration of abd contents → protect contents with silo
**WORSE THAN GASTROSCHESIS
gastroschisis
bad wall defect (NOT AT UMBILICUS) in which viscera extrude through opening in abd wall
- NOT covered by peritoneal sac or amnion
- just intestines (no organs)
- not associated with other anomalies
assoc w bronchodilator use
gastroschesis vs omphalocele
gastritis
H. pylori gastritis
- most common cause gastritis kids
- tx: PPI, amoxicillin, metronidazole?
malrotation
malrotation → midgut volvulus (EMERGENCY!!!)
failure of CCW rotation
80% present within 1mo w bilious vomiting
“corkscrew twisting”
duodenal atresia
congenital obstruction of lumen of duodenum
gastric distension
bilious vomiting (24-48h after birth)
assoc with other anomalies (30% have Down’s syndrome)
“double bubble”
tx: NGT, fluids, surgery
intussusception
telescoping of a segment of bowel into adj segment
majority: ileocolic
kids: usually 6mo-2y and usually lymphoid hyperplasia
clinical triad:
- abd pain
- curant jelly stool
- palpable abd mass
also seen: lethargy, drawing up legs
dx: surgical consult
tx: air enema
appendicitis
Meckel’s diverticulum
appedicitis: usually due to fecolith in kids
Meckel’s diverticulum
- incomplete obliteration of omphalomesenteric duct → tissue hanging off of distal ileum
- profuse maroon colored painless rectal bleeding
dx: technetium scan
ulcerative colitis
vs
Crohns
Hirschprung’s disease
absence of enteric ganglionic neurons (beginnning at anus, extending proximally)
when worry?
if infant doesnt pass meconium in 48h, need to evaluate
dx: suction rectal biospy, full thickness biopsy for unclear cases
tx: surgical resection
neonatal jaundice
either obstruction or hemolysis-based
- biliary atresia
- TORCH infections
- neonatal hepatitis
- alpha1 antitrypsin def
- CF
- other metabolic disorders
kwashiorkor
protein deficiency
most common in toddlers 1-3yo (bc require high protein intake for rapid growth) - usually after weaning off breast (due to loss of that source of protein)
almost exclusively in developing countries
- soft, pitting, painless edema - usually involving feet and legs
- “flag sign”
- ab distension
- moon facies
marasmus
severe caloric AND protein def
- “wizened old man” appearance
- cachexia
- no dedema
- thin face, arms, legs w no subcut fat, muscle wasting
- bradycardia, hypothermia, hypoTN
vomiting associations
bilious
blood
fever
emesis only
undig food
projectile
tense fontanelle
older adolescent female
acute abd pain
trauma
bilious vomiting
peritonitis
adolescent female
currant jelly stool
melena
nonspecific
