43. Pediatric GI Flashcards
When you see this on an X-ray, what is the FIRST thing that should pop into your mind?
Duodenal Atresia
Bilious emesis
failure to recanalize
How does duodenal atresia arise?
What is the typical presentation of it?
What is it associated with? (3)
What do you see on an X-ray?
How do you treat this? (3)
- duodenal failure to recanalize during the 8-10th week of gestation (usually after the ampulla of Vader)
- presentation: Bilious emesis
- associations:
- Prematurity
- Trisomy21
- Polyhydramnios (excess amniotic fluid in the amniotic sac)
- Xray: DOUBLE BUBBLE
-
Treatment:
- NG tube
- Surgery
- Support
Most common lethal disease in children?
biliary atresia
How does biliary atresia arise?
What is the typical presentation of it? (name at least 6)
What do labs typically show?
What would an US show?
How do you treat this? (5)
- failure to develop an adequate pathway for bile to drain from the liver into the GB/intestines
presentation
- jaundice with icteric eyes that begins at 2-3 weeks of age
- pale, clay stools and dark urine
- (problem isn’t due to conjugation, but actually biliary outflow)
- hepatomegaly and splenomegaly around 8 weeksfailure to thrive
- other presentations: fat malabsorption (steatorrhea), DEAK deficiencies, hyperlipidemia, and eventually cirrhosis (due to cholestasis)
Labs
- increased conjugated bilirubin (normal unconjugated levels)
- increased AP, GGT
- normal albumin + coagulation (early)
US
- absent or contracted GB after a 4hr fast + hepatomegaly
Treatment
- Kasai Procedure
- liver transplantation if Kasai procedure fails, cirrhosis or portal HTN, or progressive cholestasis develops
- Ursodeoxycholic acid
- Fat soluble vitamin supplement
- high calorie feed supplementation
What is the Kasai Procedure?
What determines the best outcome?
- connects the porta hepatis (area in the liver from which bile normally drains) to the small intestines, which allows any residual ductal tissue to drain directly into the intestines
- better surgical outcomes if done <30d and by a experienced surgeon
If you see this in the X ray of an infant after a barium swallow, what should be the FIRST thing that come to mind?
Esophageal atresia (EA)
What are the 4 different types of Tracheoesophageal Anomalies?
Which one is the most common one?
- Esophageal atresia (EA) or stenosis (ES)
- Tracheoesophageal Fistula (TEF) with EA (most common)
- TEF (H type)
How does a patient with EA present to the clinic? (1)
When you perform the NG tube test and Xray, what do you find?
Esophageal atresia (EA) or stenosis (ES)
- inability to feed
- failure to pass nasogastric tube
- Xray: gasless abdomen
How does a patient with TEF present to the clinic? (4)
When you perform the NG tube test, contrast study, and Xray, what do you find?
TEF (H type)
- often isn’t diagnosed until later in childhood, but patients often have:
- recurrent bronchitis
- aspiration pneumonia
- wheezing
- airway inflammation
How does a patient with TEF + EA present to the clinic? (5)
When you perform the NG tube test, contrast study, and Xray, what do you find?
- choking, coughing, and vomiting with 1st feeding
- cyanosis occurs secondary to reflex laryngospasm (prevent reflux-related aspiration)
- regurgitation
- excessive salivation, drooling
- respiratory distress
NG tube: failure to pass into stomach
Contrast study: pooling in atretic esophagus
Xray: air in stomach, may see dilated blind-end pouch in upper esophagus (anterior view) with anterior displacement of trachea (lateral view)
When you see this scan, what should be the FIRST thing to come to mind?
Pertechnetate study “Meckel’s Scan”
measures uptake by ectopic gastric mucosa in Meckel’s diverticulum
How does Meckel’s Diverticulum form?
How do patients usually present? (2)
How do you diagnose it?
What are some complications (3)
Treatment?
(be specific in terms of embryonic structures)
- true diverticulum – persistence of the vitelline duct (connects primitive midgut to yolk sac); may contain heterotopic gastric mucosa and/or pancreatic tissue
- presentation
- painless rectal bleeding /melena (due to peptic ulceration adjacent to a Meckel’s diverticula)
- appendicitis-like pain due to its location
- complications: intussusception, volvulus, or obstruction
- Diagnosis: **Pertechnetate study “Meckel’s Scan” **
- Treatment: surgical resection
What are the Rule of 2’s in Meckel’s Diverticulum?
there are numerous variations of this, but important ones are in bold
- 2” long
- located 2 ft proximal to ileocecal valve
- may contain 2 types of epithelia (gastric/pancreatic)
- manifest at 2 yo
- 2% of population
- 2:1 M:F ratio
Why do patients with Meckel’s diverticulum get painless rectal bleeding?
heterotopic mucosa secretes H+, which can result in peptic ulceration of the bowel wall adjacent to a Meckel’s diverticula
Where do patients with Meckel’s diverticulum feel pain? Why?
RLQ - can mimic appendicitis-like pain
due to location - it’s located 2 ft proximal to the ileocecal valve
If you see this on a CT scan, what should be the FIRST thing to pop to mind?
Intussusception
What is Intussusception?
What causes it?
How does it present? (2)
What is diagnostic on a CT scan?
telescoping of a bowel segment into a distal segment, commonly at the ileocecal junction, resulting in a compromised blood supply
Presentation
- red current jelly stools
- intermittent abdominal pain – babies present with episodes of crying + distress followed by periods of sleepiness or relatively pain-free episodes
CT: “bull’s eye” (site of intussusception)
If you see this, what should be the FIRST thing that comes to mind?
Volvulus
How does Volvulus occur?
What is the typical presentation? (1)
Where does it usually occur in adults? (1) children? (3)
What do you normally see on an X-Ray/Barium swallow? (3)
How is it treated? (2)
- anomalies of intestinal rotation results in defective posterior fixation of the mesentery, which causes increased suspensory mobility of the bowel
- results in the twisting of the bowel around it’s mesentery, leading to to obstruction and infarction
- children: midgut, cecum, ascending colon
- elderly: sigmoid
Presentation
-
Bilious emesis with abdominal distension = obstruction
- bloody stools indicate perforation
Treatment:
- Ladd’s Procedure
