6. CIS Pediatric GI disorders and Jaundice

Question 1

Common presentation for GERD in children is when symptoms or complications are present because of GER, babies will be hard to feed, cry alot, arch* and scream, and hard to gain weight. What is the way to diagnose this?

Answer 1

Esophageal pH monometry

tells you freq of GERD + HISTORY = diagnostic

Question 2

On endoscopy if there is furrowing of the esophagues with a white exudate and greater than 10 eosinophils / HPF what can be expected?

Answer 2

Eosinophilic esophagitis

Question 3

Tx of GERD includes trial of hypoallergenic formula (nah), smaller amount of food more frequently, upright position after food, H2/PPIs and how should he sleep?

Answer 3

ON HIS BACK NOT STOMACH

Question 4

A patient presents with 1 day hx of abdominal pain and vomiting, he is quiet (lethargic) w periods of intense crying, there is a sausage like mass in RUQ and mother says he had a red current jelly stool earlier…dx?

Answer 4

Intussusception

Question 5

Intussusception results from teloscopin of one part of theintestine into another, impairing venous return, bowel edema, ischemia, necrosis, and perforation, what is the MC location of Intussusception?***

Answer 5

Illeum invaginates into the colon at the ileoceccal valve/jxn (MOST ARE ILEOCOLIC)

Question 6

What is a common location for someone with HSP, which is hard to distinguish between abd pain of HSP and that of intussesception?

Answer 6

Ileo-ilial

Question 7

5 week old baby boy presents with ejectile vomiting, he barely poops, he is dehydrated, vomit literally flys out and there is a peristaltic wave…dx?

Answer 7

Pyloric stenosis: MC in first 2-4 weeks , 1/500

Question 8

With pyloric stenosis there is projectile vomiting, dehydration and poor wt gain, olive sized nontender mass in abdomen, string sign, thickened elongated pylorus, with a **classic metabolic picture including? (3)

Answer 8

Hypochloremic
Hypokalemic
Metabolic Alkalosis

Question 9

infant male, 2nd day of life, with large bilious emesis, has not passed meconium for first 36 hours of life, palpable stool throughout abdomen, empty rectal vault, never had unassisted stool?

Answer 9

Hirschsprungs Dz - megacolon - remove aganglionic part

Question 10

What is the following describing?
bilirubin bound to albumin before reaching the liver, lipid soluble (can go to brain), most common type involve in neonatal jaundice, d/t hemolysis of RBCs

Answer 10

Unconjugated/Indirect Bilirubin

Question 11

What is the following describing?
Bilirubin in the liver, via UDGT1, UGT1A1 increases rapidly in the first few weeks of birth, excreted into intestine via GB bile duct, B-Glucuronidase in the intestine can deconjugate, making water soluble, allowing it to be reabsorbed from gut into blood, excereted via stool?

Answer 11

Conjugated/Direct Bilirubin

Question 12

If there is increased enterohepatic circulation of bile acids, that means there is a decreased intake of food, and a decreased passage of stool, and an increased amount of bile being reabsobed, which causes?

Answer 12

high bile acid resorption, causing hyperbilirubinemia!

Question 13

Visible jaundice in early life means that the total BR is at least 5mg/dL, if there is jaundic down to the stomach = 10mg/dL and jaundice down to the feet=?

Answer 13

15mg/dL at least

Question 14

Common non-pathological neonatal hyperbilirubinemia includes physiologic jaundice and is ALWAYS unconjugated, associated w prematurity. There are two types due to breast feeding and breast milk, which is characterized by jaundice caused by dehydration and decreased excretion of bilirubin in the stool (more supply related)?

Answer 14

Breast feeding jaundice

Question 15

What breastfeeding/milk jaundice is due to the presence of bilirubin deconjugating enzymes in the milk (specifically B-Glucuronidase)?

Answer 15

Breast Milk Jaundice

Question 16

Pathologic Unconjugated hyperbilirubinemia can be caused by blood group incompatibility (ABO), may occur if mom’s blood type is O and bb is A/B/AB, if mom is type O or if mom is Rh- what test should be done and why?

Answer 16

Infants cord blood should be tested via a direct Coomb’s antibody test (DAT), to check for Abs against bb’s RBC

Question 17

The MC pathologic causes of conjugated hyperbilirubinemia is UTI/Sepsis, hypothyroidism, galactosemia and what?

Answer 17

**Biliary Atresia

Question 18

Acute bilirubin toxicity has 3 phases…
Phase 1: first 1-2 days: poor suck, high pitched cry, stupor, hypotonia, seizures
Phase 2: 4-5 days: Hyperotnia of externsor M, opishtotonus, retrocollis, fever
Phase 3: ?

Answer 18

Hypertonia after 1st week of life

Question 19

Why can bilirubin induce neurologic dysfunction (BIND) or Kernicterus occur?

Answer 19

EXCESSIVE Unconjugated bilirubin (criggler najar) is lipid solube so can cross the BBB and go to the basal ganglia and cause damage

Question 20

If the baby is premature, with a HIGH hematocrit count, and is A but the mom is ORH-, what is high on the list?

Answer 20

Hyperbilirubinemia**

Question 21

What is the name of the websit where you can enter in gestational age, day-of-life, and bilirubin levels to tell their risk?

Answer 21

www.bilitool.com

Question 22

Hospital protocols usually discharge at 48 hours, bilirubin check at 24 hours, DAT (direct coombs/antibody test) check in type O and Rh- moms, follow up with newborn within?

Answer 22

2 days of discharge

Question 23

Phototherapy can be used in jaundice babies due to bilirubin, and the blue light isomerizes bilirubin to a water soluble form, expose as much skin as possible- what must you remember to cover?

Answer 23

COVER THE EYES

Question 24

Biliary atresia is progressive and destructive inflammatory process affecting both extra and intrahepatic biliary treem development of jaundice occurs in the first few post natal weeks, *conjugated hyperbilirubinemia leading to what 3 major symptoms?

Answer 24

Cholestatic Jaundice*
Hepatomegaly*
Acholic Stools ***

Question 25

What is known as giant cell hepaptitis, direct bilirubinemia, prolonged cholestatic jaundice, liver biopsy shows a very disrupted hepatic architecture?

Answer 25

Idiopathic Neonatal Hepatitis