ABD problems Flashcards
Bilious emesis is sign of
neonate sign of interstinal obstruction require immediate workup
Newborn with obstruction, on xray you see pneumoperitoneum; next step?
emergent surgery
Newborn w/ obstruction, x-ray shows dilated loops and no feces in rectum, next step?
water soluble contrast enema
can be therapeutic (breaks up feces)
meconium ileus is assoc with
Cystic fibrosis
Recurrent UTI in infants and children should ring a bell for?
Congenital UT anomaly
Vesicoureteral reflux
Vesicoureteral reflux causes
dilation of ureters (hydroureter) and kidneys (hydonephrosis)
DX VUR
screen w/
voiding cystourethrogram
screen: USG
Chronic pyelonephritis appears
blunting of calices (calyceal clubbing)
focal parenchymal scarring
How to evaluate renal scarring?
Scinigraphy w/ Dimercaptosuccinic acid
MCC of chronic renal insufficiency/failure in kids
Posterior urethral valves
Increased AFP and bowel free in amniotic fluid
Gastroschisis
Complications due to amniotic fluid inflammation/edema in gastroschisis
necrotizing enterocolitis
short bowel syndrome
Dysmotility: prolonged reliance of TPN
Gastroschisis is an isolated defect _% of the time
90
Rx of Gastroschisis
After delivery cover in sterile saline and plastic wrap (minimizes insensible heat and fluid loss)
place NG tube
Start Antiobiotics
Prompt surgical repair
Omphalocele infants typically have 50% chance of
other major malformations:
cardiac disease
NT defects
Trisomy
Constipation in kids is exacerbated by
excessive milk consumption
toilet training
adjustment to day care or transitional events
Complications of constipation in kids
anal fissures hemorrhoids encopresis enuresis/UTI Vomiting
Rx constipation in kids
Increase dietary fiber
limit cows milk intake to
MCC of UT Obstruction in newborn?
Posterior urethral valves
Potters Syndrome
Pulmonary hypoplasia
Oligohydramnios
Twisted skin
Twisted face (facial abnormalities: flat facies)
Extremities (limb defects)
Renal agenesis
Sonogram: PUV= hydroureters, hydronephrosis
MC renal malignancy in kids
Nephroblastoma: Wilms tumor
mc age 2-5
Indications for renal and bladder USG during UTI?
kid
USG sees some hydronephrosis and scarring; next step?
VCUG
IDIOT: kid eats his moms iron tablets, antidote?
IV fluids
Deferoxamine
Iron poisoning causes
free radical production and lipid peroxidation which imparis various cell processes= systemic manifestation ABD pain hematemesis Hypovolemic shock M. Acidosis
Lead poisoning C/f in kids?
Irritability poor appetitie Headaches ABD pain/anemia Rx: Calcium EDTA, Succimer
Kid with blious emesis, given NG tube decompression and IV fluids, ABD xray shows no air in interstine, next step?
Upper GI series possible malrotation (ligament of treitz on R side of abd)
Procedure called for fixing a volvulus?
Ladd procedure:
fixing the bowel in a non-rotated position to minimize recurrent volvulus risk
Classic triad of Biliary cyst
Pain, jaundice and palpable mass
Usually present
Dx and Rx biliary cyst
DX: USG and ERCP
Rx: Surgical resection to relieve obstruction and prevent malignant transformation
recurrent cystitis c/f
suprapubic pain dysuria pyuria bacteriuria toddlers: constripation
henoch schonlein purpura c/f
Typically follows infection Palpable purpura arthitis/arthralgia abd pain, inussusceptions renal disease similar to IgA nephropathy
rx HSP
Supportive: hydration and NSAIDS
Severe: hospitilization and steroids
Nephrotic syndrome assoc w/ HBV
membranous nephropathy
also: sle, drugs, infections
Nephrotic syndrome assoc w/ HIV
FSGS
also: heroin, CKD, Sickle cell
infantile hypertrophic pyloric stenosis r/f
first born boy
formula feeding: gradual hypertrophy of pylorus
onset around 3-5 wks
acid base disturbance in pyloric stenosis
hypochloremic m. alkalosis
from vomiting
milk protein allergy c/f
vomiting
poor weight gain
bloody stools
asian newborn with jaundice have decreased
hepatic UGT activity
physio jaundice pathophys (3 reasons)
At bith high HCT w/ short life span= high Hb turnover
Decreased UGT activity until 2 wks of age
Sterile newborn gut= inc enterohepatic recycling (cant breakdown bilirubin to urobilinogen)
Reye syndrome labs
Hyperammonemia n/inc: bilirubin, ALP Increased PTT hypoglycemia elevated AST,ALT, LDH
Biopsy of Liver in Reye syndrome
Microvesicular steatosis
Breastfeeding failure jaundice is
exaggerated unconjugated hyperbilirubinemia inf FIRST week of life that is caused by lactation failure
normal infant stool
Normally pass dark sticky meconium during first 2 days of life
then should transition to yellowish or green stool in ingesting adequate milk
breast milk jaundice time frame
starts age 3-5 days peaks at 2 weeks
breast milk jaundice is what
High levels of B-glucuronidase in breast milke deconjugate intestinal bilirubin and increase enterohepatic circulation
Normal exam and adequate breastfeeding
Indirect (unconjugated) hyperbilirubinemia up to 10-30 mg/dl
Rx breastfeeding failure jaundice
increase frequency and duration of feeds to stimulate milk production, adequate hydration and promote bilirubin excretion
Neonates and breast feeding times?
8-12 times a day (every 2-3 hrs)
for 10-20 mins per breast for 1st month of life
ingestion of chemical management
Secure ABCs
Remove contaminated clothing and visible chemical: irrigate exposed skin
Chest xray if resp symptoms
Endoscopy w/in 24 hrs
Gut immaturity, exposure to bacteria from enteral feeds,, leads to cascade of inflammation and damage to bowel wall; Dx?
Necrotizing enterocolitis (NEC)
Decreased rates of NEC in premature infants when fed?
breast milk instead of formula
Xray of NEC?
Air visible in bowel wall= pneumatosis intestinalis
portal venous air
severe intestinal necrosis can cause perforation and pneumoperitoneum
Meckels diverticulum c/f
Asymptomatic incidental finding painless hematochezia (melena stools) intussception intestinal obstruction volvulus
Dx meckels?
Technetium 99m pertechnetate scan
meckels is what
incomplete obliteration of fetal vitelline (omphalomesenteric) duct
In 1-8 wks a kid develops, Jaundice, acholic stools or dark urine, Hepatomegaly, Conjugated hyperbilirubinemia, Mildly elevated transaminases; Dx?
Biliary atresia
Dx biliary atresia
USG: absent or abnor Gallbladder Hepatobiliary scintigraphy: failure of tracer to excretion Intraoperative cholangiogram(gold standard): biliary obstruction
Rx biliary atresia
Hepatoportenterostomy (Kasai procedure)
LIver transplant
Intussusception r/f (6)
Viral illness or rotavirus vaccine Meckels HSP Celiac disease Intestinal tumor Polyps
Wilms tumor arises from what embryologic precursor
Metanephros: renal parenchyma
Embryologic structures of mesonephros
Seminal vesicles
epididymis
ejaculatory ducts
ductus deferens
Paramesonephron gives rise to
fallopian tubes
uterus
part of vagina
Risk factors for jejunal atresia
vasoconstrictive meds
cocaine
tobacco
not assoc w/ chromosomal abnormalities
Jejunal atresia presents how
bilious vomiting
abd distention
Abd xray: triple bubble sign
