AMBOSS GI

Question 1

Young kiddo presenting with dark red blood in stool and profound anemia

Answer 1

Meckle’s diverticulum (remnant of the vittline duct)

Tech 99scan

Question 2

Abdominal pain out of proportion to exam on palpation

Answer 2

Acute mesenteric ischemia

Question 3

Pneumobilia with a bowel obstruction

Answer 3

Cholenteric fistula with gallstone ileus

Question 4

Mallory Weiss syndrome

Answer 4

Hematemesis

Partial tear at gastric/GE junction/lower esophagus

Question 5

Borhaave esophagus

Answer 5

Mediastinitis

Full tear and leaks into the mediastinum

Question 6

GERD with esophageal ulcer treatment?

Answer 6

Bleeding or ulcer suggest severe disease
Skip PPI
Nissen is first line

Question 7

Treatment of anal carcinoma

Answer 7

Radio/chemotherapy superior to surgery/excision

Question 8

S/p total pancreatectomy draining green fluid from wound. Tx?

Answer 8

Enterocutaneous fistula
Conservative
TPN with ostomy bag
Should resolve on own

Question 9

SBO but in the colon?! Plus they’re probably old or chronically sick or post op

Answer 9

Acute colonic pseudo-obstruction (Ogilvie’s syndrome)
Ng/rectal tube for decompression
Consider neostigmine
Surgery if fever or peritoneal signs

Question 10

Gold standard confirmatory test for Hirschprung dz?

Answer 10

Rectal suction bx

Absence of ganglion cells

Question 11

Managment of Borhaave?

Answer 11

Septic/unstable = surgery
Stable = conservative, IV amp

Question 12

Treatment for acalculous cholecystitis

Answer 12

Definitive = cholecystectomy

If surgery not great, bridge with IV pip-taz and perc drainage

Question 13

Young female on OCP with liver mass

Answer 13

Hepatic adenoma (benign)
<5cm = conservative, dc OCP and reimage
>5cm = resect d/t risk of bleed or transformation to HCC

Question 14

Tx of chronic pancreatitis?

Answer 14

D/C EtOH, small, regular meals high carb low fat
Enzyme replacement
ADEK

Question 15

Double bubble vs.

Triple bubble

Answer 15

Duodenal obstruction (volvulus)
Jejunal atresia (maternal coc, MDMA, tob)

Question 16

Pancreatic pseudocyst treatment?

Answer 16

Small, asx can be observed

Large or with sx can be perc CT drain

Question 17

Baby with acute abdomen?

Answer 17

Probs NEC

Ex Lap

Question 18

Kiddo with cyclic abdominal pain, normal in between, bloody/mucus stool? Dx/tx?

Answer 18

Intusseption

Air enema to dx and reduce

Question 19

Coffee bean sign in LLD?

Answer 19

Volvulus
NPO, NG decompression
If stable= endoscopic derotation
If peritoneal= Ex lap