Gastroenterology Flashcards
Intussusception
Telescoped bowel leads to congestion, edema, ischemia, necrosis, perforation
Usually preceding viral GE
Associated with Meckels, rotavirus vaccine, HSP, polyps
Episodic excruciating pain, elevated legs, red currant stools
Target sign on XR
Can be reduced with hydrostatic or pneumatic enema unless perforated then lap surg.
Appendicitis
Bacterial infection secondary to obstructed lumen (fecalith, LN, parasite)
Abdominal pain (periumbilical –> RLQ), anorexia, fever, emesis
Guarding, tenderness, rebound, psoas sign, obturator sign, Robinsky sign
Perforation usually provides temporary reduction in pain
Hypertrophic Pyloric Stenosis
Projectile NB emesis within 2-3 mo
Poor weight gain, volume depletion, hypokalemic hypochloremic metabolic alkalosis from prolonged vomiting
Olive shaped mass in epigastrum with visible peristalsis
Malrotation and Volvulus
Bilious emesis
Bloody stool/emesis
Gas in stomach but not in bowel on XR
Hirschsprungs Disease
T21
Failure to pass meconium, bilious vomiting
Gas distended upper bowel with no air in rectum
Squirt sign on DRE
Congenital aganglionosis due to failure of NC migration
compare with CF: other cause of failure to pass meconium
Meckel diverticulum
Remnant of omphalomesenteric duct
2 Feet from umbilicus, 2 year old, 2% of population
Painless bloody stools
Can contain gastrin secreting tissue
Visualize with Meckel scan
Suspect in kids with recurrent intusussception
Ulcerative Colitis
Continuous colonic inflammation, always rectal involvement
Mucosal and sub mucosal inflammation only
“Lead pipe” sign, bloody diarrhea, pyoderma gangrenosum, ank.spond., uveitis
No granulomas on histo
Sclerosing cholangitis, toxic megacolon, CRC
Crohns Disease
Any segment of GI, non continuous transmural inflammation, rectal sparing
String sign, linear ulcers, fistulae, perianal skin tags, CRC
Non caseating granulomas on histo
Migratory polyarthritis, erythema nodosum, kidney stones
-fat malabsorption leads to increased oxalate uptake –> increased risk of CaOxalate nephrolithiasis
Tracheoesophageal Fistula
VACTERL associated
Excess oral secretions, inability to feed, gagging
Polyhydramnios on fetal US (can’t swallow amniotic fluid)
Duodenal Atresia
Fully atretic or stenotic from web, band, annular pancreas etc.
Failure to recanalize in 8-10th week gestation
Bilious emesis within hours of the first feed
“Double bubble” sign - gastric and duodenal gas; no gas distal to atresia
Omphalocele
Herniation of abdominal viscera through abdominal wall covered by peritoneal membrane
Cover with sterile dressing, support, surgery
Intrauterine polyhydramnios
Associated with Beckwith-Wiedemann
Congenital Diaphragmatic Hernia
Left posterolateral diaphragm is MC site
Intrusion of GI contents into thoracic cavity leads to pulmonary growth compromise - AIRWAY
Respiratory distress, abnormal air movement, obvious on CXR
Scaphoid abdomen, barrel shaped chest
Gastroschisis
Herniation of abdominal viscera through abdominal wall without membrane covering
Cover with sterile dressing, support, surgery
Acalculous Cholecystitis
- Chronically ill pts: trauma, multiorgan failure, sepsis, TPN, surgery
- usu. no hx of GB disx, leads to infection, necrosis, sepsis
- SSx: RUQ pain, pericholecystic fluid, wall thickening
- Tx: abx + cholecystostomy; surgery when stable
Uncomplicated Diverticulitis
Inflammation of diverticuli
Treat outpatient with PO abx (eg cipro and metro), bowel rest, and observation
Immune deficient, elderly, high fever/leukocytosis can be treated with IV abx inpatient
