Gastroenterology

Question 1

portion of the bowel invaginates or “telescopes” into an adjacent segment, usually proximal to the ileocecal

Answer 1

Intussussception

Question 2

Triad in Intussusception

Answer 2

classic triad is abdominal pain, vomiting, and bloody mucus in stool (“currant jelly stool)

Question 3

“Sausage-shaped” RUQ abdominal mass, and absence of bowel in the RLQ (“empty” on palpation).
Target sign on ultrasound

Answer 3

Intussusception

Question 4

Both diagnostic and therapeutic in Intussusception

Answer 4

air-contrast barium enema should be performed without delay, as it is diagnostic in > 95% of cases and curative in > 80%.

Question 5

Hypertrophy of the pyloric sphincter, leading to gastric outlet obstruction. More common in firstborn males; associated with tracheoesophageal fistula, a maternal history of pyloric stenosis, and erythromycin ingestion.

Answer 5

Pyloric Stenosis

Question 6

Nonbilious vomiting at 3 weeks of age progressing to projectile vomiting after feeding
Dehydration and malnutrition
palpable olive-shaped, mobile, nontender epigastric mass and visible gastric peristaltic waves

Answer 6

Pyloric stenosis

Question 7

Treatment of pyloric stenosis

Answer 7

Pyloromyotomy

Question 8

The classic metabolic derangement in pyloric stenosis is

Answer 8

hypochloremic, hypokalemic metabolic alkalosis

Question 9

Caused by failure of the omphalomesenteric (or vitelline) duct to obliterate. The resulting heterotopic gastric tissue causes ulcers and bleeding

Typically asymptomatic, and often discovered incidentally.
Classically presents with sudden, intermittent, painless rectal bleeding.
I

Answer 9

Meckel’s Diverticulum

Question 10

Congenital lack of ganglion cells in the distal colon, leading to uncoordinated peristalsis and ↓ motility.
failure to pass meconium within 48 hours of birth, accompanied by bilious vomiting and FTT
Chronic constipation
Explosive discharge of stool following a rectal examination; lack of stool in the rectum; or abnormal sphincter tone.

Answer 10

Hirchsprung’s Disease

Question 11

Barium enema is the imaging study of choice and reveals a narrowed distal colon with proximal dilation.
Anorectal manometry detects failure of the internal sphincter to relax after distention of the rectal lumen

Answer 11

Hirschsprung’s Disease

Question 12

Rectal biopsy of Hirschsprung’s Disease

Answer 12

absence of the myenteric (Auerbach’s) plexus and submucosal (Meissner’s) plexus along with hypertrophied nerve trunks enhanced with acetylcholinesterase stain.

Question 13

Treatment of Hirschsprung’s Disease

Answer 13

2-stage surgical procedure
Diverting colostomy at the time of diagnosis, followed several weeks later by a definitive “pull-through” procedure connecting the remaining colon to the rectum.

Question 14

Congenital malrotation of the midgut results in abnormal positioning of the small intestine (cecum in the right hypochondrium) and formation of fibrous bands (Ladd’s bands).

Answer 14

MALROTATION WITH VOLVULUS

Question 15

First month of life with bilious emesis, crampy abdominal pain, distention, and passage of blood or mucus in the stool.

Answer 15

MALROTATION WITH VOLVULUS

Question 16

AXR may reveal the characteristic “bird-beak” appearance and air-fluid levels but may also appear normal.

Answer 16

Malrotation with volvulus

Question 17

Bilious vomiting:

Nonbilious:

Answer 17

Bilious vomiting: Hirschsprung
Malrotation
Nonbilious: pyloric Stenosis

Question 18

Meckel’s rule of 2’s: (6)

Answer 18

Meckel’s rule of 2’s:

Most common in children under 2

2 times more common in males

Contains 2 types of tissue (pancreatic and gastric)

2 inches long

Found within 2 feet of the ileocecal valve

Occurs in 2% of the population

Question 19

portion of the bowel undergoes necrosis. The most common GI emergency in neonates; most frequently seen in premature infants

Answer 19

NEC

Question 20

pathognomonic for NEC in neonateson plain films

Answer 20

Pneumatosis intestinalis on plain films is pathognomonic for NEC in neonates.

Question 21

Abdominal distention
Feeding intolerance
Bloody stool
Bowel perforation
Pneumatosis intestinalis on plain abd X-ray

Answer 21

Necrotizing enterocolitis