Gastroenterology Flashcards
portion of the bowel invaginates or “telescopes” into an adjacent segment, usually proximal to the ileocecal
Intussussception
Triad in Intussusception
classic triad is abdominal pain, vomiting, and bloody mucus in stool (“currant jelly stool)
“Sausage-shaped” RUQ abdominal mass, and absence of bowel in the RLQ (“empty” on palpation).
Target sign on ultrasound
Intussusception
Both diagnostic and therapeutic in Intussusception
air-contrast barium enema should be performed without delay, as it is diagnostic in > 95% of cases and curative in > 80%.
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.
Pyloric Stenosis
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
Pyloric stenosis
Treatment of pyloric stenosis
Pyloromyotomy
The classic metabolic derangement in pyloric stenosis is
hypochloremic, hypokalemic metabolic alkalosis
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
Meckel’s Diverticulum
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.
Hirchsprung’s Disease
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
Hirschsprung’s Disease
Rectal biopsy of Hirschsprung’s Disease
absence of the myenteric (Auerbach’s) plexus and submucosal (Meissner’s) plexus along with hypertrophied nerve trunks enhanced with acetylcholinesterase stain.
Treatment of Hirschsprung’s Disease
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.
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).
MALROTATION WITH VOLVULUS
First month of life with bilious emesis, crampy abdominal pain, distention, and passage of blood or mucus in the stool.
MALROTATION WITH VOLVULUS
AXR may reveal the characteristic “bird-beak” appearance and air-fluid levels but may also appear normal.
Malrotation with volvulus
Bilious vomiting:
Nonbilious:
Bilious vomiting: Hirschsprung
Malrotation
Nonbilious: pyloric Stenosis
Meckel’s rule of 2’s: (6)
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
portion of the bowel undergoes necrosis. The most common GI emergency in neonates; most frequently seen in premature infants
NEC
pathognomonic for NEC in neonateson plain films
Pneumatosis intestinalis on plain films is pathognomonic for NEC in neonates.
Abdominal distention Feeding intolerance Bloody stool Bowel perforation Pneumatosis intestinalis on plain abd X-ray
Necrotizing enterocolitis
