Gastroenterology Flashcards
Five diseases to know
- Pyloric stenosis
- Intussception
- Malrotation/volvulus
- Meckel’s diverticulum
- Necrotizing entercolitis
What is pyloric stenosis, best way to diagnose, and treatment
Firstborn male infants in first 3-4 weeks of life with projectile, nonbioious emesis
Diagnosis: Labs show hypochloremic, hypokalemic metabolic alkalosis, gold standard ultrasound showing hypertrophied pylorus
Barium studies will show string sign
Treatment: Correct dehydration and electrolyte abnormalities, then do surgical repair
What is intussception
Telescoping of bowel segment into itself leading to edema, arterial occlusion, gut necrosis, and death
Most common cause of bowel obstruction in first two years of life
Idiopathic < 2 years, lead point > 5 years
How does intussception present
Presents with intermittent abdominal pain, vomiting, and heme positive stools, and currant jelly stools
Abdominal exam reveals “sausage like mass”
How do you diagnose and treat intussception
Initial diagnosis: Abdominal ultrasound
Final diagnosis: Air contrast or water soluble contrast enema: Diagnostic and therapeutic
If enema fails at treatment, surgical intervention
What two diseases are associated with intussception
- Henoch Scholein purpura
2. Cystic fibrosis
What is malrotation
Failure of normal embryological rotation when gut returns to abdominal cavity during 10th week of gestation - presdisposes to intestinal obstruction
What is volvulus
A complication of malrotation, when malrotated gut twists on axis of superior mesenteric artery resulting in intestinal obstruction and ischemia
What are the symptoms of volvulus
Bilious emesis with small bowel obstruction
What is the diagnosis of malrotation and volvulus
Malrotation: An upper GI series shows duodenojejunal junction on right side of spine
Volvulus: Barium enema shows bird beak where gut is twisted
What is the treatment for volvulus, malrotation
Surgery cause this is dangerous
What are the complications of volvulus/malrotation
Short bowel syndrome, when less than 30cm of bowel is left - leads to malnutrition, TPN dependence, and liver failure
What is Meckel’s diverticulum
Remnant of omphalomesenteric duct that persists as an outpouching of distal ileum that can contain ectopic mucosa such as gastric or pancreatic
Symptoms: Painless rectal bleeding or intussception
The rules of two apply to this
How do you diagnose and treat Meckel’s diverticulum
Diagnosis: Technetium radionuclide scan to detect gastric mucosa
Gold standard is biopsy
Treatment: IV fluids, treat with surgery if symptomatic
What is necrotizing enterocolitis
Intestinal necrosis in watershed areas with air in bowel wall and portal venous system
Risk factors: Prematurity and congenital heart disease
