Gastroenterology Flashcards
What does bilious emesis indicate?
OBSTRUCTION = urgent evaluation
In what age group is Gastroesophageal Reflux Disease (GERD) considered common?
Infants <6 months
Differentiate GER from GERD
- GER = “Happy Spitter”: NO complications or consequences; normal, declines with age
- GERD = “Unhappy Spitter”: complications arise (FTT, esophagitis, resp. issues, irritable, dystonic neck posturing, feeding refusal, bloody stools)
If a patient simply has GER, what is the treatment?
Supportive
- Typically resolves within 9-12 months
What is the first line treatment for Gastroesophageal Reflux Disease (GERD) - give two examples?
Lifestyle modifications
- Avoid tobacco
- Upright position 30 minutes after feeds
If treatment of Gastroesophageal Reflux Disease (GERD) is refractory or case is complicated, what treatment may be considered (2)?
Omeprazole vs. Ranitidine
Which condition is associated with macrolide abx use during first weeks of life?
Infantile Hypertrophic Pyloric Stenosis
Which condition often involves the 1st born male?
Infantile Hypertrophic Pyloric Stenosis
If you have a 3-6-week-old infant with nonbilious “projectile” emesis immediately after feeds, what condition should be considered?
Infantile Hypertrophic Pyloric Stenosis
Which condition involves “olive-like” mass in RUQ?
Infantile Hypertrophic Pyloric Stenosis
Which condition involves US shows elongation, thickening of pylorus; UGI Barium contrast study showing string sign?
Infantile Hypertrophic Pyloric Stenosis
What is the recommended treatment for Infantile Hypertrophic Pyloric Stenosis?
Surgery (pyloromyotomy
What condition involves 1+ bowel segments absent/obstructed (duodenum is most common)?
Congenital Intestinal Atresia
Under what three conditions/diseases is there increased risk for Congenital Intestinal Atresia?
- CF
- Down syndrome
- Maternal cigarette smoking
Which condition involves vomiting (bilious), abdominal distention +/- fail to pass meconium?
Congenital Intestinal Atresia
Which condition involves “double bubble sign”?
Congenital Intestinal Atresia
- Duodenal atresia
For what condition is withhold feedings to prepare for surgery; broad-spectrum abx to prevent post-op infection considered treatment?
Congenital Intestinal Atresia
Which condition involves abnormal intestine position?
Midgut Malrotation
What is small bowel twisting around Superior Mesenteric a. → small bowel ischemia and necrosis, and what condition is it often associated with?
Volvulus
- Often seen with Midgut Malrotation
Which condition involves sxs of hemodynamically unstable, vomiting (bilious)?
Midgut Malrotation +/- Volvulus
Which condition involves UGI Barium contrast study shows “corkscrew” duodenum?
Midgut Malrotation +/- Volvulus
Which condition involves Ladd procedure to prevent ischemia and recurrent sxs for treatment?
Midgut Malrotation +/- Volvulus
Which condition involves intestinal telescoping?
Intussusception
What is the most common abdominal emergency in kids <2 years?
Intussusception
Which condition involves possible etiology of Meckel diverticulum or from a form of Rotavirus vaccine (Rotashield)?
Intussusception
What is the hallmark symptom of Intussusception?
Abdominal pain (intermittent, severe, progressive)
Which condition involves a “sausage-shaped” mass?
Intussusception
Which condition involves “currant jelly” stools?
Intussusception
Which condition involves abdominal US shows “target sign”/“coiled spring”?
Intussusception
What treatment for Intussusception is both diagnostic and therapeutic?
Hydrostatic/pneumatic enema
What is the most common pediatric surgical emergency?
Appendicitis
Which condition peaks in 2nd decade of life – rare before age 5?
Appendicitis
Which condition involves vomiting AFTER pain onset, and migrating abdominal pain?
Appendicitis
Which condition involves tender McBurney’s point? What other five findings may be present on PE?
Appendicitis
- Guarding
- Rebound
- +Rovsing
- +Obturator
- +Iliopsoas
What is the recommended diagnostic path for Appendicitis?
If classical presentation, consult THEN imaging (US)
What is the recommended treatment for Appendicitis?
Appendectomy
- Also fluids, IV abx, analgesics
What is the definition of diarrhea?
3+ loose or watery stools per day
What is the most general etiology of diarrhea? Provide three examples
Viral most common
- Norovirus
- Rotavirus
- Adenovirus
What are six red flags for diarrhea?
- Fever
- Severe abdominal pain
- Blood in stool
- Recent abx
- Persistent sxs
- Dehydration
What treatment is always recommended for acute diarrhea?
Hydration (PO vs. IV)
What four etiologies should be considered for CHRONIC diarrhea?
- Celiac disease
- Allergic enteropathy
- Malabsorption
- Functional (Toddler’s) diarrhea
Which condition peaks at 15-30 years?
Inflammatory Bowel Disease (Crohn Disease vs. Ulcerative Colitis)
What is associated with 2x risk for Crohn disease?
SMOKING
What condition involves a “step-up” for most patients vs. “top-down” for high risk patients approach to treatment?
Inflammatory Bowel Disease (Crohn Disease vs. Ulcerative Colitis)
Which condition involves transmural inflammation (mouth to anus)?
Crohn Disease
Which condition involves skip lesions on x-ray?
Crohn Disease
Which condition involves a cobblestone appearance?
Crohn Disease
Which condition involves continuous involvement of rectum and colon? What layer is ONLY affected?
Ulcerative Colitis
- Mucosal layer only
Which condition involves diffuse/continuous edema, erythema, friability, ulceration?
Ulcerative Colitis
What does Ulcerative Colitis put a patient at increased risk for?
Colon CA
What is the most common congenital anomaly of GI tract?
Meckel’s Diverticulum
Which condition involves the rule of 2’s, and what are they (4)?
Meckel’s Diverticulum
- 2% of pop.
- 2:1 M:F ratio
- 2% develop complications often before age 2 years
- 2 feet from ileocecal valve
Which condition involves painless rectal bleeding (mucosal ulcers cause bleeding)?
Meckel’s Diverticulum
Which condition involves using Technetium-99 for diagnosis? What is another name for this scan?
Meckel’s Diverticulum
- Meckel’s Scan
What are the two general etiologies of constipation?
- Functional: voluntary stool withholding due to psychological or psychosomatic; diet (low fiber, high dairy)
- Organic: anal stenosis, hypothyroidism, Celiac disease, Hirschsprung, hypercalcemia, CF
What is leakage of retained stool, and what might it be caused by?
Encopresis
- Can be caused by constipation
Weight loss, anorexia, fever, hematochezia, vomiting, acute onset, failure to pass meconium, failure to respond to conservative treatments are all red flags for what, and what is the recommended treatment?
CONSTIPATION
- GI referral if any of these are present
What are three treatments for constipation?
- Fluids
- Increase fiber intake
- MiraLAX
Which condition involves congenital aganglionic megacolon (absence of ganglion cells in mucosal layer of colon)?
Hirschsprung Disease
In what population is Hirschsprung Disease most common?
males <6 weeks of age
What condition is associated with increased risk for Hirschsprung Disease?
Down syndrome
Which condition involves failure to pass meconium in first 48 hours of life?
Hirschsprung Disease
Which condition involves tight anal sphincter, “squirt sign”?
Hirschsprung Disease
What is the gold standard for diagnosis of Hirschsprung Disease?
Rectal biopsy (confirms lack of ganglion cells)
What is the recommended treatment for Hirschsprung Disease?
Surgical resection of aganglionic colon segment
