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NNP Board Exam Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Gastroschisis

A

a defect in the abdominal wall through which the viscera protrude, not covered with sac, usually to the right of the midline, lower incidence of associated anomalies with gastroschisis than omphalacele

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2
Q

Prune Belly Syndrome or Eagle Barrett

A

congenital absence of the abdominal musculature
associated with severe renal and urinary tract abnormalities (more common in males)

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3
Q

Common GI abnormalities associated with polyhydramnios

A

duodenal atresia and esophageal atresia

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4
Q

Presence of copious oral secretions and inability to pass catheter to stomach

A

indicates esophageal atresia

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5
Q

presence of a large amount of amniotic fluid in the stomach at delivery indicates…

A

duodenal atresia

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6
Q

Until 30-32 weeks gestation, the greatest abdominal diameter is ______ than the head circumference; _____ from 32-36, and _______ after 36 weeks.

A

30-32 weeks - head > abdomen
32-36 weeks - head = abdomen
36 weeks + abdomen > head

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7
Q

The only obstruction that presents with abdominal distention at birth

A

meconium ileus

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8
Q

malrotation

A

results from abnormal fixation of the intestine in the abdomen

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9
Q

midgut volvulus

A

abnormal rotation of the bowel around the mesentary and subsequent obstruction of blood flow to the bowel.

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10
Q

an umbilical hernia is often seen with ___________.

A

hypothyroidism; usually resolve by 2 years of age

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11
Q

epigastric hernia

A

a small, firm nodule between the umbilicus and xiphoid process; surgical intervention usually required

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12
Q

omphalocele

A

herniation of the bowel contents through the umbilical cord; contents contained within a translucent sac; thought to result from failure of the bowel to reenter the abdomen after its normal extrusion into the cord before the 10th week of gestation

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13
Q

Associated Syndomes: Duodenal Atresia

A

fetal hydantoin syndrome, trisomy 21

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14
Q

Associated syndromes: EA / TEF

A

Aperts, CHARGE, Trisomy 18, VACTERL

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15
Q

Associated syndromes: Hirschsprung’s Disease

A

DiGeorge, Smith-Lemli-Opitz, Trisomy 21

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16
Q

Associated syndromes: Intestinal Malrotation

A

Trisomy 13, 18

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17
Q

Associated syndromes: Imperforate Anus

A

VACTERL

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18
Q

Associated syndromes: Pyloric Stenosis

A

Aperts, Trisomy 13, 18

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19
Q

Associated syndromes: Umbilical Wall Defects

A

beckwith-widemann, fetal hydantoin syndrome (umbilical hernia), trisomy 13, 18, 21

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20
Q

Amount of Abdominal Distention directly correlates with level of obstruction; the ______ abdominal distention the more _______ the obstruction.

A

Greater abdominal distention = more distal obstruction

21
Q

obstruction beyond the level of the ________ will always result in bilious emesis

A

ampulla of vader

22
Q

EA / TEF presentation

A

depends on type of defect, but may include excessive oral secretions, drooling, coughing, choking, regurgitation of undigested milk,

recurrent pneumonia with coughing / choking during feeds in the infant that a catheter be passed think “H Type”

23
Q

Most common type of EA/ TEF

A

EA with distal TEF

24
Q

EA / TEF management

A

repogle to low continuous suction, elevate HOB, Avoid CPAP, try to comfort to avoid crying (gets more air in the abdomen)

25
Q

Pyloric Stenosis Presentation

A

nonbilious emesis that progresses to projectile,
on palpation a small “olive” shaped mass in the right upper quadrant

26
Q

Duodenal Atresia patho, diagnosis

A

results from failure of vacuolization at 5-6 weeks GA and recanalization at 8-10 weeks
shows on U/S as dilated stomach and duodenum, “double bubble”

may also be polyhydramnios

27
Q

Duodenal Atresia Presentation

A

bilious emesis within a few hours of birth, minimal abdominal distention, failure to stool

28
Q

Ileal/Jejunal Atresia

A

more commonly occurs as an intrauterine accident where the blood supply is cut off (after 12 weeks gestation)
U/S findings: dilated bowel loops w/ absence of air in the distal bowel
proximal jejunal atresia shows up as “triple bubble”
Presentation: failure to stool, abdominal distention, bilious emesis in the first 24 to 36 hours

Contrast enema is gold standard for diagnosis

29
Q

Malrotation with Midgut volvulus presentation

A

sudden onset of bilious emesis in an otherwise healthy infant who has been stooling and feeding normally;
majority present within first week and remaining present within first month

gold standard for diagnosis is Upper GI that shows abnormal position of the ligament of treitz

30
Q

Post-op gastroschisis feeding / nutrition

A

feeding advancement may be challenging due to the prolonged ileus,

low osmolality feedings preferred; soy or elemental formulas may be needed for continued feeding intolerance or absorption

31
Q

Hirschsprung’s Disease

A

congenital absence of the ganglion cells of a segment of the colon resulting in functional obstruction; because bowel is unable to relax; more commonly affects the rectum or rectosigmoid colon; most common cause of large bowel obstruction

males affected 4x more than females

32
Q

Hirschsprung’s presentation

A

failure to stool by 48 hours of life, increased abdominal distention and bilious emesis,

rectal stimulation often results in passage of stool

rectal biopsy is the gold standard for diagnosis,

barium enema is suggestive of hirschsprungs if barium is retained for greater than 24 hours

33
Q

Hirschsprung’s management

A

rectal irrigation with warm saline x2 daily until surgery,

if irrigations succesfully pass stool, feedings can continue, but if no stool - no feeds

34
Q

Meconium Ileus

A

mechanical obstruction of the distal ileum due to thick, tenacious meconium

90% have CF due to an autosomal recessive gene defect that results in altered function of the chloride channel transporter

gold standard for diagnosis is a water-soluble contrast enema showing a microcolon with pelets of meconium at the site of distal obstruction.

on abdominal xray the distal intestine has a “soap bubble” appearance

35
Q

Meconium Plug

A

mechanical obstruction of the distal lumen of the colon due to thick, tenacious meconium in the absence of enzymatic deficiency or abnormal ganglion cells

results from colon dysmotility

commonly associated with: maternal diabetes due ot increased fetal glycogen production, maternal magnesium therapy, neonatal CNS disease with hypotonia, neonatal sepsis, prematurity

36
Q

Small Left Colon Syndrome

A

obstruction due to thick meconium, but site of obstruction is commonly the splenic flexure

50% of cases associated with IDM

37
Q

NEC

A

bowel inflammation & necrosis; ,most common site terminal ileum and proximal ascending colon

38
Q

NEC presentation on X-ray

A

pneumatosis intestinalis (indicates hydrogen gas in bowel wall from bacterial fermentation)

39
Q

NEC Bell Staging - Stage 1

A

clinical signs and symptoms - inconclusive radiologic findings

40
Q

NEC Bell Staging - Stage 2

A

definitive

clinical signs and symptoms present + pneumatosis or portal venous gas on xray

2A - moderately ill infant

2B moderately ill infant with systemic clinical signs

41
Q

NEC Bell Staging - Stage 3

A

advanced

3A critically ill infant with concern for impending perforation

3B critically ill infant with proven intestinal perforation with pneumoperitoneum on x-ray

42
Q

NEC Stage 1 Management

A
  • Bowel rest
  • fluid resuscitation
  • replogle to continuous suction
  • monitoring labs (CBC, electrolytes)
  • blood culture with broad spectrum antibiotics to cover gut flora
  • abdominal x-rays q4-8
43
Q

NEC Stage 2 management

A
  • Bowel rest
  • fluid resuscitation
  • replogle to continuous suction
  • monitoring labs (CBC, electrolytes)
  • blood culture with broad spectrum antibiotics to cover gut flora - consider addition of anaerobic agent
  • abdominal x-rays q4-8 - + lateral decubitus imaging for increased risk of pneumoperitoneum
44
Q

NEC stage 3 management

A
  • supportive care
  • treatment of coagulopathies
  • treatment of hypotension
  • surgical consultation (indicated if abdominal free air present)
45
Q

NEC risk factors in term infant

A

CHD, polycythemia, hypotension, in utero cocaine exposure, IUGR

46
Q

NEC Lab Indicators

A

thrombocytopenia, persistent metabolic acidosis, refractory hyponatremia

47
Q

Ileocecal Valve function

A

slows down intestinal transit time to increase absorption

48
Q

Short Bowel Syndrome

A

malnutrition and malabsorption resulting from a surgical loss of intestine; degree depends on amount removed and presence of ileocecal valve

49
Q

Spontaneous Intestinal Perforation Presentation

A

isolated perforation not associated with necrosis or ischemia

sx: acute abdominal distention with bluish color over abdomen

abdominal xray shows pneumoperitoneum

NNP Board Exam Review (19 decks)

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