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Gastrointestinology Flashcards

1
Q

Choking
Coughing
Cyanosis
with an attempt at feeding

A

Atresia

Tracheoesophageal fistula

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2
Q

Fistula connects trachea to distal esophagus thus air enters abdomen 87%

A

Type A atresia/TEF

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3
Q

Most common type of TEF

A

Type A 86% (Nelson)

Type C (Schwartz)

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4
Q

VACTERL

A 
Vertebral
Anorectal
Cardiac
Trachea
Esophagus
Renal/Radial/Limb
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5
Q

Posterolateral defect in congenital diaphragmatic hernia

A

Bochdalek’s hernia

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6
Q

Anterior defect in congenital diaphragmatic hernia

A

Morgagni’s hernia

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7
Q

Dx for congenital diaphragmatic hernia

A

CXR

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8
Q

Most common congenital diaphragmatic hernia

A

Bochdalek’s hernia

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9
Q

Scaphoid abdomen at birth
Bowel sound on left chest
Bilateral lung hypoplasia (more severe on affected side) distress
Repair once stabilized through abdominal approach

Give extracorporeal oxygen therapy

A

Bochdalek’s hernia

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10
Q

Loss of normal peristalsis in esophagus due to failure of LES to relax in response to swallowing

LES Hypertensive

A

Achalasia

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11
Q

Decreased ganglion cells and surrounded by inflammatory cells

Difficulty in swallowing
Regurgitation
Coughing
Failure to thrive

A

Achalasia

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12
Q

Air fluid levels in dilated esophagus
“Beaking”

Confirmed by:

A

Achalasia

Esophageal manometry

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13
Q

Tx for Achalasia

A

Nifedipine when definitive treatment cannot be given
Intersphincteric injection of botulinun toxin

Sx: Heller Myotomy

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14
Q

Most common surgical cause of vomiting (infant)

Hypertrophy of smooth muscle of pylorus
4-6w old, male, 1st born child
Non bilious vomiting
Dehydration
Hypokalemia, HypoChloremia, Metabolic alkalosis
A

Pyloric stenosis

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15
Q

Hypertropic pyloric stenosis is associated with blood type

A

O & B

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16
Q

Hypertropic Pyloric stenosis PE

A

olive shaped mass pyloric firm, movable 2cm in length above and to the right of umbilicus

epigastric

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17
Q

In contrast pyloric stenosis shows

A

string sign

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18
Q

Barium studies with pyloric stenosis show

A

Shoulder sign
Double tract sign
String sign

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19
Q

Epigastric pain
Intractable retching with emesis
Inability to pass a tube into the stomach

A

Gastric volvulus

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20
Q

Failure to recanalize lumen after the solid phase of the intestinal development during the 4th and 5th week AOG

Most born premature

Assoc with DS, malrotation, esophageal atresia, CHD, polyhydramnios

A

Duodenal atresia

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21
Q

85% of duodenal atresias are

A

distal to ampulla of Vater

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22
Q

Billious vomiting in 1st 24h
NO abdominal distention
High obstruction

A

Duodenal atresia

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23
Q

Congenital absence or complete closure of portio of a lumen of the duodenum

A

Duodenal atresia

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24
Q

Duodenal atresia radiographic finding

A

Double bubble sign on abdominal xray

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25
Cardiac Renal GI defect
Duodenal atresia
26
Ground glass appearance in right lower quadrant with trapped bubbles of air within obstructing meconium Associated with cystic fibrosis
Meconium ileus
27
Diagnostic test for cystic fibrosis
Chloride sweat test
28
Intestinal obstruction due to solid meconium concretion >95% cystic fibrosis
Meconeum ileus
29
Soap bubble on AXR Meconium mixes with air and appears like ground glass Calcification on xray
Neuhauser’s sign
30
``` Atypical in pediatric patients Poor localization Atypical hx Low index of suspicion Delay in diagnosis Increased frequency in perforation ```
Acute Appendicits Diff: Mesenteric adenitis Mekel’s
31
Most common cause of AA in pedia
Lymphoid hyperplasia In adult, fecalith
32
Most common congenital anomaly Persistence of omphalomesenteric duct or vitelline duct (remnant of yolk sac)
Meckel’s diverticulum
33
45-60cm proximal to ileocecal valve on antimesenteric border of bowel 3-6cm outpuching of ileum 2ft True diverticulum
Meckel’s diverticulum
34
Meckel’s diverticulum Rule of twos
``` 2% symptomatic 2ft from ileocecal valve <2 y/o, 1 in 2 with ectopic tissue Most common 85% gastric mucosa M:F = 2:1 ```
35
Meckel’s ectopic tissue
Gastric | Pancreatic
36
Complication in meckel’s
Bleeding - most common | Perforation
37
Hernia in Meckel’s
Littre’s hernia
38
Most common cause of GI bleeding in children
Meckel’s
39
Significant painless rectal bleeding stool brick colored or currant jelly
Intussuception
40
Meckel’s dx
Technetium scan
41
Complication in Meckel’s
Hemorrhage 50 Obstruction 25 Inflammation 20
42
Most common cause of colonic obstruction in children Absence of
Hirschprung’s disease ganglion cells in myenteric plexus M:F 4:1
43
Mutation in Hirschprung’s
RET protooncogene Rectum and rectosigmoid 80%
44
Hx of hirschprung’s
Absence of Meissner’s secretion | Auerbach motility
45
Hirschprung’s is associated with
Down syndrome | Laurence-Moon Bardet Bidet
46
functional obstruction failure to pass meconium within first 24h of life Constipation Abdominal distention Failure to thrive
Hirschprung’s disease
47
Hirschprung’s dx
Deep rectal or suction biopsy But barium enema: transition zone
48
Tx of Hirschprung
Pull through procedure
49
Equal incidence in male and female | Failure of descent of urorectal septum in embryo
Imperforate anus
50
Ends above levator muscle | Fistula into membranous urethra in M or vagina
High type imp anus
51
Rectum descends into levator Fistula in perineum found in median raphe of scrotum in M or at posterior fouchette in F
Low type imperforate anus
52
Imperforate low type Anus tx
Anoplasty
53
Imperforate anus High type tx
Colostomy newborn and pull through procedure at 2 months
54
Most common cause of intestinal obstruction between 3 mos and 6 mos of age
Intussuseption
55
Two types of intussuception
Ileocolic | Ileoileocolic
56
Most common type of intussuception
Ileocolic ileocecal
57
Upper portion invaginating into
Intussuseptum
58
Receives invaginating bowel
Intussusipiens
59
Intermittent colicky abdominal pain Bilious vomiting Currant jelly stool Well between attack Polyps malignant tumor Meckel’s
Intussuseption
60
Radiologic sign of Intussuseption
Spring coiled sign
61
Bilirubin > 2 mg/dl
Adult sclera
62
Bilirubin level > 5 mg/dl
Newborn skin
63
Most common site of NEC
proximal colon | distal ileum
64
Presents in 1st 24h of life ``` Persists beyond 1 week (term) 2 weeks (preterm) ```
Pathologic
65
Presents after 48h of life Resolves in 1 week (term) 2 weeks (preterm)
Physiologic
66
``` Onset: 3-4 dol 13% breastfed Accentuated unconjugated hyperbilirubinemia Dec milk intake with dehydration Reduced caloric intake Duration is few days ```
Breastfeeding jaundice
67
Onset after 7th dol | Associate with glucoronyl transferase enzyme in breast milk
Breast milk jaundice
68
Prolonged elevated levels of conjugated bilirubin after 14 dol Jaundice hepatomegaly normal or acholic stool
Neonatal cholestasis
69
Tx for biliary atresia
Kasai Hepatoportoenterostomy | <8 w of life
70
Cystic dilatation of intrahepatic bile duct
Caroli disease
71
Tumor at junction of hepatic duct
Klatskin tumor
72
Cholangiocarcinoma parasites
Clonorchis sinensis | Opisthorcis
73
Inherited form of non hemolytic jaundice | More severe death
Crigler Najjar syndrome
74
Inherited form of non hemolytic jaundice | Survives but a form of Crigler Najjar Syndrome
Type II arias syndrome
75
Most common hereditary cause of inc bilirubin | Major characgeristic: jaundice by elevated levels of unconjugated bilirubin
Gilbert-Meulengracht syndrome
76
AR Causes increased conjugated bilirubin without elevation of liver enzymes Defect in ability of hepatocyte to secrete conjugated bilirubin into bile
Dubin-Johnson syndrome
77
Hyperbilirubinemia Benign AR disorder Non itching jaundice with elevated conjugated hyperbilirubinemia
Rotor syndrome
78
Bilirubin encephalopathy
Kernicterus
79
2-3 mg/dl bilirubin
Icteric sclerae
80
15 mg/dl of bilirubin
Requires phototherapy
81
kernicterus bilirubin
>20 mg/dl
82
Lethargy Poor feeding High pitched cry Hypotonia
Early 3-4d
83
``` Irritability Seizure Apnea Hypertonia Fever ```
Late >1 week
84
``` Athetoid cp High freq hearibg loss Paralysis upward gaze Dental dysplasia Mild mental retardation ```
Chronic 3 years of age | Kernicterus
85
In phototherapy unconjugated bilirubin undergoes
Geometric photoisomerization
86
Bilirubin in phototherapy becomes
Luminubin
87
Pharm therapy in kernicterus
Phenobarbital induces glucoronyl transferase hence improved hepatic uptake
88
Inhibits heme oxygenase to form bilirubin
Metalloporphyrin
89
3 weeks old Persistent BILIOUS vomiting NON DISTENDED abdomen
Malrotation

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