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Pedia > Gastrointestinology > Flashcards

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
Q

Cardiac
Renal
GI defect

A

Duodenal atresia

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26
Q

Ground glass appearance in right lower quadrant with trapped bubbles of air within obstructing meconium

Associated with cystic fibrosis

A

Meconium ileus

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27
Q

Diagnostic test for cystic fibrosis

A

Chloride sweat test

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28
Q

Intestinal obstruction due to solid meconium concretion

> 95% cystic fibrosis

A

Meconeum ileus

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29
Q

Soap bubble on AXR
Meconium mixes with air and appears like ground glass

Calcification on xray

A

Neuhauser’s sign

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30
Q 
Atypical in pediatric patients
Poor localization
Atypical hx
Low index of suspicion 
Delay in diagnosis
Increased frequency in perforation
A

Acute Appendicits

Diff:
Mesenteric adenitis
Mekel’s

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31
Q

Most common cause of AA in pedia

A

Lymphoid hyperplasia

In adult, fecalith

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32
Q

Most common congenital anomaly

Persistence of omphalomesenteric duct or vitelline duct (remnant of yolk sac)

A

Meckel’s diverticulum

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33
Q

45-60cm proximal to ileocecal valve on antimesenteric border of bowel
3-6cm outpuching of ileum

2ft

True diverticulum

A

Meckel’s diverticulum

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34
Q

Meckel’s diverticulum Rule of twos

A 
2% symptomatic
2ft from ileocecal valve
<2 y/o, 1 in 2 with ectopic tissue
Most common 85% gastric mucosa
M:F = 2:1
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35
Q

Meckel’s ectopic tissue

A

Gastric

Pancreatic

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36
Q

Complication in meckel’s

A

Bleeding - most common

Perforation

37
Q

Hernia in Meckel’s

A

Littre’s hernia

38
Q

Most common cause of GI bleeding in children

A

Meckel’s

39
Q

Significant painless rectal bleeding stool brick colored or currant jelly

A

Intussuception

40
Q

Meckel’s dx

A

Technetium scan

41
Q

Complication in Meckel’s

A

Hemorrhage 50
Obstruction 25
Inflammation 20

42
Q

Most common cause of colonic obstruction in children

Absence of

A

Hirschprung’s disease

ganglion cells in myenteric plexus

M:F 4:1

43
Q

Mutation in Hirschprung’s

A

RET protooncogene

Rectum and rectosigmoid 80%

44
Q

Hx of hirschprung’s

A

Absence of Meissner’s secretion

Auerbach motility

45
Q

Hirschprung’s is associated with

A

Down syndrome

Laurence-Moon Bardet Bidet

46
Q

functional obstruction
failure to pass meconium within first 24h of life

Constipation
Abdominal distention
Failure to thrive

A

Hirschprung’s disease

47
Q

Hirschprung’s dx

A

Deep rectal or suction biopsy

But barium enema: transition zone

48
Q

Tx of Hirschprung

A

Pull through procedure

49
Q

Equal incidence in male and female

Failure of descent of urorectal septum in embryo

A

Imperforate anus

50
Q

Ends above levator muscle

Fistula into membranous urethra in M or vagina

A

High type imp anus

51
Q

Rectum descends into levator
Fistula in perineum found in median raphe of scrotum in M
or at posterior fouchette in F

A

Low type imperforate anus

52
Q

Imperforate low type Anus tx

A

Anoplasty

53
Q

Imperforate anus High type tx

A

Colostomy newborn and pull through procedure at 2 months

54
Q

Most common cause of intestinal obstruction between 3 mos and 6 mos of age

A

Intussuseption

55
Q

Two types of intussuception

A

Ileocolic

Ileoileocolic

56
Q

Most common type of intussuception

A

Ileocolic ileocecal

57
Q

Upper portion invaginating into

A

Intussuseptum

58
Q

Receives invaginating bowel

A

Intussusipiens

59
Q

Intermittent colicky abdominal pain
Bilious vomiting
Currant jelly stool

Well between attack

Polyps malignant tumor
Meckel’s

A

Intussuseption

60
Q

Radiologic sign of Intussuseption

A

Spring coiled sign

61
Q

Bilirubin > 2 mg/dl

A

Adult sclera

62
Q

Bilirubin level > 5 mg/dl

A

Newborn skin

63
Q

Most common site of NEC

A

proximal colon

distal ileum

64
Q

Presents in 1st 24h of life

Persists beyond 1 week (term)
2 weeks (preterm)
A

Pathologic

65
Q

Presents after 48h of life
Resolves in 1 week (term)
2 weeks (preterm)

A

Physiologic

66
Q 
Onset: 3-4 dol 13% breastfed
Accentuated unconjugated hyperbilirubinemia
Dec milk intake with dehydration 
Reduced caloric intake
Duration is few days
A

Breastfeeding jaundice

67
Q

Onset after 7th dol

Associate with glucoronyl transferase enzyme in breast milk

A

Breast milk jaundice

68
Q

Prolonged elevated levels of conjugated bilirubin after 14 dol

Jaundice hepatomegaly normal or acholic stool

A

Neonatal cholestasis

69
Q

Tx for biliary atresia

A

Kasai Hepatoportoenterostomy

<8 w of life

70
Q

Cystic dilatation of intrahepatic bile duct

A

Caroli disease

71
Q

Tumor at junction of hepatic duct

A

Klatskin tumor

72
Q

Cholangiocarcinoma parasites

A

Clonorchis sinensis

Opisthorcis

73
Q

Inherited form of non hemolytic jaundice

More severe death

A

Crigler Najjar syndrome

74
Q

Inherited form of non hemolytic jaundice

Survives but a form of Crigler Najjar Syndrome

A

Type II arias syndrome

75
Q

Most common hereditary cause of inc bilirubin

Major characgeristic: jaundice by elevated levels of unconjugated bilirubin

A

Gilbert-Meulengracht syndrome

76
Q

AR
Causes increased conjugated bilirubin without elevation of liver enzymes

Defect in ability of hepatocyte to secrete conjugated bilirubin into bile

A

Dubin-Johnson syndrome

77
Q

Hyperbilirubinemia
Benign AR disorder
Non itching jaundice with elevated conjugated hyperbilirubinemia

A

Rotor syndrome

78
Q

Bilirubin encephalopathy

A

Kernicterus

79
Q

2-3 mg/dl bilirubin

A

Icteric sclerae

80
Q

15 mg/dl of bilirubin

A

Requires phototherapy

81
Q

kernicterus bilirubin

A

> 20 mg/dl

82
Q

Lethargy
Poor feeding
High pitched cry
Hypotonia

A

Early 3-4d

83
Q 
Irritability
Seizure
Apnea 
Hypertonia
Fever
A

Late >1 week

84
Q 
Athetoid cp
High freq hearibg loss
Paralysis upward gaze
Dental dysplasia
Mild mental retardation
A

Chronic 3 years of age

Kernicterus

85
Q

In phototherapy unconjugated bilirubin undergoes

A

Geometric photoisomerization

86
Q

Bilirubin in phototherapy becomes

A

Luminubin

87
Q

Pharm therapy in kernicterus

A

Phenobarbital induces glucoronyl transferase hence improved hepatic uptake

88
Q

Inhibits heme oxygenase to form bilirubin

A

Metalloporphyrin

89
Q

3 weeks old
Persistent BILIOUS vomiting
NON DISTENDED abdomen

A

Malrotation

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