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PANCE 2.0 > GI #13 > Flashcards

GI #13 Flashcards

1
Q

What is a Meckel’s (Ileal) Diverticulum?

A

Persistent portion of the embryonic vitelline duct in the small intestine

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2
Q

True or False: A Meckel’s Diverticulum is the MC congenital anomaly of the GI tract

A

True

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3
Q

Explain what the Rule of 2’s means in terms of a Meckel’s Diverticulum

A
  • 2% of the population
  • 2x more common in males
  • 2 years old is MC presentation
  • 2 inches in length
  • 2% symptomatic
  • 2 types of ectopic tissue (gastric MC and pancreatic)
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4
Q

Symptoms of a Meckel Diverticulum

A
  • Usually asymptomatic

- Painless rectal bleeding or ulceration

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5
Q

How do you diagnose a Meckel Diverticulum?

A
  • Meckel scan: look for ectopic gastric tissue in ileal area

- Mesenteric arteriography

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6
Q

How do you manage a Meckel Diverticulum?

A

Surgical excision if symptomatic

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7
Q

What is duodenal atresia?

A

-Complete absence or closure of a portion of the duodenum, leading to gastric outlet obstruction

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8
Q

What are some risk factors for duodenal atresia?

A
  • Polyhydramnios (increased amniotic fluid)

- Down Syndrome

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9
Q

Symptoms of duodenal atresia

A
  • Neonatal intestinal obstruction: within 24-48 hours of life
  • Bilious vomiting
  • Abdominal distention
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10
Q

What is seen on abdominal radiographs for duodenal atresia?

A

Double bubble sign (distended air filled stomach and smaller distended duodenum separated by pyloric valve)

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11
Q

What is definitive management for duodenal atresia?

A

Duodenoduodenostomy

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12
Q

A volvulus is _______ and MC involves what two parts?

A
  • Twisting of any part of the bowel at its mesenteric attachment site
  • sigmoid colon and cecum
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13
Q

Symptoms of a volvulus

A
  • Obstruction: crampy pain, nausea, distention, vomiting, tympanitic abdomen with tenderness to palpation
  • Impaired vascular supply: rigidity, rebound tenderness, fever, tachycardia
  • Neonates: bilious vomiting, colicky pain
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14
Q

Abdominal CT for volvulus shows

A

-Dilated sigmoid colon (bird beak appearance at site of volvulus)

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15
Q

Abdominal radiograph for volvulus shows

A

bent inner tube or coffee bean sign (U shaped appearance of air filled closed loop of distended colon with loss of haustral markings)

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16
Q

What is the management for a volvulus?

A 
Endoscopic decompression (proctosigmoidoscopy) is initial
-Decompression followed by elective surgery due to recurrence
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17
Q

MC etiology of small bowel obstruction

A

Post-surgical adhesions

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18
Q

Other etiologies of small bowel obstructions

A
  • incarcerated hernias
  • Crohn’s Disease
  • Malignancy
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19
Q

Symptoms of a small bowel obstruction

A
  • Crampy abdominal pain
  • Abdominal distention
  • vomiting
  • Obstipation (no flatus)
  • High pitched tinkles on auscultation
  • Visible peristalsis (early obstruction)
  • Hypoactive bowel sounds (late obstruction)
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20
Q

What is seen on exam with early obstruction vs late obstruction?

A

Visible peristalsis in early and hypoactive bowel sounds in late

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21
Q

Abdominal radiographs for small bowel obstruction shows

A

-Multiple air fluid filled levels in a step ladder appearance, dilated bowel loops

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22
Q

Treatment for a small bowel obstruction

A
  • Nonstrangulated: NPO, bowel rest, IVF, Bowel decompression if severe and vomiting
  • Strangulated: surgical intervention
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23
Q

Which organ is the MC organ injured during trauma?

A

Spleen

24
Q

Symptoms of a splenic rupture or laceration?

A

kehr sign: referred left shoulder pain due to irritation of diaphragm and phrenic nerve

25
Q

What is a paralytic (adynamic) ileus?

A

Decreased peristalsis WITHOUT structural obstruction

26
Q

Etiologies of paralytic ileus

A
  • Postoperative State
  • Medications: Opiates
  • Metabolic: Hypokalemia, hypercalcemia
  • Hypothyroidism, Diabetes
27
Q

Symptoms of paralytic ileus

A
  • Symptoms similar to small bowel obstruction
  • Decreased or absent bowel sounds
  • No peritoneal signs
28
Q

Plain radiographs of paralytic ileus shows

A

-Dilated loops of bowel with no transition zone

29
Q

How does imaging for a small bowel obstruction and paralytic ileus differ?

A

CT scan for small bowel obstruction shows transition zone from dilated loops with contrast to areas of bowel with no contrast

Paralytic ileus does not have transition zones

30
Q

Treatment for paralytic ileus

A
  • Supportive care: NPO or dietary restriction
  • Electrolyte and fluid repletion
  • NG suction if moderate or persistent with vomiting
31
Q

What is intussusception

A

-Telescoping (invagination) of an intestinal segment into adjoining distal intestinal lumen leading to bowel obstruction

32
Q

Where does intussusception MC occur?

A

At ileocolic junction

33
Q

True or False: Intussusception is the MCC of bowel obstruction in children 6 months - 4 years of age?

A

True

34
Q

Risk factors for intussusception

A
  • Children
  • Males
  • After viral infections
35
Q

MC etiology of intussusception

A

Idiopathic MC

36
Q

Triad of symptoms of intussusception

A
  • Vomiting
  • Abdominal pain
  • Passage of blood per rectum (currant jelly stools: blood and mucus)
37
Q

What is unique about physical exam of a patient with intussusception?

A

Sausage shaped mass in the RUQ and emptiness in the right lower quadrant (Dance’s Sign) due to telescoping of the bowel

38
Q

Best initial test for intussusception

A

US: shows target or donut sign

39
Q

What other diagnostic test is done for intussusception?

A

Air or contrast enema: both diagnostic and therapeutic

40
Q

Treatment for intussusception

A
  • Fluid and electrolyte replacement initially
  • NG decompression next (pneumatic or hydrostatic with saline or contrast)
  • Admit for observation
41
Q

What is Hirschsprung Disease?

A

Congenital megacolon due to absence of ganglion cells, leading to functional obstruction

42
Q

Hirschsprung Disease is MC in what area?

A

Distal colon and rectum

43
Q

Risk factors for Hirschsprung Disease

A
  • Males
  • Down Syndrome
  • Chagas Disease
  • MEN II
44
Q

Pathophysiology of Hirschsprung Disease

A

-Failure of complete neural crest migration leads to absence of enteric ganglion cells (Auerbach and Meissner Plexuses)

45
Q

Symptoms of Hirschsprung Disease

A
  • Meconium Ileus (no meconium passage > 48 hour) in full term infant
  • Bilious vomiting, abdominal distention
  • Failure to thrive
  • Vomiting, diarrhea, chronic constipation in older kids
46
Q

Diagnostics for Hirschsprung Disease

A
  • Contrast enema: transition zone between normal and affected bowel
  • Anorectal manometry: increased anal sphincter pressure and lack of relaxation
  • Rectal biopsy: definitive
47
Q

Treatment for Hirschsprung Disease

A

-Resection of affected bowel segment

48
Q

True or False: appendicitis is the MCC of acute abdomen in children 12-18 years old

A

True

49
Q

Common etiologies of appendicitis

A
  • Fecalith and lymphoid hyperplasia (MC)
  • Inflammation
  • Malignancy
50
Q

Symptoms of Appendicitis

A
  • Anorexia and periumbilical pain followed by RLQ pain

- Vomiting, Nausea

51
Q

Appendiceal inflammation stimulates nerve fibers around ______ causing vague periumbilical pain

A

-T8-T10

52
Q

What are 4 specific physical exam findings and tests for appendicitis?

A
  • Rovsing Sign: RLQ pain with LLQ palpation
  • Obturator Sign: RLQ pain with internal and external hip rotation with flexed knee
  • Psoas Sign: RLQ pain with right hip flexion/extension (raise leg against resistance)
  • McBurney’s Point: 1/3 distance from anterior superior iliac spine and navel pain
53
Q

In adults, _____ is the preferred imaging of choice for appendicitis

A

CT scan

54
Q

In children, _____ is often obtained prior to imaging to determine whether imaging is needed for appendicitis

A

surgical consult

55
Q

Treatment for appendicitis

A

-Appendectomy (laparoscopic when possible is preferred)

PANCE 2.0 (62 decks)

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