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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?

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
What is a paralytic (adynamic) ileus?
Decreased peristalsis WITHOUT structural obstruction
26
Etiologies of paralytic ileus
- Postoperative State - Medications: Opiates - Metabolic: Hypokalemia, hypercalcemia - Hypothyroidism, Diabetes
27
Symptoms of paralytic ileus
- Symptoms similar to small bowel obstruction - Decreased or absent bowel sounds - No peritoneal signs
28
Plain radiographs of paralytic ileus shows
-Dilated loops of bowel with no transition zone
29
How does imaging for a small bowel obstruction and paralytic ileus differ?
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
Treatment for paralytic ileus
- Supportive care: NPO or dietary restriction - Electrolyte and fluid repletion - NG suction if moderate or persistent with vomiting
31
What is intussusception
-Telescoping (invagination) of an intestinal segment into adjoining distal intestinal lumen leading to bowel obstruction
32
Where does intussusception MC occur?
At ileocolic junction
33
True or False: Intussusception is the MCC of bowel obstruction in children 6 months - 4 years of age?
True
34
Risk factors for intussusception
- Children - Males - After viral infections
35
MC etiology of intussusception
Idiopathic MC
36
Triad of symptoms of intussusception
- Vomiting - Abdominal pain - Passage of blood per rectum (currant jelly stools: blood and mucus)
37
What is unique about physical exam of a patient with intussusception?
Sausage shaped mass in the RUQ and emptiness in the right lower quadrant (Dance's Sign) due to telescoping of the bowel
38
Best initial test for intussusception
US: shows target or donut sign
39
What other diagnostic test is done for intussusception?
Air or contrast enema: both diagnostic and therapeutic
40
Treatment for intussusception
- Fluid and electrolyte replacement initially - NG decompression next (pneumatic or hydrostatic with saline or contrast) - Admit for observation
41
What is Hirschsprung Disease?
Congenital megacolon due to absence of ganglion cells, leading to functional obstruction
42
Hirschsprung Disease is MC in what area?
Distal colon and rectum
43
Risk factors for Hirschsprung Disease
- Males - Down Syndrome - Chagas Disease - MEN II
44
Pathophysiology of Hirschsprung Disease
-Failure of complete neural crest migration leads to absence of enteric ganglion cells (Auerbach and Meissner Plexuses)
45
Symptoms of Hirschsprung Disease
- 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
Diagnostics for Hirschsprung Disease
- Contrast enema: transition zone between normal and affected bowel - Anorectal manometry: increased anal sphincter pressure and lack of relaxation - Rectal biopsy: definitive
47
Treatment for Hirschsprung Disease
-Resection of affected bowel segment
48
True or False: appendicitis is the MCC of acute abdomen in children 12-18 years old
True
49
Common etiologies of appendicitis
- Fecalith and lymphoid hyperplasia (MC) - Inflammation - Malignancy
50
Symptoms of Appendicitis
- Anorexia and periumbilical pain followed by RLQ pain | - Vomiting, Nausea
51
Appendiceal inflammation stimulates nerve fibers around ______ causing vague periumbilical pain
-T8-T10
52
What are 4 specific physical exam findings and tests for appendicitis?
- 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
In adults, _____ is the preferred imaging of choice for appendicitis
CT scan
54
In children, _____ is often obtained prior to imaging to determine whether imaging is needed for appendicitis
surgical consult
55
Treatment for appendicitis
-Appendectomy (laparoscopic when possible is preferred)

PANCE 2.0 (62 decks)

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