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Pediatrics > GI > Flashcards

GI Flashcards

1
Q

28 yr old G1 Po0 with no prenatal care came in with contractions saying her water broke that morning. A quick bedside US showed a term sized infant and polyhydramnios. Due to the size and position of the infant she couldn’t see much else beside grossly normal skeleton and head size.
What fetal abnormalities lead to polyhydramnios?

A

not swallowing fluid, kidney problems, obstruction is the most common cause

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2
Q

You (and everyone) immediately notice the mass of intestines outside the baby. As you lay the baby on the warmer you can see that the intestines are separate from the cord and there are no other organs visible.

A

Gastroschesis

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3
Q

Functional abdominal pain… sx caused by, work up

A

Sx without pathologic correlate
Lab tests/ work up negative
Variant of normal anatomy

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4
Q

Organic problems… sx caused by, workup

A

Sx caused by a distinct pathological entity
Labs and workup indicative of underlying pathology
Disease state -requires intervention

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5
Q

CBC shows

A

infection, inflammation, bleeding

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6
Q

Chem 7 shows

A

hydration

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7
Q

LFTs show

A

Bili/ALT /AST/ Alk Phos/ GGT

Coags : PT / PTT / Fibrinogen

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8
Q

amy and lipase show

A

pancreas

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9
Q

xray shows

A

Gas patterns, dilation, ileus, retained stool, obstruction

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10
Q

Barium swallow or barium enema shows

A

Reflux, obstruction, malrotation , ulcer, certain IBD
Colon size, obstruction,intususseption, US
Pylorus, gallbladder, appendicitis

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11
Q

CT shows

A

Mass, appendicitis

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12
Q

Endoscopy shows

A

Gastritis, ulcers

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13
Q

what are the most common sources of acute abd pain in young children

A

Malrotation, intussusception, incarcerated hernia, congenital anomalies

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14
Q

what are the most common sources of acute abd pain in older children?

A

appendicitis

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15
Q

Chronic abdominal pain is ____70-90% of time

A

Functional

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16
Q

what are functional problems? 2 ex chronic

A

constipation or IBS

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17
Q

chronic abd pain is ____10-30% of time:

A

Organic

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18
Q

short list of causes of chronic abd orgainic pain

A

Gastritis/ulcer
Lactose intolerance
Parasites
Gall bladder disease

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19
Q

what are symptomos of chronic fxnl abd pain

A 
periumbilical – or not,
Pain day and night
No weight loss
May have pallor, N/V/F
Little relationship to bowel habits
May be IBS (bloating, postprandial pain, lower abdominal distension)
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20
Q

what are useful tests in chronic fxnl abd pain

A

CBC, UA/UC , stool for occult blood

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21
Q

how do you treat chronic fxnl abd pain?

A

: reassurance and explanation of functional pain

Fluids, diet, activity, sleep, emotions

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22
Q

what is IBS also called

A

Recurrent Abdominal Pain Syndrome of Childhood

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23
Q

what is IBS?

A

Abnormal electrophysiology of bowel wall

Familial

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24
Q

when does IBS start and what are symp?

A

Often have diarrhea as infants, then constipation as older children
Abdominal pain in early school years
Often stress-associated, risk of school avoidance
Rarely awakens at night

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25
Q

how do you treat IBS

A

Important not to “medicalize”

Increased fiber in diet may be helpful

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26
Q

what is the most common cause of vomiting?

A

Viral Gastroenteritis

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27
Q

what are other things that could cause vomiting

A

-Obstruction, and acute or chronic inflammation of GI tract
-CNS inflammation, pressure or tumor
-Metabolic derangements
IEM, sepsis, drug intoxication

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28
Q

projectile vomiting is a result of

A

high obstruction, ie pyloric stenosis

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29
Q

what does bilious vomit mean?

A

obstruction
Beyond ampulla of vater … duodenal, jejunal, ileal, colonic
** Malrotation

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30
Q

what does bloody vomiting mean?

A

mallory weis tear
Gastritis
Peptic ulcer?

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31
Q

vomiting in neonates what should you think?

A

obstruction or stenosis

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32
Q

what is forceful nonbilious vomiting in neonates?

A

pyloric stenosis

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33
Q

what else should you thing for vomiting in neonates?

A 
-Obstruction
Duodenal atresia and stenosis
Malrotation / volvulus
Pyloric stenosis- forceful, nonbilious
-MetabolicAcidosis
Sepsis
Metabolic disorders / Inborn errors of metabolism
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34
Q

Vom first thing in the morning with HA might mean

A

CNS related

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35
Q

in older children vomiting is d/t

A

Viral Illness
Strep pharyngitis
UTI
Otitis media

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36
Q

if chronic vomiting think…

A

consider CNS

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37
Q

if with pain or bilious emesis in older children?

A

bowel obstruction, peptic disorders, appendicitis

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38
Q

what labs should you do for vomiting?

A

Electrolytes, BUN/Cr , CBC, UA/UC , amylase, lipase, LFT

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39
Q

what will US pick up for vomiting?

A

pyloric Stenosis, gallstones, renal stones, hydronephrosis, biliary obstruction, pancreatitis, appendicitis, malroattion, intussusception.

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40
Q

what should you do if you suspect appendicitis?

A

CT

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41
Q

how do you treat vomiting?

A

Treat underlying cause if identified
Management of fluid and electrolytes
Anti-emetics: very carefully

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42
Q

Acute diarrhea nearly always

A

infectious

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43
Q

how do you manage viral diarrhea?

A

Management is supportive – fluids, Na, K
Oral rehydration, starvation prolongs diarrhea
Avoid lactose is helpful

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44
Q

what is the most common cause of diarrhea in kids?

A

rota virus

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45
Q

what does rotavirus affect?

A

Rotavirus affects small intestine

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46
Q

how does rotavirus present?

A

Vomiting first in 80-90% pt followed by low fever

Diarrhea next .. Can last 4-8 days

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47
Q

who does rotavirus affect and when

A

Mainly infants 3-15mo

Peaks in winter ….. Transmitted fecal- oral

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48
Q

what are complications of rotavirus

A

Pt become dehydrated / hypernatremic, metabolic acidosis, ketosis from poor intake

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49
Q

how do you treat rotavirus?

A

No antidiarrheal medications- ineffective, poss worsening illness
should be vaccinized at 246 mo

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50
Q

what are bacterial causes of diarrhea in kids?

A

Bacterial – Campylobacter, Salmonella, Shigella, E. coli, Yersinia, C diff

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51
Q

Shigella patients often have

A

high fever

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52
Q

Suspect if blood in stool (colitis); if foreign travel

A

bacterial diarrhea

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53
Q

what is shigella dysenteriae?

A

Shigella dysenteriae, Shigatoxin producing bacteria (E coli O157:H7)

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54
Q

how do you work up bacterial diarrhea?

A

CBC stool culture

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55
Q

what is chronic diarrhea?

A

Healthy appearing – probably functional

Normal 5-8 stools /day for infants

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56
Q

if have wt loss FTT and seem ill with diarrhea what should you think?

A

probably organaic

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57
Q

what are fxnl causes of chronic diarrhea?

A

Functional causes
Irritable bowel syndrome
Toddler’s diarrhea

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58
Q

what are organic cuases of chronic diarrhea?

A

Organic causes
Food allergies
Malnutrition / Malabsorption syndromes
Impaction

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59
Q

what are causes of malabs diarrhea?

A

Lactose Intolerance
Celiac disease (gluten enteropathy)
Cystic fibrosis
steatorrhea

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60
Q

what are other causes of diarrhea?

A

Inflammatory bowel disease
Hirschsprung’s disease
Immune deficiency syndromes

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61
Q

what is Psedomembranis colitis caused by?

A

C diff

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62
Q

who gets cdiff

A

pt taking abx (Clindamycin, cephalosporins, ampicillin

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63
Q

how does cdiff present?

A

Fever, tenesmus, abdominal pain with diarrhea

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64
Q

how do you treat cdiff?

A

oral metronid or vanco

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65
Q

what is definition of chronic constipation?

A

2 or more of the following for 2 months:
1) < 3 BM/Wk 2)> 1 episode of encoporesis/wk 3) impaction of rectum with stool 4) stool that plugs toilet 5) retentive posturing and fecal withholding 6) pain with defecation

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66
Q

what is most childhood constipation

A

functional

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67
Q

what are fxnl constipation causes?

A

Withholding

Slow transit times (Irritable Bowel Syn.)

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68
Q

what are organic causes of constipation?

A

Hirschsprung’s disease (obstruction)

Hypothyroidism, cystic fibrosis, anorectal malformation

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69
Q

what is hirschsprungs disease?

A

poor innervation of lg intestines: Absence of Meissner and Auerbach plexi
Sympathetic hyperactivity leading to tonic contraction (doesn’t relax)

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70
Q

what is encorpresis?

A

Chronic constipation with dilatation of rectal ampulla and fecal soiling – soft stool comes out around

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71
Q

what does encorpresis require?

A

Requires stool evacuation followed by chronic management to avoid reaccumulation of stool,
Stool softeners important

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72
Q

how do you treat constipation non pharm? 2 ways

A

-Diet
Whole grains, fruits, and vegetables. Recommended fiber amount, add 5 to age until 15 then adult amount.
Sorbital-containing fluids (prune or apple juice)
Consider milk elimination trial

-Behavior Modification-based on age and individual factors
Regular sitting on the toilet for 5-10minutes after meals/ gastrocolic reflex. Make sure child has a stepstool if they cannot touch the floor.
Motivation-rewards
Diary/calendar with stickers
Biofeedback-no resources as of yet.

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73
Q

what are signs of organic constipation? 5

A

No passage of meconium within 2 days of birth
Hard, infrequent stooling since birth, especially if breast fed
Poor growth/ development
Distended abdomen
Abnormally placed anus, commonly anteriorly

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74
Q

how do you treat constipation with pharm?

A

Laxatives(MAINSTAY
-Osmotic
Lactulose
Magnesium hydroxide
Magnesium citrate
PEG 3350 (MiraLax, Glycolax)-mix in smallest
amount of fluid like water or crystal light

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75
Q

what is the ideal consistency of poo?

A

ideal consistency- Soft mushy banana or peanut butter like.

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76
Q

what else besides laxatives do you treat constipation with?

A 
Osmotic enema-phosphate enemas
Lavage-Polyethylene glycol-electrolyte solution (GoLytely)
Lubricant-Mineral oil
Stimulants
Senna-Little tummies
Bisacodyl
Glycerin suppositories
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77
Q

what are causes of GI bleeding that cause significant amt?

A 
uncommon
Peptic ulcer disease
Meckel’s diverticulum
Colitis
Intussusception
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78
Q

what are causes of minor bleeding in GI

A

not uncommon
Anal fissures
Mallory-Weiss tear
Swallowed nasopharyngeal blood

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79
Q

what are the causes of rectal bleeding in infants?

A

Colitis (from milk protein) allergy, anal fissure, milk protein allergy

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80
Q

what are the causes of rectal bleeding in older children?

A

Inflammatory Bowel Disease, Meckel’s diverticulum

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81
Q

how do you work up GI bleed? labs, imaging

A

CBC/ CoAgs/ LFT’s/ Stool for blood and culture
xrays
Colonoscopy, Barium enema, CT with contrast
Meckel scan (nuclear med test)

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82
Q

what are functional obstructions?

A

Disordered paristalsis
Paralytic ileus
Septic ileus
Dysmotility

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83
Q

what are mechanical obstructions

A

Narrowing of lumen
Malrotation
Intraluminal obstruction
Meconium plug / CF

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84
Q

what are etiologies of obs?

A

Adhesive
Intussuseptive
Malignant

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85
Q

obstruction nonbilious vom? problem is?

A

proximal to ampulla of Vater

86
Q

obstruction bilious vom? problem is

A

distal to ampulla of Vater

often considered surgical issue

87
Q

what is crampy midline pain from?

A

distension and increased paristalsis

88
Q

what is pain Increasing or progressing in severity and frequency

A

suggestive of ischemia

89
Q

if no stool in the first 24 hrs…

A

think about hirschprungs

90
Q

if have fever obstruction could be

A

+ with gastroenteritis or UTI or sepsis

91
Q

if have fever the obstruction is probably not

A

intestinal perforation

92
Q

what can cause polyhydramnios?

A

doesn’t swallow… or obstruction
obstruction often high
esophageal atresia , duodenal atresia

93
Q

what imaging do you do for obstructions?

A

KUB, crosstable lateral

94
Q

Distension? Loops of bowel visible?

A

Ileus.

95
Q

Discoloration? Neonates.. Blueish hue .

A

Perforation, bleeding

96
Q

Erythema

A

underlying peritonitis

97
Q

increased bowel sounds?

A

Paralytic ileus, obstruction, ischemia

98
Q

palpations Bowel loops? Guarding? Rebound tenderness

A

Mass – intussesseption

pyloric stenosis, early appendicitis

99
Q

on a CBC with diff may show

A

Thrombocyptopneia

left shift -> ischemia, sepsis

100
Q

increased lymphocytes ->

A

viral, gastroenteritis

101
Q

neutropenia

A

neutropenia -> poor sign

102
Q

what is GER

A

is the exposure of the esophagus to gastric contents

103
Q

is GER norm in infants?

A

yes norm to have weakened LES so acid goes up

104
Q

what may cause reflux? 7

A

Increased frequency of sphincter relaxation
Decreased lower esophageal sphincter resting tone
Poor esophageal clearance of refluxed material
Slow gastric emptying
Eosinophilic Esophagitis
Food Allergies
H Pylori infection

105
Q

how do you treat obstruction?

A 
Hydration -> NS/LR IV
Sepsis treatment -> translocation of bacteria
	broad spectrum antibiotics, anaerobes?
NG decompression
Surgery
106
Q

when is spitting up concerning?

A

PAIN causes Behaviors: Arching (Sandifer’s Syndrome), crying, oral aversion

GROWTH FAILURE Failure to Thrive (FTT) Pain during or after feeding results in
feeding difficulty
feeding aversion
decreased intake of food

PULMONARY COMPLICATIONS
ESOPHAGITIS

107
Q

what are pulm complications of reflux?

A

Aspiration pneumonia
Broncho-pulmonary disease
Asthma/reactive airway disease
Apnea and bradycardia

108
Q

what is esphagitis?

A

irritation of the esophagus

109
Q

what cases of GER are disease and need treatment?

A 
Pain in person of any age
Possible cause of severe colic
Family Stress 
    Crying
    Not sleeping
Near-miss SIDS
110
Q

what tests do you do for GER?

A 
Upper GI Series
pH Probe/Impedance Scan
Video swallow study
Upper Endoscopy (EGD)
Gastric Emptying Study
111
Q

what is Sandifer’s Syndrome halmarked by?

A

GER

112
Q

what are easy treatments for GER?

A

Time-honored, sm freq meals, positioning

Thickened feeds:
  -may or may not help
  -risk of choking
  -may decrease intake
Change of formulas
113
Q

what are NOT approved with treatment of GER?

A

Prone position: NOT used now because of SIDS risk

114
Q

what do you use pharm for GER

A

H2 antag, or PPIs

115
Q

what is blackbox warning on reglan?

A

unacceptable irritability

116
Q

what do you do if no meds work for GER

A 
NG tube feeds 
Surgical Procedures:
	-Nissen fundoplication
	-PEG procedure: 
	-G-tube, J-G-tube
117
Q

what has syptoms of copious oral secretions,choking aspiration

A

TE fistula

118
Q

how do you test for TE fistula?

A

unable to pass NG tube. Xray showing coiled NG tube at ~ T3

119
Q

what is TE fistula associated with?

A

VACTERL

120
Q 
what has associated  anomalies with
Vertebral 70%
Anal atresia 50%
Cardiac 30%
TE –F  70%
Renal 50%
Limb anomalies 70%
A

esophageal atresia

121
Q

who gets umbilical hernias?

A

Girls> boys

African Americans> others

122
Q

how do you repair umb hernias

A

Repair surgically at 1-2 years if > 2 cm.

Bands/taping doesn’t help

123
Q

who gets ing hernias?

A

Boys > girls 9:1

More prevalent in premature infants (30% in < 1000g)

124
Q

how do you treat ing hernias?

A

Rarely incarcerated

Surgical correction per surgeon.

125
Q

what has Projectile, nonbilious vomiting

Usually starts 2-6 weeks of life

A

pyloric stenosis

126
Q

what causes pyloric stenosis?

A

Hypertrophy of pylorus - cause unknown
Progressive gastric outlet obstruction

oral Erythromycin in neonatal period has been associated with higher incidence of pyloric stenosis in infants < 30days

127
Q

if kid shows Constipation, dehydration, weight loss,  apathy think..

A

pyloric stenosis

128
Q

what is the gold standard diag of pyloric stenosis

A

US

129
Q

what is less common cause of peptic disease?

A

Hpylori

130
Q

what is the common age of peptic ulcers?

A

12-18

131
Q

what are causes of peptic disease?

A

In childhood most are secondary to underlying illness, toxins, or drugs causing a breakdown in mucosal defenses.
CNS disease, burns, sepsis, multiorgan failure
Pulmonary insufficiency, Crohn disease, RA

132
Q

in kids under six sx for PUD are

A

vomiting and UGI bleeding

133
Q

in older kids what is sx for PUD?

A

abd pain hours after meals

134
Q

what is the most accurate test for PUD

A

UGI shows ulcer crater. Endoscopy most accurate test.

135
Q

pain with peptic ulcer disease..

A

Pain usually several hours after meals
Can awaken pt at night
Eating relieves pain
Gastric ulcers may be more painful with eating

136
Q

where are intestinal atresias most likely?

A

jejunum

137
Q

what is intestinal atresia?

A

Complete or partial blockage by stenosis, webs or atresia

138
Q

what is the end result of atresias?

A

End result is obstruction with dilated bowel proximally, small disused bowel distally

139
Q

what obstruction presents sooner with distension and possible emesis

A

complete

140
Q

sx =polyhydramnios, bilious emesis, abdominal distension within hours of birth

A

dudoenal atresia

141
Q

what Can pass meconium normally
associated with
Esophageal atresia, intestinal atresias, cardiac and renal abnormalities
Down Syndrome 20-30%

A

duodenal atresia

142
Q

what is the work up of duodenal atresia?

A

Xray = double bubble sign
Absence of gas distal to obstruction suggests atresia , severe obstruction
BE may help determine malrotation or atresia in lower GI

143
Q

how do you treat duodenal atresia?

A

surgery – duodenoduodenoscopy (bipass stenosis)

144
Q

what are common congenital issues?

A

Gastroschisis
Omphalocele
CDH

145
Q 
what is an Abd wall defect 
Rt of umbilicus
No sac over intestines
Associated with atresias
Surgical correction
Motility probems common
A

gastroschisis

146
Q

what is a Herniation through cord
Associated with anomalies
Esp cardiac
Liver and stomach involvement

A

omphalocele

147
Q

Abdominal contents in chest due to failure in diaphragm formation at 8-10wk gestation
what is this?

A

Congenital Diaphragmatic Hernia

148
Q

how do you treat CDH?

A

NPO, NG for gastric decompression, Surgery

149
Q

if CDH is small….

A

Can present in toddlerhood with worsening respiratory distress and failure to thrive

150
Q

what is Outpouching of ileum in mid to distal ileum

A

meckels diverticulum

151
Q

what Can be a lead point for intussusception or volvulus

A

meckels divertic

152
Q

what are symptoms of meckels?

A

Sx can mimic appendicitis if inflammed

Dx: via history, nuclear medicine testing

153
Q

how do you treat meckels?

A

surgery

154
Q

what is absence of ganglion cells in all or part of the colon (colon unable to relax)

A

hirschsprungs disease

155
Q

90% of infants with Hirschsprung’s in the first____ 24 hours of life.

A

fail to pass meconium

156
Q

how do you treat hirschsprungs?

A

Surgery. Diverting colostomy, anastomosis

157
Q

what are sx of hirschsprungs? in neonates

A

Neonatal – failure to pass meconium by 24 h
Vomiting (can be bilious), abdominal distention, poor feeding
Enterocolitis with fever, explosive diarrhea withhigh mortality.
Accounts for 15-20% of neonatal intestinal obstrx

158
Q

what are sx of hirschsprung in late infancy?

A

obstipation and distension

159
Q

what are sx of hirschsprung in older child?

A

constipation

160
Q

what has Foul smelling stools and ribbon-like / abd distension with prominent veins
or FTT as the only presentation

A

hirshsprungs

161
Q

what are complications of hirshsprungs and sx of it?

A

Major complication (25%): enterocolitis (fever, foul-smelling diarrhea – significant mortality)

162
Q

what is Telescoping of bowel that causes progressive edema and ischemia

A

intussusception

163
Q

what ages does intuss occur?

A

Occurs from 3 months to 3 years (peak 9 months)

164
Q

what is the Hx of intuss?

A

~20 minute cycles of intermittent pain,
vomiting
Heme positive stools(jelly like) (95% of the time.)

165
Q

how do you treat intuss?

A

Contrast enema are 95% diagnostic

60-80% therapeutic

166
Q

what are complications of intuss?

A

CI: peritonitis, suspected perforation, shock

167
Q

what is Most frequent cause of intestinal obstruction in 1st 2 yrs of life – idopathic

A

intuss

168
Q

what presents as Paroxysmal pain and screaming, drawing up legs
Vomiting / Diarrhea 90%
Blood in stools with mucus 50% within next 12 hrs
Lethargy, febrile

A

intuss

169
Q

Most common indication for emergency abdominal surgery in childhood

A

appendicitis

170
Q

who gets appendicitis?

A

Frequency peaks ages late teenage years

171
Q

what are sx of acute append?

A

Sx :Fever +/- N/V and periumbilical pain RLQ “mcburney’s point”
Peritoneal irritation
Anorexia, vomiting (sometimes bilious) , constipation, diarrhea
Atypical presentations  serial exams
Children< 2yr often perf before surgery due to vague sx

172
Q

what labs should you get for append?

A

Labs: WBC < 15K; pyuria, fecal leukocytes, guiac + stool occasionally ( obtain amylase/lipase/LFT/ UA /Ucx)
Studies: fecolith on xray ~60% , US shows thickened appendix in 93%
CT IS GOLD STANDARD

173
Q

how do yu treat appendicitis

A

surgery whenever appendicitis cannot be ruled out

174
Q

who gets IBD?

A

2nd generation but single greatest risk is fhx

175
Q

where does crohns affect? sx?

A 
anywhere in GI tract
Most often in terminal ileum (50-70%)
Obstruction, fistulas, absess formation
Perforation or hemorrhage rare
Not continuous –> skip lesions
Sx : abd pain, diarrhea, weight loss
Extra-intestinal symptoms suggest
RA, SLE, hypo pit
Fever, poor growth, uveitis, renal stones, erythema nodosum, microcytic anemia
BE for small bowel disease
Slight increased risk of colon cancer
176
Q

UC where? sx?

A 
Colon
Sx: rectal bleeding, diarrhea, abd pain
Extra-intestinal symptoms
Arthritic, uveitis, liver disease
Continuous disease – crypt absesses
Colonoscopy with mucosal biopsy best diagnostic
BE also has nearly pathognomonic findings
Increased risk of colon cancer
177
Q

disease is a multifactorial, autoimmune disorder that occurs in genetically susceptible individuals.

A

celiac

178
Q

what is trigger for celiac?

A

Trigger is an environmental agent-gliadin component of gluten. The enzyme tissue transglutaminase (tTG) has been discovered to be the autoantigen against which the abnormal immune response is directed.

179
Q

what are classic sx of celiac?

A 
Abdominal pain
Diarrhea, constipation
Gassiness, distention, bloating
Anorexia
Poor weight gain, FTT (but can be obese)
Irritability, lethargy
180
Q

what are 2ndary problems in celiac

A 
Anemia, fatigue
Vitamin deficiencies
Muscle wasting
Osteopenia
Short stature
Recurrent abortions / infertility
Delayed puberty
Dental enamel hypoplasia
Dermatitis Herpetiformis
Aphthous ulcers
181
Q

only tx of celiac?

A

fluten free diet

182
Q

how do you dx celiac?

A

Serum immunoglobulin A (IgA) endomysial antibodies and IgA tissue transglutaminase (tTG) antibodies. Sensitivity and specificity > 95%.
Testing for gliadin antibodies is no longer recommended because of the low sensitivity and specificity for celiac disease.
The tTG antibody test is less costly because it uses an enzyme-linked immunosorbent assay; it is the recommended single serologic test for celiac disease screening in the primary care setting.
IgA deficiency can give false negative

183
Q

what is the gold standard of diagnostic of celiac disease

A

Confirmatory testing, including small bowel biopsy,

184
Q

what is cholestasis? labs?

A

= reduced bile flow elevated direct bilirubin

185
Q

generally appear well but jaundiced with

A

biliary atresia

186
Q

what does biliary atresia progress to?

A

progresses to cirrhosis

187
Q

how do you treat pyloric stenosis?

A

pyloromyotomy

188
Q

how do you treat Imperforate anus and Hirschsprungs ?

A

temporary colostomy

189
Q

how do you treat intestinal atresias?

A

primary anastomosis

190
Q

how do you treat malrotation/adhesions?

A

lysis of adhesions and resection of nonviable intestine

191
Q

how do you treat mec ileus?

A

therapeutic enemas (peds surgery)

192
Q

what has Upper abdomen distended after feeding

A

pyloric stenosis

193
Q

what labs do you do for pyloric stenosis?

A

Hypochloremic alkalosis, low K+

194
Q

what will UGI show for pyloric stenosis?

A

narrowing of pylorus, retention of contrast

195
Q

what is Due to abnormal movement of intestine around the superior mesenteric artery as intestine reenters abdominal cavity at ~10 weeks

A

malrotation

196
Q

what is midgut volvulus?

A

duodenojejunal junction-> mid transverse colon. Supplied by superior mesenteric artery

197
Q

what is the most common anomaly in malrotation?

A

cardiac

198
Q

when do you malrotation present? and how?

A

> 50% present as high obstruction in 1st weeks of life

Bilious vomiting, distension, bleeding

199
Q

what are late presentations of malrotations?

A

intermittent intestinal obstruction, malabsorption,diarrhea

200
Q

what does UGI show for malrotation?

A

UGI shows abnormal placement of ligament of Treitz. (DJ junction rt of spine)

201
Q

how do you treat malrotation?

A

Absolute Surgical Emergency .. Bowel ischemia and necrosis

202
Q

what is a disease that is primarily of prematurity

Translocation of Bacteria to bowel wall.

A

NEC

203
Q

what does radiography show for NEC?

A

pneumatosis, fixed loop, stacking of bowel, free air

204
Q

how do you treat NEC

A

Medical NEC – ABX, bowel rest

Surgical NEC - perforation

205
Q

if pt is perfectly still what should you think?

A

peritonitis

206
Q

if distended abd and loops of bowel visible on radiograph?

A

ileus

207
Q

if have a blue belly

A

perforation or bleeding

208
Q

if have erythema on belly

A

underlying peritonitis

209
Q

increased BS

A

obs or gastroenteritis

210
Q

decreased bowel sounds

A

paralytic ileus, obs, ischemia

211
Q

palpation tenderness, guarding, rebound tenderness and distended bowel loops

A

intuss pyloric stenosis or early appendicitis

Pediatrics (9 decks)

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