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GI Flashcards

1
Q

Most common type of EA/TEF

A

Type C- EA with distal TEF ~85%

abnormal formation during 4th week of gestation
usually isolated finding
30-40% with other anomalies

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2
Q

Intestine elongates _____-fold from 5-40 weeks

A

1000

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3
Q

How long is the intestine at birth?

A

275 cm

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4
Q

Length doubles in the last __ weeks of gestation

A

15

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5
Q

When do villi start to form in small intestine?

A

9 weeks
completed by 16 weeks

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6
Q

Microvilli begin to cover the apical surface of the SI epithelium at ?? weeks

A

10 weeks

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7
Q

When is meconium present?

A

16 weeks

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8
Q

When are villi present in the large intestine?

A

14 weeks

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9
Q

What does the small intestine absorb?

A

Nutrients

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10
Q

What does the large intestine absorb?

A

Salt and water

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11
Q

Describe the anatomic development of the GI tract

A

week 5-9: intestinal tube elongates, herniates into the umbilical cord, undergoes a series of rotations
week 10: tube re-enters abdominal cavity after rotating 270 degrees

when either of these fail –> omphalocele

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12
Q

how much fluid does the fetus swallow in the 3rd trimester

A

450 mL/day

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13
Q

Pyloric stenosis

A

Idiopathic hypertrophy of pyloric muscle
1-3/1000 live births
M>F (5:1)
1st born= half of cases
associated with blood groups O and B

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14
Q

Risk of pyloric stenosis

A

Mother has pyloric stenosis: 19% if boy, 7% if girl
Father has pyloric stenosis: 5.5% if boy, 2.4% if girl
Sibling has pyloric stenosis: 4% if boy, 2.4% if girl

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15
Q

Electrolyte abnormalities in Pyloric Stenosis

A

dehydration
hypochloremic, hypokalemic metabolic alkalosis
“olive” palpable in epigastric or just right of midline

signs and symptomsof 3-5 weeks of age- nonbilious vomiting, PROJECTILE

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16
Q

US findings of pyloric stenosis

A

elongation and thickening of pylorus
>3mm and >15mm
string sign

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17
Q

Duodenal atresia

prenatal US

in utero: polyhydramnios, distended duodenum

A

DOUBLE BUBBLE
No distal air
MC in 2nd part of duodenum

Post natal: bilious emesis in 1st 24 hours, abdominal distention, may pass meconium, dehydration with metabolic acidosis

assoc anomalies: T21 (31%), malro (20%), CHD (30%), annular pacrease (20%)

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18
Q

Mechanism of duodenal atresia

A

failure of recanalizatin of intestinal tube during 8-10 weeks after lumen obstructed by epithelium at 6-7 weeks

3 types
1: membrane/web
2. fibrous cord with continuity of duodenum
3. complete separation of proximal from distal duodenum

during repair, inspect entire bowel as 15% with multiple atresias

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19
Q

Jejunal atresia

A

TRIPLE BUBBLE

male = female
Location:
distal ileum>prox jejunum>distal jejunum>prox ileum

mechanism: intrauterine ischemia
causes: volvulus, malrotation, intestinal strangulation at umbilical ring, intestinal perf/peritonitis
Substances: cocaine, pseudoephedrine, nicotine (vasoconstrictive)

more air= more distal obstruction
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20
Q

malrotation and volvulus

60% cases by 1st month, 90% cases by 1 yr

A

UGI:
partial obstruction = corkscrew sign
complete obstruction = bird’s beak

Barium enema: cecum in RUQ

Mechanism: incomplete rotation, cecum stops near RUQ, duodenum fails to move behind the mesenteric artery

Ladd’s bands- abnormal tethering that facilitates twisting fo the bowel
Surgery: Ladd’s procedure

clinical assoc: CDH, abdominal wall defects, intestinal atresia, BW syndrome

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21
Q

Meconium ileus

A

KUB: bowel distention WITHOUT air-fluid levels
Barium enema: microcolon, filling defects

obstruciton of the distal ileum with hyperviscous secretions from mucous glands of the small intestine
adhesion of meconium to intestinal lining due to decreased water content

In utero: dilated loops of bowel, peritoneal calcifications if in utero perf
Post-natal: abdominal distention at birth, sx 24-48 hrs, bilious emesis, failure to pass meconium

Management: hypertonic enema, surgery

90% with meconium ileus have CF, 10-15% of CF have meconium ileus

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22
Q

mechanism of meconium peritonitis

A

in utero intestinal perforation with spillage of meconium into peritoneum

assoc with intestinal obstruction or mesenteric vascular occlusion

due to meconium ileus, intestinal atresia, gastroschisis, volvulus

imaging: peritoneal calcifications, ascites, obstruction on KUB/fluoro

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23
Q
A

Hirschprung’s

large colon with no air in rectum
transition zone of barium enema–> narrow rectum relative to colon

DEFINITIVE DIAGNOSIS = BIOPSY

associated with T21, Waardenburg, congenital deafness, 13q deletion, pheochromocytoma, NF, neuroblastoma

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24
Q

Mechanism of Hirschsprung’s

A

failur to complete cranial to caudal migratin of neural crest cells at 8-10 weeks
aganglionic, no parasympathetic innervation to distal colon
abnormal peristalsis

enterocolitis: sick baby with abdominal distention, vomiting, foul-smelling bloody stools, sepsis

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25
Omphalocele Male predominance other anomalie: 50-70% - trisomies - cardiac defects - syndromes: Pentalogy of Cantrell, BW, OEIS Intestine protected from exposure to amniotic fluid
26
Giant omphalocele
defect >5 cm
27
Mechanism of omphalocele
bowel loops fail to return to abdominal cavity by 11 wks OR somatic folds fail to complete formation of abdominal wall by 19 wks
28
Persistent elevated direct hyperbilirubinemia
Most likely due to prolonged TPN use ALSO think of panhypopit- direct hyperbili due to decreased cortisol
29
In utero findings for omphalocele
elevated maternal serum AFP seen on prenatal US 2nd trim - fetal echo/MRI for coexisting defects - amnio for chromosomal anomalies outcome: 10% mortality in isolated omphalocele 60% mortality with multiple anomalies
30
gastroschisis increased risk with young maternal age increased incidence - olig - growth restriction - meconium stained fluid may development polyhydramnios if obstruction present MALROTATION present by definition rarely found with non-GI anomalies In utero: elevated maternal serum AFP Primary closure or staged silo >90% survival
31
gastric perforation imaging: isolated gastric pneumonitis, deep/malpositioned OG tube risk factors: - perinatal stress - prematurity - postnatal steroid exosure Mechanism: - spontaneous- overdistenstion - traumatic- OG placement Presentation: - day 2-7 - abrupt increasein abdominal distention, GI bleeding, respiratory distress, shock, sepsis
32
necrotizing enterocolitis imaging: - pneumatosis intestinalis - portal venous gas (extending 2cm beneath liver capsule ~7% of all premature infants 1-3/1000 live births M=F 90% = preterm infants - lower GA = higher risk
33
Lab findings in NEC
leukopenia thrombocytopenia hyponatremia hypokalemia metabolic acidosis DIC glucose instability
34
Risk factors for NEC
prematurity= higher risk with lower GA and smaller size lack of BM feeds antibiotic exposure
35
Pathologic features of NEC
## Footnote Abx: amp/gent, flagyl/cinda if perf or portal venous gas
36
NEC prognosis
37
NEC complications
38
Meconium composition
intestinal secretions mucosal cells bile salts solid portions of amniotic fluid
39
pepsinogen --> pesin in what cells?
Chief cells important for protein digestion stimulated by vagus nerve, histamine, gastrin
40
stomach acid produced by?
parietal cells increased gastric pH in neonates --> dec HCl secretion Preemies >> terms > adults
41
intrinsic factor
responsiblte for **vitamin B12** absorption in **distal ileum**
42
bile acids
decreased in neonate reach adult values at ~2 months
43
disaccharidases maltase sucrase lactase
in the brush border maltose --> glucose + glucose (adult = 28 wks) sucrose --> glucose + fructose (adult = 28 wks) lactose --> glucose + galactose (adult = 36 wks)
44
colonic salvage pathway
important for carb digestion colonic bacteria help ferment malabsorbed carbs
45
cholecystokinin CCK
hormon that trigger release ofp ancreatic juice and bile decreases gastrin secretion
46
secretin
hormone that stimulates pacrease to release bicarb --> slows gastric emptying
47
gastrin inhibitory peptide GIP
hormone that is stimulated by protein and fat slows gastric emptying decreases gastrin
48
motilin
hormone that increases gastric emptying *erythromycin = motilin agonist*
49
benefits of early feeding physiologic and clinical
increased intestinal blood flow increased gut barrier defense --> earlier intestinal closure increased enzyme maturation increased gut hormone regulation increased motility earlier attainment of full enteral feedings
50
reasons for small left colon/microcolon
maternal diabetes - MOST COMMON maternal hypothyroidism maternal toxemia --> mag exposure prematurity rare complication of cecal perforation *rectum is normal on barium enema*
51
risks for meconium plug
diabetic mothers antenatal exposure to magnesium sulfate cystic fibrosis --> more common meconium ileus
52
small left colon syndrome
subset of infants with meconium plug that demonstrate transition zone between dilated proximal bowel and normal-decreased distal colon at SPLENIC FLEXTURE transition zone = rectosigmoid region in Hirschsprung
53
idiopathic neonatal hepatitis
multinucleated giant cells increased alpha-fetoprotein
54
SIP
more likely smaller/more immature occurs earlier postnatally (1st week) unlikley to be fed more likely to have PDA/tx with indocin more likely to have received vasopressor support more likley to have received surf/ventilation Meds: Indomethacin, early hydrocortisone, vasopressors associated with chorio abdominal distension with black-bluish discoloration, hypotension, pneumoperitoneum (NO pneumatosis or portal venous gas)
55
most common location of NEC
terminal ileul proximal colon
56
lab findings in NEC
leukopenia >> leukocytosis thrombocytopenia hyponatremia hypokalemia metabolic acidosis DIC glucose instability
57
NEC onset: 26 weeks >31 weeks full term
23 days 11 days 3 days
58
intestinal strictures post NEC
mostly in colon L > R median presentation = 5 weeks
59
worse prognosis with short bowel syndrome
colon resected no IC valve > 25 cm bowel resected with IC valve > 40 cm without IC valve *if not IC valve, needs ~30-45cm of intestinal length*
60
echogenic bowel on fetal US
Chromosomal abnormalities - T21 Congenital infection - CMV Meconium ileus Meconium peritonitis Atresia or volvulus Swallowed blood Proximal bowel obstruction associated with polyhydramnios
61
recurrence rate of NEC
6%
62
recurrence risk of neonatal hemachromatosis
90% in pregnancies subsequent to the index case
63
most common intestinal atresia
jejual/ileal 2nd MC is duodenal
64
most to least common site of intestinal atresias
distal ileum > proximal jejunum > distal jejunum > proximal ileum polyhydramnios in 30% jejunal atresias, less common in ileal atresia
65
MC cause of ileal/jejunal atresia
intrauterine ischemia due to: - volvulus - malrotation - intestinal strangulation at the umbilical ring - intestinal perforation - vascoconstrictive drugs including cocaine, pseudoephedrine, nicotine
66
when does duodenal atresia occur?
during intestinal development
67
most common cause of an abdominal flank mass
hydronephrosis
68
progressive familial intrahepatic cholestasis
69
alpha 1 anti-trypsin deficiency
70
first imaging study for concern of biliary atresia
liver US then HIDA scan percutaneous biopsy prior to surgery
71
progressive familial intrahepatic cholestasis
3 types, AR rapid cholestatic hepatitism, FTT, pruritis type 3: presents in adolescence type 1&2: GGT is normal

Neonatology Boards (19 decks)

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