GI Flashcards
Anatomically explain difference between meconium plug and meconium ileus?
meconium plug functional immaturity of colon
meconium ileus involves distal ileum
Does biliary atresia occur in intra or extrahepatic bile ducts?
Extrahepatic
Does duodenal atresia or annular pancreas appear first?
Both have bilious emesis
How do you treat meconium plug syndrome?
Contrast enema is the investigation of choice and is often diagnostic and therapeutic.
How does volvulous occur?
Volvulus occurs because the narrow mesenteric base, which develops due to malrotation, allows the small bowel to twist around the superior mesenteric artery.
Is it rarer to have other intestinal anomalies with omphalocele or gastroschisis?
Gastroschisis has intestinal anomalis like atresias
omphaloceles extra intestinal manifestations, other problems
Terminal ileum has critical role in reabsorptin of what ?
B12, bile acids
What are Ladd’s bands?
fibrous bands that form between cecum and right posterior retroduodenal peritoneum
What does contrast enema show in meconium plug syndrome?
visualizes meconium against colonic wall, creating a double contrast impression.
When does duodenal atresia occur (embryo)?
failure of recanilization during 8th -10th week. usually occurs 2nd part of duodenom
Where do partial small bowel obstructions occur?
In order of occurence
distal ileum 36%
proximal jejunum 31%
distal jejumum 30%
proximal ileum (13%)
where does spontaneous intestinal perforation occur?
Terminal ileum
what causes midgut volvulous?
defect in counterclockwise rotatoin of small intestine around SMA during protrusion through yolk sac
causes displacement of cecum to right upper abdominal quarter and obstruction of duodenum by Ladd’s band
what does midgut volvulous show on imaging?
paucity of gas throughout with few scattered air-fluid levels
doppler shows abnormal relation of superior mesentric vessels to the superior mesenteric artery
Which of the following is a common late complication seen in neonates who undergo repair of esophageal atresia?
GERD
How does Diabetes contribute to meconium plug syndrome?
neonatal hypoglycemia stimulates the autonomic nervous system. Increased stimulation of the sympathetic nervous system causes a decrease in intestinal movement, which accelerates the development of meconium plugs.
hypoglycemia induces the pancreas to secrete glucagon. In turn, glucagon decreases peristalsis in the left colon.
What is most common cause of liver failure and need for transplant in newborn?
Neonatal hemochromatosis
What are electrolyte findings in pylorics stenosis
hypochloremic, hypokalemic metabolic alkalosis
What might cause triple bubble sign?
Jejunal atresia
Xray can be nonspecific for volvulus, but on barium what will you see that can be diagnostic.?
cecum in upper right quadrant and not lower right quadrant
What is the MCC association with microcolon?
maternal diabetes
How is Hirschprung’s Diagnosed?
looking for ganglionic cells, or absence there of
by pattern of acetylcholinesterase staining
At what age is definitive treatment of Hirschprung
10kg or 1 year old
Deviations of the uro-rectal septum can lead to …
persistent cloaca
rectovesical fistula
rectourtethral fistula
what does urorectal septum do?
divides cloaca into 2 parts
ventral (urogential sinus)
dorsal (anorectal canal)
All patients with gastroschisis have what finding?
abnormal rotation and fixation
(malrotation)
When does omphalocele occur?
11 weeks GA if abodminal contents do go back into cavity
or at 18 weeks if somatic folds fail to create abdominal wall
What is MCC additional anomaly seen in omphalocele?
Cardiac Defect
How does Alagille cholestasis differ from biliary atresia?
Intrahepatic duct problem with Alagile
Extrahepatic duct problem with biliary atresia
Multinucleated Giant cells are pathognomonic for what?
neonatal hepatitis
What is transit time of ELBW vs term infant?
ELBW 2-4 days
Term 12 hours to 1 day
What usually comes first Apnea or Reflux?
Usually an apneic episode will happen prior to reflux episode
When does fistula occur in TE Fistula, how?
at 5 weeks, fistula occurs due to abnormal posterior positioning of TE septum, resulting in a connection.
if it’s isolated occurs at 8 weeks, when esophagus fails to recanalize during 8th week of development
