GI

Question 1

Hirshsprung

Answer 1

Constipation without soiling, poor anal tone and dilated canal. Diagnose with barium enema, rectal manometry and biopsy showing high AChE and no ganglion cells.

Question 2

Functional Constipation

Answer 2

Conditioned habit due to pain with defecation. Get withholding behaviors, overflow diarrhea, palpable mass, normal sphincter tone, normal anal wink. Normal first stool time (Hirsh around 36 hrs). Tx: laxatives, regular habits, eliminate pain.

Question 3

Constipation DDx

Answer 3

Hypothyroid, metabolic (low K, high Ca), Anatomic (hirshsprung, imperforate anus with fistula, fistula, hemorrhoid, fissure), neuro (look for sacral dimple/pit, CNS issues, anal wink), drugs, neurofibromatosis.

Question 4

Meckel Diverticulum

Answer 4

remnant of the vitelline duct. Contains gastric or pancreatic tissue that can cause ulceration. Often a painless bleed in early childhood.

Question 5

TPN Complications

Answer 5

Common: Sepsis (1-5%); thrombosis, vein perforation, pneumothorax, bleed, brachial plexus injury. SI mucosa atrophy is reversable. Hyperglycemia and hyperTAG.

Question 6

Hypertrophic Pyloric Stenosis

Answer 6

Persistent, Progressive, palpable olive (mid epigastric or RUQ), projectile. Non-bilious. Weight loss. Usually presents in week 2-6. Low Cl- and low K+ and metabolic alkalosis.

Question 7

Pancreatitis acute

Answer 7

severe pain (10/10, radiating to back), N/V. Tender, guarding, rebound, distension, paralytic ileus.

Question 8

Pancreatitis causes (GETSMASHED)

Answer 8

gallstones, ethanol, trauma, steroids, mumps, autpimmune (PAN), scorpion sting, hyperTAG, hyperCa2+, ERCP, drugs.

Question 9

Gilbert Syndrome

Answer 9

Inherited deficiency of glucoronyltransferase (conjugates bili). 5% incidence. Unconjugated jaundice.

Question 10

Criggler Najjir

Answer 10

Inherited, rare. Unconjugated. Dangerous hyperbilirubinemia.

Question 11

peak age of brush border lactase activity

Answer 11

3 years.

Question 12

Rome III criteria for IBS

Answer 12

Fucntional disorder: recurrent or continuous with no structural or biochemical abnormalities. IBS: Abdo pain that (2 or more): is relieved upon defecation, onset associated with change in stool frequency, and onset associated with change in stool quality.

Question 13

Red flags against functinoal abdo pain

Answer 13

Failure to thrive, abnormal lab results, abnormal physical, blood in stool/vomit, bilious vomit, fever,

Question 14

Primary teeth order/timing

Answer 14

6 mo: mandibular central incisors. Then max c.i’s. Then lateral incisors. First molar, cuspids and then 2nd molars around 2 years of age. Last teeth: maxillary second molars.

Question 15

Things that activated charcoal wont help bind

Answer 15

strong bases or acids, ferrous sulfate, alcohols, cyanide, lithium, K+

Question 16

Broken tooth procedure

Answer 16

Replant ASAP, at scene if possible then go to dentist (5% success by 2 hr). Can rinse in cold water, dont brush, can transport in milk. Depends on integrity of periodontal ligament.

Question 17

caustic ingestion

Answer 17

Generally supportive care. Figure out agent, concentration and volume. Consult poison control/MDS. Do not induce vomit. Do not neutralize (exothermic reaction). Do not give NG by traditional methods. Can give small volumes of water/milk. Diluents though are often discouraged.

Question 18

Fe Ingestion

Answer 18

Caustic to GI tract (diarrhea, vomiting) and causes metabolic acidosis. Aggressive fluid care by IV, whole bowel irrigation, desfuroxime. Ipecac not recommended. NG lavage may help.

Question 19

Hemorrhagic disease of newborn

Answer 19

Rare now with Vit K injection. Presents a few days after birth: hematemesis, bloody stool, purpura, blood from umbilical stump.

Question 20

Vitamin C deficiency

Answer 20

Diffuse tenderness (worse in legs), poor wound healing, evidence of hemorrhage, low fever, poor appetite, tachy, swelling.

Question 21

Vit A deficiency

Answer 21

Vision affected first, then moisture: poor vision, night blindness, conjunctival/sclera dryness. Dry skin. Growth failure

Question 22

Secondary teeth

Answer 22

Replacement goes from age 6 to 12 usually. More teeth.

Question 22

Necrotizing Enterocolitis

Answer 22

Mostly premature babies. Hematemesis, bloody stool, distension, hypoxia, acidosis. Dx by plain film and apt test. Usually presents a few days after birth.