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Pediatrics > GI > Flashcards

GI Flashcards

1
Q

Difficulty swallowing
Feeding refusal
Vomiting

What should this raise concern for?

A

Foreign body ingestion

Coins = #1

Flex endoscopy = dx and tx

Observe only if pt is NOT symptomatic

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2
Q

Intussusception

  • what is it
  • age group
  • triggers
  • sx
  • dx
  • tx
A

Telescoping of one bowel into another

Usually between 6-24 mo age

Triggers:

  • preceeding viral infections –> Peyer patches hyperplasia
  • Meckel’s diverticulum
  • Polyps and hematomas (HENOCH-SCHONLEIN purpura!)

If kid is older and getting intussusception, should think about pathologic lead point like Meckel’s diverticulum

Sx:

  • periodic pain (crampy, colicky)
  • emesis before ab pain
  • currant jelly stools (late finding)
  • sausage shaped mass in RUQ (invagination of ileum into colon causes obstructive mass to be found in RUQ)

Dx

  • Ultrasound will discover target sign
  • -> 100% sen and specific during period of pain
  • Barium enema will see coil spring sign

Tx

  • air enemas
  • water soluble contrast enema
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3
Q

Cleft lip cause

A

Medial nasal and maxillary processes fail to join

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4
Q

Cleft palate cause

A

Failure of palatal shelves to fuse

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5
Q

Black hairy tongue

A

result of elongation of filform papillae

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6
Q

Secretory Diarrhea

A

Binds receptor on epithelium to induce diarrhea

Watery
Large volume

Normal osmolarity - electrolyte loss

Persists even w/o PO intake

Causes:

  • cholera
  • toxigenic E coli
  • neorblastoma
  • C diff
  • cryptosporidosis
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7
Q

Osmotic diarrhea

A

2/2 ingestion of poorly absorbed solute or one not absorbed due to defect (eg lactase deficiency)

Lesser volume

Dec diarrhea w/ fasting

Increased osmolarity - free fatty acids released from CHO fermentation

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8
Q

Motility disorders

A

Loose to normal appearing stool

Ex:

  • IBS
  • thyrotoxicosis
  • infection
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9
Q

Mucosal inflammation

A

Decreased mucosal surface area and colonc reabsorption, increased motility

  • Blood and WBC in stool (dysentery)

Ex:

  • Celiac
  • salmonella
  • shigella
  • amebiasis
  • rotavirus
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10
Q

Obstipation

A

Absence of bowel mvmts

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11
Q

What should you consider in neonate w/ constipation?

A

HIrschsprung until proven otherwise!

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12
Q

Dx hirschsprung

A

Bx of rectosigmoid region
- no ganglion cell

Barium enema - megacolon

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13
Q

Encopresis

A

voluntary or involuntary fecal soiling in children who have usually already been toilet trained

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14
Q

Anal tone in Hirschsprung

A

Normal

No rectal stool present

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15
Q

Duodenal atresia

A

Obstruction 2/2 failure of recanalization of duodenal lumen

20-30% pts w/ duodenal atresia have trisomy 21

1/10,000 live births

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16
Q

Duodenal atresia

  • presentation
  • dx
  • tx
A

Usually present on 1st day life

  • bilious vomiting
  • no ab distension
  • +/- hx polyhydramnios

Double bubble on xray

Tx w/ surgery

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17
Q

Gastroesophageal reflux + opsithotonus

What do you think of?

A

Sandifer syndrome

18
Q

Standard for dx GERD

A

pH probe

19
Q

Incidence hypertrophic pyloric stenosis

Risk factors

A

3/1000

Boys > girls (esp 1st born boy)

  • Erythromycin
  • formula feeding
20
Q

Hypertrophic pyloric stenosis

  • presentation
  • dx
  • tx
A

Nonbilious projectile vomiting > 3 wks old

Olive in abdomen palpated
+/- jaundice, wt loss, dehydration

Dx

  • Ab US - thickened pylorus
  • barium swallow
  • hypokalemic hypochloremic metabolic alkalosis

Tx

  • fluid rehydration
  • correct electrolytes
  • surgery
21
Q

Crohns disease

  • presentation
  • dx
  • tx
  • complications
A

Usually more extraintestinal manifestations than UC

Arthritis
Wt loss
Ab pain - crampy
Diarrhea +/- blood
Perianal disease (fistula)

Can occur anywhere along GI tract

Dx

  • String sign w/ upper GI studies
  • skip lesions
  • fistulas
  • increased ESR
  • colonoscopy + bx to dx

Tx

  • steroids
  • aminosalicylates
  • azathioprine + metronidazole for fistulas
  • cyclosporine
  • tacrolimus
  • TNF alpha

Complications

  • malabsorb
  • FTT
  • wt loss
22
Q

Ulcerative colitis

  • presentation
  • dx
  • tx
  • complications
A

Usually only in colon
Blood diarrhea + mucus
Ab pain + tenesmus

Moderate = > 6 stools/day, fever, anemia, hypoalbuminemia

Severe = anemia, fever, leukocytosis, tachy

Pyoderma gangrenosum

Dx

  • dx of exclusion
  • sx present 3-4 weeks
  • anemia
  • endoscopy
  • -> mucosa friable + bleeds easily
  • NO skip lesions

Tx

  • aminosalicylates
  • sulfasalazine
  • steroids
  • surgery - total colectomy

Complications
- higher risk colon cancer

23
Q

Meckel Diverticulum - what is it?

A

1 congenital anomaly of GI tract

Vestigial remnant of omphalomesenteric duct

24
Q

Meckel diverticulum risk factors/etiology

A 
2% infants
2 yo - peak incidence
2 types of tissue - ectopic gastric mucosa
2 cm size
2 ft from ileocecal valve
25
Q

Meckel

  • presentation
  • dx
  • tx
A

Painless rectal bleeding

Dx - technetium scan

Tx - surgery

26
Q

Prune Belly (Eagle Barrett Syndrome)

A

2/2 congenital absence of anterior ab wall muscles

Triad:

  • urinary anomalies (hypoplastic kidneys, hydronephrosis, hydroureter)
  • no ab wall muscles
  • undescended testes

95% are males

27
Q

Umbilical polyp

A

persistence of omphalomesenteric duct or urchus.

Tissue is firm, red, with mucoid secretion.

Tx is surgery

28
Q

Breastfeeding failure jaundice

A

Seen in breastfed only kids (no formula) not getting enough breast milk

Feeding insufficiency –> insufficient caloric intake –> prolongs intestinal transit time –> increased absorption of unconj bilirubin through enterohepatic circulation

Occurs in 1st wk of life

Lose > 10% BW
Decreased wet diapers
Decreased stools

Tx:

  • promote and support successful breastfeeding
  • increase feedings
29
Q

Normal diapers and wt loss/gain in first week for babies

A

15-20 min / breast, 8x/day

4-6 wet diapers / day

8-12 stools/day

lose 10% of birth weight in first week

30
Q

Breast milk jaundice

A

Factor in human milk increases bilirubin enterohepatic circulation

UNCONJUGATED (indirect) hyperbilirubinemia into 3rd and later weeks of life

Tx:

  • temporary stop of breastfeeding if bilirubin very high
  • otherwise, no tx
31
Q

Extensive fatty vacuolization of liver without inflammation

Hepatomegaly

No icterus

What is this?

A

Reye syndrome = fatty live + encephalopathy

Seen in kids < 15 yo

Diffuse mt injury –> N/V, HA, excitability, delirium, liver failure progressive CNS damage

Labs:
Increased AST, ALT
Increased ammonia
PT increased
Hypoglycemia
Metabolic acidosis

Tx:

  • glucose
  • FFP
  • mannitol (for cerebral edema)
32
Q

Balloon degeneration w/ polymorphic cellular infiltrates in liver

A

Acute alcoholic hepatitis

33
Q

Panlobular mononuclear infiltration w/ hepatic cell necrosis

A

Acute viral hepatitis

Kupffer (macrophages) phagocytose hepatocellular debris

34
Q

Neonatal jaundice with conjugated hyperbilirubinemia is suggestive of…

A

noenatal cholestasis

35
Q

Indications to evaluate neonatal jaundice

A

Conjugated hyperbilirubinemia (even if baby is otherwise nl)

Jaundice in 1st 24-36 htss life

Serum bilirubin rising rate > 5mg/dL /24hr

Serum bilirubin > 12mg/dL in full term or 10-14 mg/dL in preterm

Jaundice persisting after 10-14d life

Presence of signs or sx

36
Q

Is the abdomen distended in duodenal atresia

A

No!

Air cannot pass the duodenum

37
Q

Best way to avoid necrotizing enterocolitis

A

premies and LBW higher risk!

Decreased rates of NEC in breastfed premies

38
Q

Hischsprung highly assoc w/ what genetic condition?

A

Down sydnrome

39
Q

Meconium ileus vs hirschsprung

A

Meconium ileus

  • ileum obstruction
  • plugs are super thick and won’t propel so won’t have “squirt sign” = expulsion of feces w/ rectal
  • meconium is inspissated
  • assoc w/ CF

Hischsprung

  • assoc w/ down
    • squirt sign
  • meconium consistency is normal
40
Q

Jejunal atresia

A

Vascular accident in utero

Triple bubble sign and gasless colon on Ab Xray

P/w bilious vomiting + ab distension

Risk factors:
- exposure to cocaine and other vasoconstrictive drugs

41
Q

Midgut volvulus onset

A

After 4-5 days after birth

Pediatrics (17 decks)

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