GI Flashcards
When is hyperbilirubinemia pathological?
First day of life
Rises >5mg/dL/day
Above 19.5mg/dL in term child
When direct bili rises >2mg/dL at any time
Most serious complication of neonatal jaundice
Kernicterus.
Deposition of bili into basal ganglia.
Hypotonia, seizures, choreoathetosis, hearing loss
Ix for hyperbilirubinemia
ABO and Rh incompatibility, peripheral blood smear and retic count for hemolysis
Esophageal atresia-definition, presentation
Esoph ends blindly. TEF in nearly 90%
Presents with vomiting after first feed or choking/coughing with cyanosis.
Poss Hx of polyhydramnios
Recurrent aspiration pneum
Pathophys-pyloric stenosis
Sphincter hypertrophy. Usu idiopathic
Not commonly found at birth; becomes more pronounced by first month of life or as late as 6/12
Presentation and findings-pyloric stenosis
Non-bilious projectile vomiting
Hypochloremic, hypokalemia metabolic acidosis. K+ loss worsens from aldosterone release in response to hypovolemia
Signs of pyloric stenosis
String sign on upper GI series
Olive sign on abdo palpation
Shoulder sign: filling defect in antrum due to prolapse of muscle inward
Mushroom sign: hypertrophic pylorus against duodenum
Railroad track sign: excess mucosa in pyloric lumen resulting in two columns mucosa
Choanal atresia
Membrane b/w nostrils and pharyngeal space that prevents breathing when feeding.
Associated with CHARGE syndrome
Turn blue when feeding, pink when crying
CHARGE syndrome
Coloboma of eye/CNS abnormalities Heart defects Atresia-choanae Retardation of growth and devel GU defects e.g. hypogonadism Ear anomalies and/or deafness
Hirschsprungs
Lack Auerbach plexus causes constant contracuture of muscle tone.
Freq assoc w/ Downs.
Boys: girls = 4:1
Do not pass meconium in first 48 hrs or at all.
Extreme constipation followed by LBO
Rectal exam shows extremely tight sphincter and inability to pass flatus
3 stage curative sx
Imperforate anus
Rectum ends in blind pouch; conservation sphincter.
Unknown cause but assoc with Down’s.
Part of VACTERL.
Don’t pass meconium
Prototype finding of duodenal atresia
Bilious vomiting
Duodenal atresia
Lack or absence apoptosis, leading to improper canalization of duodenal lumen
Assoc w/ annular pancreas and Downs
CXR findings in duodenal atresia
Double bubble
Treatment-duodenal atresia
Fluids, electrolytes. NGT to decompress bowel.
Sx-duodenostomy
Volvulus
Vomiting, colicky abdo pain.
Mult air fluid levels.
Bird beak appearance on upper GI series at site rotation
Tx-sx or endoscopic untwisting
Intussusception
Currant jelly stool. Sausage-shaped mass, neuro sxs, abdo pain. Caused by polyp, hard stool, or lymphoma.
May be viral.
Bilious vomiting
Assoc with rotavirus vaccine, HSP
Signs-inflamm diarrhea
Fever, abdo pain, poss bloody diarrhea
Signs-noninflamm diarrhea
Vomiting, crampy abdo pain, watery diarrhea
Tx necrotizing enterocolitis
Abx, IV fluids, NGT. If medical management not successful, sx to remove affected bowel
Presentation necrotizing enterocolitis
Severely premature baby w/ low birth weight, vomiting, abdo distention, fever.
Frank or occult blood can be seen in stool.
AXR-necrotizing enterocolitis
“Pneumotosis intestinalis”-air within bowel wall
MOA-necrotizing enterocolitis
Bowel undergoes necrosis, bacteria invade intestinal wall.
Bile stained vomit
Intestinal obstruction
Projectile vomiting
Pyloric stenosis
Vomiting at end paroxysmal coughing
Pertussis
Vomiting + Abdo distention
Intestinal obstruction, incl strangulated inguinal hernia
Vomiting + Blood in stool
Intussusception
Gastroenteritis-salmonella, campylobacter
Vomiting + FTT
GERD
Celiac
Other chronic GI conditions
Appendicitis
Anorexia, vomiting, abdo pain, flushed, oral fetor, low grade fever, persistent tenderness, guarding
Lies still, knees flexed
If no signs perforation, Abx and elective sx (give time to decrease inflamm).
Malrotation/volvulus
Signs obstruction +/- strangulation
Bilious vomiting in first few days life
Abdo pain
Tenderness from peritonitis/ischemic bowel
Contrast study whenever bile stained vomit to assess rotation
Urgent laparotomy if vascular compromise. Untwist volvulus, mobilize duod
mesenteric adenitis
Isolated non-specific inflamm mesenteric LNs
Dx of exclusion
Sxs: abdo pain (non-specific, self-limiting 24-48hrs), D&V, nausea, fever
Rule out appendicitis (USS, CRP, WCC)
Conservative management, painkillers
Can be caused by Yersinia
Recurrent abdo pain
Sufficient to interrupt normal activities, >3/12
10% kids
Psychogenic, somatization (stress, anxiety).
Need to rule out infection, stones, tumors, IBS, abdo migraine, Meckel’s, sickle, DM, porphyria, Crohns/UC, celiac, Pb, HSP, pancreatitis, etc.
Red flag sxs in constipated child
Failure to pass meconium in first 24 hrs life
FTT/growth failure
Gross abdo distention
Abn lower limb neurology (lumbosacral path)
Signs spina bifida
Perianal bruising or multiple fissures (sexual abuse)
Perianal fistulae, abscesses, or fissures (perianal Crohn’s)
Abn appearance anus
Anal fissure-causes, sxs
Causes: Idiopathic, Constipation
Sxs: severe anal pain (tearing, cutting, burning before/after defecation), PR bleed bright red blood, itchy bum
Crohn’s-sxs
Abdo pain, diarrhea, weight loss, ?bloody stools Growth failure, delayed puberty Systemic sxs (fever, lethargy, weight loss) Extra intestinal: oral lesions, perianal skin tags, anterior uveitis, arthralgia, erythema nodosum, pyoderma gangrenosum
UC-sxs
PR bleeding, diarrhea, colicky pain
Weight loss and growth failure less common than Crohn’s
Extraintestinal: erythema nodosum, pyoderma gangrenosum, arthritis
Meckel’s diverticulum
Rule of 2s: 2 inches long 2 feet from ileocecal valve 2 types tissue (gastric hence blood) Presents by 2 years of age 2% of population
Meckel’s-dx
Technecium scan–increased uptake by gastric mucosa
Meckel’s-sxs
Severe rectal bleeding–neither bright nor melena.
Can also present with intussusception, volvulus, or diverticulitis
Diaphragmatic hernia
Failure of diaphragm to fuse properly. Abdo organs migrate upwards into chest
Can be posterolateral, anterior (Morgagni’s), or hiatus (via esophageal aperture)
Can cause pulmonary hypoplasia
Most diagnosed pre-natally on USS. Mother may have polyhydramnios
Surgical repair after NG tube and suction
Inguinal hernia
Patent processus vaginalis (indirect)
RF: male, prematurity
Sxs: intermittent swelling in groin or scrotum on straining, cyring. Infant may be unwell with irritability and vomiting
Tx: analgesics and gentle compression. If can’t reduce then emergency sx
Hydrocele
Abnormal collection fluid in remnant processus vaginalis usu disappears in 1-2 years Transilluminates Nontender Surgery if persists beyond 18-24mo
Biliary atresia
Extrahepatic ducts obliterated (inflamm and fibrosis)
Persistent jaundice, pale stools, dark urine
FTT, abn LFTs (esp GGT)
USS to differentiate from neonatal hepatitis
Tx: Abx to prevent cholangitis, ursodeoxycholic acid to encourage bile flow, fat soluble vit supplementation, sx (portoenterostomy)
Gastro-esophageal reflux disease (GERD)
Common in infancy
Inappropriate relaxation LES as result functional immaturity
RFs: predominantly fluid diet, horizontal posture, short intra-abdominal length esoph, CP/neurodevel disorder, pre-terms (esp if pre-existing bronchopulm dysplasia), post esoph atresia/diaphragmatic surgery
Tx: most resolve. Feed thickening, 30 degrees head up after feeds, ranitidine/PPI if severe, Domperidone (enhance gastric emptying)
