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Year 5 Paediatrics > GI > Flashcards

GI Flashcards

1
Q

When is hyperbilirubinemia pathological?

A

First day of life
Rises >5mg/dL/day
Above 19.5mg/dL in term child
When direct bili rises >2mg/dL at any time

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2
Q

Most serious complication of neonatal jaundice

A

Kernicterus.
Deposition of bili into basal ganglia.
Hypotonia, seizures, choreoathetosis, hearing loss

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3
Q

Ix for hyperbilirubinemia

A

ABO and Rh incompatibility, peripheral blood smear and retic count for hemolysis

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4
Q

Esophageal atresia-definition, presentation

A

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

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5
Q

Pathophys-pyloric stenosis

A

Sphincter hypertrophy. Usu idiopathic

Not commonly found at birth; becomes more pronounced by first month of life or as late as 6/12

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6
Q

Presentation and findings-pyloric stenosis

A

Non-bilious projectile vomiting

Hypochloremic, hypokalemia metabolic acidosis. K+ loss worsens from aldosterone release in response to hypovolemia

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7
Q

Signs of pyloric stenosis

A

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

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8
Q

Choanal atresia

A

Membrane b/w nostrils and pharyngeal space that prevents breathing when feeding.
Associated with CHARGE syndrome
Turn blue when feeding, pink when crying

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9
Q

CHARGE syndrome

A 
Coloboma of eye/CNS abnormalities
Heart defects
Atresia-choanae
Retardation of growth and devel
GU defects e.g. hypogonadism
Ear anomalies and/or deafness
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10
Q

Hirschsprungs

A

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

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11
Q

Imperforate anus

A

Rectum ends in blind pouch; conservation sphincter.
Unknown cause but assoc with Down’s.
Part of VACTERL.
Don’t pass meconium

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12
Q

Prototype finding of duodenal atresia

A

Bilious vomiting

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13
Q

Duodenal atresia

A

Lack or absence apoptosis, leading to improper canalization of duodenal lumen
Assoc w/ annular pancreas and Downs

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14
Q

CXR findings in duodenal atresia

A

Double bubble

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15
Q

Treatment-duodenal atresia

A

Fluids, electrolytes. NGT to decompress bowel.

Sx-duodenostomy

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16
Q

Volvulus

A

Vomiting, colicky abdo pain.
Mult air fluid levels.
Bird beak appearance on upper GI series at site rotation
Tx-sx or endoscopic untwisting

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17
Q

Intussusception

A

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

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18
Q

Signs-inflamm diarrhea

A

Fever, abdo pain, poss bloody diarrhea

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19
Q

Signs-noninflamm diarrhea

A

Vomiting, crampy abdo pain, watery diarrhea

20
Q

Tx necrotizing enterocolitis

A

Abx, IV fluids, NGT. If medical management not successful, sx to remove affected bowel

21
Q

Presentation necrotizing enterocolitis

A

Severely premature baby w/ low birth weight, vomiting, abdo distention, fever.
Frank or occult blood can be seen in stool.

22
Q

AXR-necrotizing enterocolitis

A

“Pneumotosis intestinalis”-air within bowel wall

23
Q

MOA-necrotizing enterocolitis

A

Bowel undergoes necrosis, bacteria invade intestinal wall.

24
Q

Bile stained vomit

A

Intestinal obstruction

25
Q

Projectile vomiting

A

Pyloric stenosis

26
Q

Vomiting at end paroxysmal coughing

A

Pertussis

27
Q

Vomiting + Abdo distention

A

Intestinal obstruction, incl strangulated inguinal hernia

28
Q

Vomiting + Blood in stool

A

Intussusception

Gastroenteritis-salmonella, campylobacter

29
Q

Vomiting + FTT

A

GERD
Celiac
Other chronic GI conditions

30
Q

Appendicitis

A

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).

31
Q

Malrotation/volvulus

A

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

32
Q

mesenteric adenitis

A

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

33
Q

Recurrent abdo pain

A

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.

34
Q

Red flag sxs in constipated child

A

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

35
Q

Anal fissure-causes, sxs

A

Causes: Idiopathic, Constipation
Sxs: severe anal pain (tearing, cutting, burning before/after defecation), PR bleed bright red blood, itchy bum

36
Q

Crohn’s-sxs

A 
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
37
Q

UC-sxs

A

PR bleeding, diarrhea, colicky pain
Weight loss and growth failure less common than Crohn’s
Extraintestinal: erythema nodosum, pyoderma gangrenosum, arthritis

38
Q

Meckel’s diverticulum

A 
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
39
Q

Meckel’s-dx

A

Technecium scan–increased uptake by gastric mucosa

40
Q

Meckel’s-sxs

A

Severe rectal bleeding–neither bright nor melena.

Can also present with intussusception, volvulus, or diverticulitis

41
Q

Diaphragmatic hernia

A

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

42
Q

Inguinal hernia

A

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

43
Q

Hydrocele

A 
Abnormal collection fluid in remnant processus vaginalis
usu disappears in 1-2 years
Transilluminates
Nontender
Surgery if persists beyond 18-24mo
44
Q

Biliary atresia

A

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)

45
Q

Gastro-esophageal reflux disease (GERD)

A

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)

Year 5 Paediatrics (10 decks)

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