GI Flashcards
Imperforate anus pathogenesis?
No anal opening
Imperforate anus associated with?
VACTERL
How to diagnose imperforate anus?
Clinical, then upside down babygram to determine whether to fix
How to treat imperforate anus?
Upside down babygram to see where rectum is. If far, make colostomy and fix before toilet training. If close, fix today.
Hirschsprung’s Disease Pathogenesis
No auerbach’s plexus due to decreased migration of neurons
How does hirschsprung’s patient present?
Failure to pass meconium or chronic constipation which is explosive after a DRE.
How to diagnose hirschsprung’s disease?
Babygram shows dilated loops of bowel with normal segment.
Full thickness rectal biopsy, can also do barium enema or anal manometry
How to treat hirschsprung disease?
Resection of bad colon
Meconium ileus pathogenesis?
Cystic fibrosis
How does mec ileus present?
FTPM, no prenatal screen.
Bilious emesis
How to diagnose mec ileus?
Babygram shows ground glass with dilated loops of bowel
How to treat mec ileus?
Gastrographin enema
Voluntary constipation patient presentation?
Constipation with intermittant diarrhea and encopresis
How to diagnose voluntary constipation/
Xray shows a colon full of stool
How to treat voluntary constipation?
Laxatives then disimpaction in OR under anesthesia
Malrotation pathogenesis?
Volvulus
Patient presentation with malrotation?
Normal uterine course presents with bilious emesis
How to diagnose malrotation?
X-ray shows double bubble sign with a normal gas pattern beyond. This is ominous. Barium swallow shows birds beak duodenum
How to treat malrotation?
Surgery
Duodenal atresia/annular pancreas pathogenesis?
Failure of duodenum to recanalize or failure of pancreas to fuse properly.
How does patient with duodenal atresia or annular pancreas present?
With bilious emesis, but polyhydramnios in utero.
Duodenal atresia happens with downs, annular pancreas does not.
Pathogenesis of Intestinal Atresia
Vascular accident in utero (cocaine)
How does patient with intestinal atresia present?
+/- polyhydramnios, bilious emesis
How to diagnose intestinal atresia?
Double bubble sign on x-ray with multiple air fluid levels beyond
How to treat intestinal atresia?
Resect dead bowel.
Pyloric stenosis patient presentation
Patient feeds normally for ~3 weeks, then projectile nonbilious vomiting with an olive shaped mass
How to diagnose pyloric stenosis
CMP shows decreased K, decreased Cl, increased pH and donut sign
How to treat pyloric stenosis?
Myomectomy
Necrotizing enterocolitis pathogenesis?
Prematurity
Necrotizing enterocolitis patient presentiation
Premature baby with bloody BM at first feeding
How to diagnose necrotizing enterocolitis
Pneumatosis intestinalis on XR
How to treat necrotizing enterocolitis?
NPO, IVF, TPN, IV antibiotics
F/u for NEC?
Check for retinopathy, interventricular hemorrhage, respiratory distress syndrome
How to treat anal fissures?
Reassurance
Intussuception pathogenesis
Telescoping section of bowel, vascular comprimise
Patient presentation of intussuception
abrupt onset of colicky pain, knees to chest, sausage mass with currant jelly stool.
How to treat intussuception?
Air enema is diagnostic and therapeutic
Meckel’s Diverticulum pathogenesis
Most common cause of lower GI bleed in children. Vitelline duct. True diverticulum
How does patient with meckel’s present?
Painless lower GI bleed, FOBT+, BRBPR
How to diagnose meckel’s?
Technicium 99
How to treat meckels?
Resection
Causes of prehepatic jaundice?
Hemolysis
Causes of posthepatic jaundice?
Biliary atresia, sepsis, metabolic syndromes
Features of unconjugated bilirubin
Fat soluble, can’t get excreted into urine, can cross BBB, can cause Kernicterus
Features of conjugated bilirubin
Water soluble, can get excreted into urine, so causes darkening, doesn’t cause BBB, cannot cause kernicterus.
Physiologic vs pathologic jaundice onset and resolution
Phys onsets >72 H, pathologic onsets 1 week if normal or >2 if premie
Physiologic vs pathologic jaundice D bili content and rise
Physiologic jaundice has D bili 10.
Rise for physiologic jaundice is 5 points/day.
Tests to order to work up physiologic jaundice?
Coombs (to see if there’s isoimmunization with Rh or ABO incompatibility).
Hgb (to see if there’s a blood transfusion from twin-twin or mom-baby with delayed clamping)
Reticulocyte count (to check for hemorrhage/hemolysis like in G6PD, pyruvate kinase deficiency or hereditary spherocytosis)
If all negative, then breast jaundice.
Breast feeding vs breast milk jaundice
Breast feeding due to low intake. Gut motility decreases, more reabsorption. tx: feed more
Breast milk jaundice decreases activity of 2,3 UGT. Conjugation decreases. Tx by switching to formula.
How to treat physiologic jaundice
UV light or exchange transfusion.
