GI

Question 1

List the two most common causes of jaundice in the newborn.

Answer 1

• Physiologic jaundice of the newborn (60% of newborns) – peaks at day 3 and declines over 2 weeks
• Breast milk jaundice (peak 10 D, declines weeks 3-10)

Question 2

List indications to work up a jaundiced infant.

Answer 2

• Sick appearing infant
• Jaundice 3 wks
• Elevated direct (conjugated) >18umol/L or >20%
  Rapidly rising bili approaching exchange level, or not responding to phototherapy

Question 3

What is the most common cause of infantile GI obstruction beyond the first month of life?

Answer 3

Hypertrophic pyloric stenosis (HPS)

Question 4

What is the characteristic ABG finding in HPS?

Answer 4

Hypochloremic, hypokalemic metabolic alkalosis

Question 5

What is the clinical presentation of volvulus?

Answer 5

• Sudden onset bilious (yellow or green) vomiting and abdominal distension
• Ill appearing
• Shock
• May give history of intermittent, mild episodes that suddenly become more intense.

Question 6

What are diagnostic strategies for volvulus?

Answer 6

• AXR
• Upper GI – modaility of choice (duodenum of R of spine)
  CT – shows abnormal relationship between SMA and SMV

Question 7

What three condition have a “double-bouble” sign on abdominal x-ray?

Answer 7

1. Duodenal atresia (/stenosis/webs): dilated stomach and proximal duodenum
   
   2. Malrotation with midgut volvus: dilated stomach and proximal duodenum whith distal paucity
   3. HPS: modified double-bubble – stomach and pylorus
   4. Extrinsic compression from annular pancreas

Question 8

What is the most common cause of intestinal perforation in the newborn period?

Answer 8

• Most common GI emergency in neonates
• Necrotizing enterocolitis (NEC)
• It is a disease of the 1st few weeks of life
  o Premature (90%) – 1 – 4 weeks
  o Term (10%) – within a week
• Distal ileum and proximal colon most commonly affected, may be continuous or patchy

Question 9

List proposed risk factors for NEC.

Answer 9

rematurity

• Aggressive enteral feeding
• Birth-related hypoxic-ischemic insults
• Infectious causes

Question 10

What is the most common cause of vomiting in infancy?

Answer 10

GERD

Question 11

What is the most common cause of intestinal obstruction in children b/t 3mo – 6 years?

Answer 11

• Intussusception!
• Most common in 5mo-12 mo of age, rare 2yo, there is usually a bowel abnormality acting as the lead point.
• 1:2000 incidence
• Males 4:1
• Increased risk if sibling affected.

Question 12

List some of the “lead points” that can result in intussusception.

Answer 12

• Enlarged Peyer’s patches (secondary to a recent viral infection)
• HSP
• Meckel’s diverticulum
• Lymphoma
• Polyps
• Post surgical scars
• Celiac disease
• Cystic fibrosis

Question 13

Where is the most common site of intussusception?

Answer 13

lleocecal (90%)

ileoilial if HSP

Question 14

What is the classic triad of intussusception?

Answer 14

abdo pain
vomiting
bloody stools
- Triad present in 30% of patients; 75% have 2; 13% have only 1 or none
- Often bowel obstruction is presenting sign

Question 15

List 5 x ray findings of intusussception

Answer 15

1. Crescent sign
2. Target sign
3. absent liver edge sign
4. free air
5. bowel obstruction

Question 16

Which intusussception might US miss

Answer 16

Ileoilial. good at ileocecal

Question 17

What is the mgmt of intususception

Answer 17

ABCs, NPO, abx if ill
air contrast or hydrostatic enema
surgery if reduction fails

Question 18

What is the most common cause of intestinal obstruction in early infancy?

Answer 18

• Hrishprung’s!
• 20% of partial intestinal obstruction
• M:F is 4:1

Question 19

What is the “rule of 2s” in regards to Meckel’s diverticulum?

Answer 19

• 2% of population
• 2% of affected become symptomatic
• Mean age of presentation is 2 years
• 2cm long
• within 2 feet of ileocecal valve
  Most patients present by age 20

Question 20

What is the classic presentation of Meckel’s diverticlua?

Answer 20

• Boys

Question 21

List complication of Meckel’s diverticula.

Answer 21

• GI hemorrhage
• Intussusception
• Obstruction
• Perforation
  Peritonitis

Question 22

What is Henoch-Schonlein Purpura (HSP)?

Answer 22

• Hypersensitivity IgA mediated vasculitis involving the small blood vessels supplying the skin, GI tract, and joints.
• Results from immune complex deposition
• Causes abdominal pain and rash
• IC deposition also causes acute glomerulonephritis
• MC 4-11 yo, 33% experience recurrence,
• Associations:
  o Post viral URTI in spring (50%) à Parvo B-19, EBV
  o Bacterial: post-UTI, mycoplasma, campylobacter infections
  o Insect bites
  o VZV
• 75% have GAS +ve throat swabs

Question 23

List extraintestinal manifestations of IBD.

Answer 23

fever
anemia
apthous ulcers
erythema nodosum
pyoderma gangrenosum
ankylosing spondylitis
uveitis
liver dysfxn
FTT

Question 24

List the three esophageal anatomic narrowings where an swallowed FB may become stuck?

Answer 24

1. upper esophageal sphincter
   C6-T1
   cricopharyngeus muscle-thoracic inlet
2. aortic arch/tracheal bifurcation
   T4-6
3. over mainstem bronchus
4. lower esophageal sphincter/diaphragmatic hiatis
   T10-11

Question 25

List cause of biliary tract disease in childhood.

Answer 25

- Gallstones 
	o Hemolytic disease
	o CF
	o TPN
	o Sepsis
	o Dehydration
- Biliary sludging – ceftriaxone
- Acute acalculous cholecystitis
	o RMSF
	o Salmonella
	o Shigella
- Hydrops of the gallbladder
	o Upper respiratory infections
	o Gastroenteritis
	o Kawasaki’s disease
	o Strep pharyngitis
	o Mesenteric adenitis
	o Nephritic syndrome
	o Leptospirosis
	o HSP