GI Flashcards
Pediatric Bilious Vomiting
Malrotation with volvulus
Hirschsprungs
Intussusception
Segment of bowel invaginates into distal segment
Leading cause of obstruction in infants
MC in 3-12 months
MC ileocolic, lead point hypertrophied Peters patch
Triad: colicky abd pain, vomiting, bloody stools only in 20%
Most common cause of SBO and surgical abdomen 3 months – 6 years
Increased risk of HSP and cystic fibrosis
Intermittent paroxysmal pain, vomiting, heme-positive stools
Child appears well between episodes
“Currant jelly” is a late finding
Imaging shows “sausage-shaped” mass in right abdomen or “coiled spring”
Ultrasound, plain XR, or barium enema
Treated with air-contrast enema or surgery
Pyloric Stenosis
Gastric outflow obstruction from hypertrophied pyloris
90% <10wks, peak at 5 wks
Nonbilious projectile vomiting with wt loss and dehydration, vomiting progresses
HypoNa, hypoK, hypoCl metabolic alkalosis
Ultrasound
Non-bilious projectile vomiting after feeding in 3rd week to 3rd month of life
Increased incidence in 1st born males
Classic exam finding of “palpable olive” in RUQ
Classic lab finding of hypokalemic, hypochloremic, metabolic alkalosis (late)
Diagnosed by ultrasound or upper GI study
Surgical treatment
Malrotation with volvulus
Malrotation-Incomplete rotation of gut in utero puts cecum in RUQ and fixes dorsal mesentery to narrow base
Volvulus-Small bowel twists on mesentery, impairs blood flow
Any age, 1/3 in 1st month of life
Bilious emesis in young infant
Pain, abd distention, shock
Can be intermittent
Surgery
Onset in 1st month
Sudden bilious vomiting; heme-positive stools
Rigid, distended abdomen
Double bubble sign on XR: air-fluid levels in stomach and distended duodenum
Emergency surgery consult
Hirschsprungs Disease
Congenital megacolon
Failure to pass meconium in newborn
Chronic constipation in children
Complicated by enterocolitis
