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Paeds > GI > Flashcards

GI Flashcards

1
Q

RF for NEC

A
  1. Pretrem
  2. Umbilical venous catheter
  3. CHD
  4. Immunosuppression
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2
Q

What is the diagnosis?

caterpillar sign: which describes the undulating contour of the gastric wall peristalsing against an obstructed pylorus

A

Pyloric stensosis

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3
Q

USS findings of Pyloric stenosis

A
  1. wall thickness > 4 mm measuring from echogenic mucosa to echogenic serosa and
  2. a channel length of more than 16 mm.
  3. pyloric volume: >1.5 cm3
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4
Q

The treatment of malrotation with volvulus is ….

A

Ladd procedure

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5
Q

colicky abdominal pain, “currant jelly stool,” and a palpable right lower quadrant abdominal mass. the diagnosis is …..

A

Intussusception

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6
Q

What is the diagnosis? target or pseudo kidney sign on USS

A

Intussusception

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7
Q

Ddx for bloody stool and thick-walled bowel on ultrasound includes :

A
  1. intussusception,
  2. coltis, and
  3. much less commonly intramural hematoma e.g., due to trauma or Henoch Schonlein purpura .
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8
Q

Treatment of intussuception

A

Air insufflation

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9
Q

air should be insufflated up to….

A

Air should be insufflated up to 120 mm Hg- bwn cries.

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10
Q

What is the rule of 3 re insufflation

A

The “rule of 3’s” applies to hydrostatic reduction:

  • Up to 3 attempts can be performed,
  • up to 3 minutes each.
  • If unsuccessful –> surgery.
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11
Q

Contraindications to pneumatic reduction include :

A
  1. free air,
  2. peritoneal signs, and
  3. septic shock.
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12
Q

50 % of patients with TEF have associated anomalies, most commonly the VACTERL association:

A
  • Vertebral segmenta on anomalies.
  • Anal atresia.
  • Cardiac anomalies.
  • Tracheo-Esophageal Fistula.
  • Renal anomalies.
  • Limb (radial ray ) anomalies.
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13
Q

Classic type C/ n TEF

A

82%- TEF ( with proximal esophageal atresia and a distal tracheoesophageal Fistula) shows an Ng tube terminating in the mid-esophagus with air- filled bowel from a distal TEF.

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14
Q

Type A TEF

A

8% may present with a gasless abdomen, due to esophageal atresia without fistula.

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15
Q

Type H TEF

A

6 %- features a continuous esophagus without esophageal atresia, but with an upper esophageal TEF. This type may present later in childhood with recurrent aspiraton.

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16
Q

When is Esophageal atresia suspected in utero?

A

Polyhydramnios and lack of visualisation of stomach

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17
Q

What is TEF associated with?

A

Associated with tracheal anomalies including tracheomalacia and bronchus suis = right upper lobe bronchus arising directly from trachea .

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18
Q

A diagnostic imaging finding of gastric atresia

A

single bubble, with a large bubble of air ( or contrast in the proximal stomach).

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19
Q

the imaging test of choice for a distal obstruction is a ….

A

contrast enema

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20
Q

Associations of duodenal atresia

A
  1. Down’s syndrome
  2. VACTERL.
  3. Shunt vascularity
  4. cardiac lesions ASd, vSd, PdA, and endocardial cushion defect .
  5. malrotation.
  6. Annular pancreas, which is seen in 20 % of babies with duodenal atresia.
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21
Q

If distal bowel gas is present with a double bubble sign

A
  1. midgut volvulus,
  2. annular pancreas- pancreas wraps around the duodenum , and
  3. the less severe variants of duodenal atresia including duodenal stenosis and web.
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22
Q

A patient with a double bubble and no distal bowel gas can be presumed to have …..

A

duodenal atresia.

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23
Q

Triple bubble sign

A

jejunal atresia

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24
Q

Most common causes of microcolon

A
  1. meconium ileus and
  2. ileal atresia.
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25
Q

Microcolon with filling defects in bowel

A

Meconium ileus

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26
Q

Microcolon and abrupt cut-off at site of atresia

A

Ileal or colonic atresia

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27
Q

meconium ileus is the earliest manifestation of …..

A

CF

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28
Q

Classic radiographic appearances of meconium ileus

A

distal obstruction (multiple loops of dilated bowel) , with soap-bubble lucencies in the right lower quadrant.

Ca due to meconium peritonitis.

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29
Q

neonates who fail to pass meconium

A

Small left colon, also known as functional immaturity of the colon or meconium plug syndrome,

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30
Q

RF for small left colon:(3)

A
  1. preterm
  2. neonates born to mothers who received magnesium for pre eclampsia, and
  3. infants born to diabetic mothers.
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31
Q

T/F ? Small left colon is a cause of microcolon

A

False

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32
Q

T/F? Small left colon is associated with CF/ or meconium ileus

A

False

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33
Q

Appearances of small left colon on contrast enema

A

typically with a discrete transition in caliber at the splenic flexure. There may be filling defects within the small left colon representing meconium plugs.

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34
Q

Main DDX for small left colon;

A

Hirschsprung disease with transition at splenic flexure.

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35
Q

Hirschsprung vs small left colon

A

Hirschsprung disease would not feature a distensible rectum and would not resolve after an enema treatment.

36
Q

Which part of bowel is almost always affected in Hirschsprung disease?

A

anus

37
Q

Radiography of Hirschsprung disease shows a …..

A

distal bowel obstruction pattern.

38
Q

Definitive diagnosis of Hirschsprung disease and management:

A

Biopsy Surgical

39
Q

In contrast enema shows a cone shaped transition zone of narrowed distal colon and dilated proximal colon

A

Hirschsprung

40
Q

megacystis microcolon intestinal hypo peristalsis syndrome findings (2)

A

rare congenital disorder characterised by a dilated non-obstructive urinary bladder and hypoperistalsis of the gastrointestinal tract and microcolon,

41
Q

Imperforate anus is classified as high or low based on which anatomical location?

A

to the puborectalis sling.

42
Q

Anomalies associated with High lesion in imperforate anus: (3)

A
  1. GU/GI fistula
  2. VACTREL
  3. L/S anomaly
43
Q

Definitive Tx for high lesion imperforate anus

A

Colostomy and repair

44
Q

Definitive Tx for low grade imperforate anus

A

Single stage perineal anoplasty

45
Q

Clinical findings in high grade imperforate anus in boys and girls:

A

Boys: Meconium in urine (secondary to fistula between Anus and posterior urethra/ bladder

Girls : Meconium in vagina

46
Q

Clinical findings in low grade imperforate anus in girls:

A

Distal vaginal fistula

47
Q

Causes of conjugated hyperbilirubinemia: (6)

A
  1. biliary atresia,
  2. Alagille syndrome,
  3. bile acid synthetic defects,
  4. metabolic disease,
  5. alpha-1- antitrypsin deficiency, and
  6. infectous aetiologies.
48
Q

to differentiate between biliary atresia (approximately 25 % of neonatal conjugated hyperbilirubinemia) and “neonatal hepatitis”

A

Tc-99m-HIDA hepatobiliary scintgraphy

49
Q

Findings of biliary atresia on NM study:

A

normal hepatic tracer uptake and clearance but NO excretion into the small bowel.

USS: echogenic fibrous tissue anterior to the to the portal vein: triangular cord sign

50
Q

T/F Lack of GB on uss is diagnostic of biliary atresia

A

False- GB is present in 20% of cases

51
Q

What is affected in biliary atresia

A

affects the intra- and extra-hepatic bile ducts, leading to obstructive (conjugated) jaundice.

Biliary atresia leads to progressive cirrhosis and death in early childhood if untreated.

52
Q

Findings of hepatitis on NM studies:

A
  1. poor hepatic excretion,
  2. delayed hepatic clearance beyond 12 hours , and
  3. variable bowel excretion
53
Q

T/F? In mesenchymal tumours, the tumour marker are not elevated.

A

True

54
Q

What is mesenchymal hamartoma?

A

is a benign, multi cystic, hamartomatous lesion, which contains malformed bile ducts, portal vein fragments, and often extramedullary hematopoiesis

***Swiss cheese ***

Non calcified

55
Q

Which inflammatory process causes GB hydrous (distension)?

A

Kawasaki

56
Q

Vascular hepatic tumour that may cause congestive cardiac failure

A
  1. Infantile haemangioma and
  2. haemangioendothelioma
57
Q

hemangioendothelioma is usually benign, it has the potential to…….

A

metastasize

58
Q

Infantile hemangioma is associated with ………..

A

kasabach merrit syndrome

59
Q

kasabach merit syndrome is a syndrome of …

A
  1. vascular neoplasm,
  2. hemolytic anemia, and
  3. consumptive coagulopathy.
60
Q

Hepatoblastoma is associated with ….. (4)

A
  1. Beckwith Wiedemann (Q6 month screening ultrasound screening is performed ).
  2. Familial adenomatous polyposis syndrome.
  3. Fetal alcohol syndrome.
  4. Wilms tumour
61
Q

Which tumour marker is raised in hepatoblastoma?

A

AFP

RUQ Ca++

62
Q

List the paediatric causes of liver cirrhosis:

A
  1. alpha-1-antitrypsin deficiency,
  2. glycogen storage disease,
  3. tyrosinemia,
  4. biliary atresia, and
  5. chronic viral hepatitis.
63
Q

Which tumour marker is raised in HCC

A

AFP

64
Q

What is the diagnosis?

highly aggressive mesenchymal neoplasm occurring in school-age children 6 -10 years old. AFP is negative.

A

Undifferentiated embryonal sarcoma

65
Q

Common paediatric tumours metastasising to the liver: (2)

A
  1. Wilm’s
  2. Neuroblastoma
66
Q

Meckel diverticulum can be diagnosed with….

A

Tc-99m- pertechnetate scan. (only +ve if it contains positive ectopic gastric mucosa)

67
Q

What is meconium peritonitis?

A

It is caused by in-utero small bowel perforation and meconium spillage, resulting in peritonitis, secondary calcification, and meconium pseudocyst formation.

68
Q

Causes of RUQ Calcification:

A
  1. gallstones,
  2. hepatoblastoma, and
  3. hepatic ToRCH infections e.g., Cmv and toxoplasmosis .
69
Q

types of meckels mucosa

A
  1. gastric- take up pertechnetate
  2. pancreatic
70
Q

patients at high risk of NEC are

A
  1. Low birth weight <1500g
  2. Perinatal asphyxia
  3. Hirschsprung
  4. Premature
  5. Cardiac patient
71
Q

difference between gastroschisis and omphalocoele

A

gastroschistosis

Omphalocele

No surrounding membrane.

Do not have associated anomalies.

maternal AFP will be elevated higher

Gastro always on the right side

72
Q

Omphalocele

A

covered by….. Associated with trisomy…. associated anomalies are: - - - - -

73
Q

Which condition has a higher maternal AFP?

A

gastroschisis

74
Q

Right sided heterotaxia

A
  • left lung has 2 fissures
  • asplenia
  • cardiac malformations
  • reversed aorta/ivc
75
Q

left sided heterotaxia

A
  • right lung has 1 fissure
  • polysplenia
  • less cardiac malformation
  • azygos continuation of IVC
76
Q

cystic mass with normal AFP, no ca++, there is a large PV branch feeding the tumour

A

mesenchymal hamartoma

77
Q

child is less than 1 with skin lesions, CXR shows a large heart, doctors can feel a lump in the liver

A

haemangioendothelioma

78
Q

this hepatic tumour can cause precocious puberty

A

hepatoblastoma

79
Q

Caroli is associated with (2)

A
  1. polycystic kidney disease
  2. Medullary sponge kidney
80
Q

Common causes of pancreatic insufficiency

A
  1. CF
  2. Shwachman diamond syndrome
81
Q

Pancreatic insufficiency with diarrhea, short stature, and eczema- lipomatous pseudohypertrophy of the pancreas and cupping of the ribs

A

Shwachman diamond syndrome

82
Q

Pancreatic mass in a 1 year old

A

Pancreatoblastoma

83
Q

Pancreatic mass in a 6 year old

A

Adenocarcinoma

84
Q

Pancreatic mass in a 15 year old

A

Solid Pseudopapillary tumour of the pancreas.

85
Q

For antenatal hydronephrosis with hydroureter consider:

A
  1. Prune belly syndrome: tends to be associated with oligohydramnios
  2. posterior urethral valves: also tends to be associated with oligohydramnios

Paeds (6 decks)

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