GI Flashcards
Gastroschisis is associated with what anomaly?
Intestinal Atresia
1 in 10
BUT other malformations rare (versus omphalocele has many)
List 3 ways to tell gastroschisis from omphalocele:
- No membranous sac
- Periumbilical (R)
- No liver eviscerated
- Abdo developed well
- 1/10= intestinal atresia
BUT other malformations rare - Need more hydration due to lack of sac
XR bubble in stomach and left of this. None distal. XR sign? Dx? Associated syn? Heart lesion?
- Double bubble
- Congenital duodenal atresia
- Trisomy 21
- AV canal defect
Tx: NG decompression, fluid resus, look of other anomalies, Sx repair
List three things associated with chronic anal fissures in older kids.
- Constipation
- Crohn’s Dx
- Chronic Diarrea
- Prior Rectal Sx
What is the CC triad for Crohn’s Disease?
Diarrhea
Wt loss
Abdo Pain
Other: FTT, dermatitis herpteformis
Best test to tell diaphragmatic eventration versus hernia:
- diaphragm fluoro
- US
- exploratory laparotomy
- MRI
US
Diaphragmatic eventration= abnormal elevation= paradoxical motion of hemidisphragm
- DX usually XR but if uncertain US to confirm
Tx: Sx plication of muscle
13 y.o. early morning throat pain. Bad breath in am.
- Upper GI
- AUS
- CXR
- pH probe
pH probe
List three RF for GERD:
- neuro impairment
- obesity
- lung dx
- esophageal atresia
- prematurity
Admitted for viral gastro. Intermittent scream and vomit in 8 month old. Pale, lethargic. Which is most helpful ind x:
- AXR
- serum lactate
- air enema
Air enema
(less complication than saline)
R/O INTUSSUSCEPTION
T or F: intussusception is most common abdo emergency in kids < 2
True
T or F: most common site of intussusception is ileocolic
True
Abdo pain+
palpable sausage shaped abdo mass
+ bloody currant jelly stool
Intussusception
more common pain, vomit, mass
What test can you order to see intussusception? Sign on image
US.
Bull’s eye.
Swallowed nickel. In stomach on XR. Next?
- observation
- upper endoscopy and removal
- cathartics
Observation
** once in stomach, 95% ingested without difficulty.
XR monitoring till pass for long or sharp, straight pin.
Watch out for multiple magnets - can cause pressure necrosis and perf
Note: failure to progress out within 3-4 wk= impending perf.
If FB in esophagus:
remove ASAP (battery, sharp, meat can wait 12 hr)
asymptomatic blunt and coin can be watched up to 24h to see if pass into stomach.
Child swallowed coin and in stomach on XR. What do you do? (1 pt)
Observe.
List three indications for FB removal in esophagus:
- Battery
- Magnet
- Sharp or pointed
- Meat (can wait up to 12 h)
- size dimension (won’t get through GI; vary per age)
List tests for hepatic synthetic function:
“Plt down -> INR up -> Alb down -> Bili up -> Glucose down”
Synthetic F’n:
- INR, PTT up (does not improve with Vit K IM)
- albumin low
Metabolic F’n: BG
Storage Capacity F’n:
- low cholesterol, TG, lipoprotein
Excretory F’n:
- Bilirubin
Stool reducing substance NOT (+) in:
- glucose
- sucrose
- fructose
- lactose
- galactose
Sucrose/starch NOT reducing substances.
Watery diarrhea. Flatulence. Abdo distended. Abdo Pain. (+) Unabsorbed reducing sugar. Dx? Tests?
Carb malabsorption
- Primary (congenital sucrose deficiency, lactase deficiency etc.)
- Secondary (temp lactose intolerance, intractable diarrhea of infancy, toddler’s diarrhea)
Hydrogen Breath Test (correlate to degree of malabsorption)
Stool pH < 5.5
(+) reducing substance
List 4 test for celiac Dx?
- Anti- tissue transglutaminase IgA antibodies (anti-TTG)
- IgA level
- Anti-endomesial antibody testing (anti-EMA)
- IgG anti-deaminated gliadin peptide antibodies
- HLA DQ2 and HLA DQ8 (for unclear cases as min. one must be (+))
Kid with CP. Tolerate GT. Got botox in leg. P/E oral secretion and less hypertonic. Next:
- pH probe
- swallow study
- observe
Observe.
Botox can have systemic spread past local and cause dysphagia.
Progressive dysphagia with solid. List two most common cause:
- EoE
- Achalasia
- GERD with stricture
List two things on ddx for dysphagia for solid and two for solid + lq.
Solid only
- EoE
- Peptic stricture
- Extrinsic (vascular ring, mass)
Solid + Liquid
- Neuromuscular (CP, Muscular dystrophy, MS)
- Achalasia
- Systemic AI (myasthenia gravis, scleroderma)