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GI Flashcards

1
Q

Ventral wall defects - types and results

A
  1. Rostral fold closure –> sternal defects
  2. Lateral fold closure –> omphalocele, gastroschisis
  3. Caudal fold closure –> bladder exstrophy
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2
Q

Tracheoesophageal anomalies - types (MC)

A
  1. Pure esophangeal atresia or stenosis
  2. Pure Tracheoesophageal (H-type)
  3. Esophangeal atresia with distal Tracheoesophageal fistula (MC-85%)
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3
Q

Tracheoesophageal anomalies - clinical presentation

A
  1. polyhydramnios in utero
  2. Neonates drool, choke, and vomit with first feeding
  3. air in the stomach visible in CXR (in TEF, not in pure esophagus anomaly)
  4. cyanosis 2ry to laryngospasm (to avoid reflux-related asperation)
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4
Q

Tracheoesophageal anomalies - CXR of abdomen

A
  1. Pure esophangeal atresia or stenosis –> gasless abdomen
  2. Pure Tracheoesophageal –> air in stomach
  3. Esophangeal atresia with distal Tracheoesophageal fistula –> air in stomach
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5
Q

Intestinal atresia presents with

A

bilious vomiting (with bile) and abdominal distension within first 1-2 days of life. Proximal atresia is also presented with polyhydraminios

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6
Q

MCC of gastric outlet obstruction in infants (and frequency)

A

Hypertrophic pyloric stenosis (1:600

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7
Q

Hypertrophic pyloric stenosis - presentation and results

A

Palpable “olive” mass in epigastric region and nonbilious projectile vomiting at 2-6 weeks old –> hypokalemic hypochloremic alkalosis (2ry to vomitng of gastric acid and subsequent volume contraction)
OLIVE MASS –> NOT ALWAYS

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8
Q

Hypertrophic pyloric stenosis - associated with

A
  • exposure to macrolides
  • more common in firstborn males
  • formula feeding
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9
Q

Annular pancreas (mechanism and presentation

A

Ventral pancreatic bud abnormally encircles 2nd part of duodenum –> forms a ring of pancreatic tissue that may cause duodenal narrowing and nonobilious vomiting

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10
Q

Pancreas divisum - mechanism and symptoms

A

ventral and dorsal parts fail to fuse at 8 week –> mostly assymptomatic but may cause chronic abdominal pain and/or pancreatitis

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11
Q

inguinal canal conveys

A

men –> the spermatic cord

women –> the round ligament of uterus

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12
Q

site of protrusion of direct hernia

A

Inguinal (Hesselbach) triangle

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13
Q

Indirect inguinal hernia - direction

A

–> follows the path of descent of the testes
enters the internal inguinal ring laterally to inferior epigastric vessels –> external inguinal ring –> into scrotum - COVERED BY ALL 3 LAYERS OF SPERMATIC FASCIA)

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14
Q

Indirect inguinal hernia - occurs in (mechanism)

A

infants owing to failure to processus vaginalis to close –> can form hydrocele (MUCH MORE COMMON IN MALES)

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15
Q

Direct inguinal hernia - direction

A

protrudes through the inguinal (Hesselbach triangle) –> bulges directly through abdominal wall (medially of inferior epigastric vessels) –> goes through the external superficial ring. Covered by external spermatic fascia

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16
Q

inguinal (Hesselbach) triangle - borders

A
  • inferior epigastric vessels
  • lateral border of rectus abdominis
  • inguinal ligament
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17
Q

Celiac disease - lab findings

A
  1. IgA anti-tissue transglutaminase
  2. IgA anti-endomysial
  3. anti-deamidated gliadin peptide antobodies
  4. IgG also present (useful in IgA deficiency)
  5. biopsy –> villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis
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18
Q

Celiac disease - results in/symptoms

A
  1. malabsorption
  2. statorrhea
  3. dermatitis herpetiforms
  4. failure to thrive (children)
  5. low bone density
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19
Q

Celiac disease - complications

A

increased risk of malignancy (T-cell lymphoma)

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20
Q

Celiac disease - location of decreased mucosal absorption / treatment

A

distal duodenum and/or proximal jejunum

- treatment: gluten-free diet

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21
Q

Appendicitis can be due to

A
  1. obstruction by fecalith (adults)

2. lymphoid hyperplasia (children)

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22
Q

Appendicitis - signs

A

may elicit:

  1. psoas sign 2. obturator signs
  2. Rovsing sign (LLQ 4. guarding and rebound
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23
Q

obturator sign?

A

The examiner rotates the hip by moving the patient’s ankle away from the patient’s body while allowing the knee to move only inward.

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24
Q

psoas sign

A

passively extending the thigh of a patient lying on his side with knees extended

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25
Q

MC congenital anomaly of the GI tract

A

Meckel diverticulum

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26
Q

Meckel diverticulum - definition/due to

A

True diverticulum of bowel due to persistence of vitelline duct (partial closure –> patent portion attached to ileum)

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27
Q

Meckel diverticulum can causes

A
  1. painless melena (or hematochezia) 2. RLQ pain 3. intussusception 4. volvulus
  2. obstruction near terminal ileum (mimics appendicitis)
    MC asymptomatic
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28
Q

Meckel diverticulum the rule of 6 2s

A 
2 times as likely in males
2 inches long
2 feet from ileocecal valce
2% of population
present in first 2 yeras of life
may have 2 types of epithelial (gastric/pancreatic)
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29
Q

Hirschsprung disease - definition, findings

A
  • congenital megalcolon characterized by lack of ganglion cells/enteric nervous plexuses (both) in distal segment of colon
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30
Q

Hirschsprung disease - due to

A

failure of neural crest cell migration

RET MUTATION

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31
Q

Hirschsprung disease is associated with / sex

A

Down syndrome

MC in boys

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32
Q

Hirschsprung disease - diagnosis/treatment

A

diagnosed by rectal suction biopsy

treatment: resection (3 stages surgery

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33
Q

Hirschsprung disease present with

A

bilious emesis, abdominal distention and failure to pass meconium within 48h –> chronic constipation
rectal examination: extremely tight sphincter:
inability to pass flatus

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34
Q

Malrotation - due to/mechanism / management

A 
anomaly of midgut rotation during fetal development 
--> improper positioning of bowel, formation of fibrous bands (Ladd bands) (esp on cecum connected with other structures) 
Ladd procedure (surgery) --> reduces risk of volvulus
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35
Q

Malrotation can lead to

A
  1. vovlulus

2. duodenal obstruction

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36
Q

Volvulus - definition / can lead to

A

twisting of portion of bowel around its mesentery

can lead to obstruction and infraction

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37
Q

Intussusception - definition / age

A

telescoping of priximal segment bowel into distal segment commonly at ileocecal junction
- age: 6-24 months

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38
Q

Causes of Intussusception

A

adults –> 1. tumor or mass that acts as a lead point that is pulled into lumen
children (MC) –> 1. idiopathic (usually), 2. viral infection (adenovirus –> Payer hypertrophy –> lead pont)
3. Meckel (MC patholoci lead point)

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39
Q

Intussusception - tests

A
  1. best initial: U/S (bull’s eye or doughnut sign, or target sign)
  2. most accurate: air or water enema is both DIAGNOSTIC AND THERAPEUTIC –> contraindicated if sings of peritonisis, shock, perforation
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40
Q

Intussusception - presentation / mechanism

A

compromised blood supply –> intermittent abdominal pain often with currant jelly stools (mixed with blood and mucus)
sausage like abd mass

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41
Q

Cringler-Najjal syndrome, type I - treatment

A

plasmapheresis and phototherapy

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42
Q

Cringler-Najjal syndrome, type II (vs type I)

A

less severe and responds to phenobarbial, which increases liver enzyme synthesis

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43
Q

Cringler-Najjal syndrome, type I - mechanism

A

Absent of UGT (present early in life) –> die within a few years

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44
Q

Dubin-Johnson syndrome - everything

A

deficiency of bilirubin canalicular transport protein (defective excretion) –> Conjugated hyperbilirubinemia
Grossly black liver (Benign)

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45
Q

Rotor syndrome - everything

A

similar to Dubin-Johnson but milder in presentation without black liver
DUE TO: impaired hepatic uptake (?) + excretion

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46
Q

Physiologic neonatal jaundice - mechanism

A

At birth, immature UDP-glucuronosyltransferase –> uncojugated hyperbilirubinemia –> jaundice/kernicterus

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47
Q

Physiologic neonatal jaundice - treatment

A

phototherapy (non-UV) isomerizes unconjugated bilirubin to water-soluble form

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48
Q

consider exchange transfusion if

A

bilirubin rises to 20-25

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49
Q

esophageal atresia - treatment

A
  1. surgical repair in 2 STEPS
  2. antibiotic coverage for anaerobes
  3. FLUIDS before surgery
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50
Q

pyloric stenosis - best initial test

A

abdominal U/S (thickened pyloric sphincter)

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51
Q

pyloric stenosis - most accurate

A

upper GI series:

  1. string sign: thin column of barium leaking through the tightened muscle
  2. shoulder sign: filling defect in the antrum due to prolapse of the muscle inward
  3. Mushroom sign: hypertrophic pylorus against the duodenum
  4. Railroad tract sign: excess mucosa in the pyloric lumen resulting in 2 columns of bacteria
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52
Q

duodenal atresia treatment

A
  • replace lost volume with IV fluids, taking special care to replace lost electrolytes. NGT to decompress the bowel.
  • Surgical duodenostomy is the MC surgical procedure
53
Q

volvulus - treatment

A 
best initial: endoscopic decompression 
most effective (and if endoscopy fails): surgical decompression
54
Q

choanal atresia

A

infant born with a membrane between the nostrils and pharyngeal space that prevents breathing during feeding

55
Q

choanal atresia is associated with

A

Charge syndrome

56
Q

Charge syndrome

A 
Coloboma of the eye
Heart defects
Atresia of choanae
Retardation of growth and/or development
Genital and/or urinary defects (hypogonadism)
Ear anomalies and/or deafness
57
Q

choanal atresia presentation

A

turn blue when feeding and then pick with crying

58
Q

choanal atresia - diagnostic tests

A

best iniital: pass NG tube

confirmed with CT scan

59
Q

choanal atresia - treatment

A

initially: oropharyngeal airway and orogastric tube feeding
definitive: surgical intervention to perforate the membrane

60
Q

imperforate anus is associated with

A

Down syndrome

61
Q

VACTERL syndrome

A 
Vertebral anomalies
Anal atresia
Cardiovascular
Tracheoesophageal fistula
Esophageal atresia
Renal anomalies
Limb anomalies
62
Q

imperforate anus - presentation / diagnostic tests / treatment

A

failure to pass meconium

surgery

63
Q

current jelly - seen in

A
  • pneumonia with Klebsiella as sputum

- Intussesception in the stools

64
Q

Intussusception - treatment

A
  • fluids and electrolytes correction are the most important initial tests –> NGT decompression
  • Barium enema is also curative –> if not –> emergent surgical intervention
    10% occur within 24 hours
65
Q

Meckel diverticulum - most accurate test

A

Meckel scan (99mTc)

66
Q

causes of bilious vomiting - onset / initial test / treatment

A
  1. duondenal atreasia –> 1st day –> AXR –> fluids + surgery
  2. vovlulus –> 1st year –> AXR –> fluids + surgery
  3. intussesception –> 1st year –? U/S –> fluids + surgery
67
Q

2nd MCC of infants death worldwide

A

acute diarrhea

68
Q

acute diarrhea - the most important next step

A

rehydration
mild: oral fluids
severe: IV
antidiarrheal such as loperamide are always wrong

69
Q

Viral infectious diarrhea - ddx (MC?) seasons? / duration

A
  • Rotavirus (MC) –> winter, less than 7d
  • Adenovirus (endemic) –> less tan 7d
  • Norwalk (epidemic) –> 1-2d
70
Q

Viral infectious diarrhea - symptoms

A
  • Rotavirus: fever, emesis, NO BLOOD / viral prodrome
  • Adenovirus: fever, emesis, NO BLOOD / viral prodrome
  • Norwalk: explosive, cramping, pain
71
Q

Necrotizing enterocoitis - definition / presentation

A
  • premature infants, bowel undergoes necrosis and bacteria invade the wall (30% mortality)
  • vomiting, abd distention
    -FEVER
    HYPOTHERMIA
72
Q

Necrotizing enterocoitis - diagnostic tests

A
  • abd x-ray: pneuatosis intestinalis
  • CT: air in portal vein, dilated bowel loops, pneumoperitoneum (if perforation)
  • frank or occult blood can be seen in stool
73
Q

Necrotizing enterocoitis - treatment

A
  • stop feeding
  • IV fluids
  • NGT
    antibiotics: vano, gentamicin, metronidazole
    if medical management fail –> surgery
74
Q

how to estimate fluid loss of a baby after diarrhea

A

by the weight AND:

  1. mild dehydr (3-5%): history of decreased intake or loss with minimal or no symptoms
  2. Moderate (6-9%): decreased skin tugor, dry mucus membbranes, tachycardia, irritability, 2-3 sec capillary refill, low urinary output
  3. Severe (10-15%), cool, clammy skin, more than 3 sec capil refill, cracked lips, dry mucus, sinken eyes, hypotension and signs of shock
75
Q

IV fluids resuscitation - fluids?

A

20 ml / kg NORMAL saline IV

76
Q

Hirschsprung vs Mecocium ileus

A

Hirschsprung –> Down, obstraction on Rectosygmoid, Normal Meconium consistency, (+) Squirt sign (explosion of gas and stools in rectal examination)
Meconium ileus –> CF, obstraction on ileum, inspissated meconum consistency, (-) Squirt sign

77
Q

biliary atresia - presentation

A

jaundice and pale stools by the 2nd month

well initially

78
Q

Reye syndrome - biopsy / treatment

A

MICROVESICULAR fatty infiltration

supportive

79
Q

DDX of crying infant

A
  1. Colic: more than 3h / day (usually evening, more than 3 times / wk, for 3 or more weeks
  2. GERD: back pain during or after food (Sandifer syndrome), Frequent spits up or vomiting, poor weight gain
  3. Corenal abrasion: (+) fluorescein examin)
  4. Hair tourniquet: tied hair around extremity
  5. Mild protein allergy: blood-steaked mucousy, loose stools, severe constipation
  6. Normal infant crying: less than 2 h / day, resolves with consoling methds
80
Q

CF - infertility ?

A

100% males

20% females

81
Q

milk protein allergy present with

A

nonbillous voimiting and bloody stools or constipation

82
Q

Diagnostic criteria of cyclic vomiting syndrome

A
  1. 3 or more episodes in 6 months
  2. easily recognisable to family (stereotypical)
  3. lasts 1-10 days
  4. vomiting 4 or more times/hr at peak
  5. no symptoms in between episodes
  6. no underling condition can be identified
83
Q

cyclic vomiting syndrome - family history? / treatment

A
  • family history of migraines often presents

- antiemetics + antimigraine are often beneficial

84
Q

advantages of human milk over formula

A
  1. human decreases reflex + colic
  2. contain lactoferin, lysozyme, and IgA
  3. less Ca2+ and P+, but better absorbed
  4. improves gastric emptying
  5. contains proteins that are absorbed better (WHEY)
    NO VIT D
85
Q

necrotizing enterocolitis - RF

A 
prematurity 
LOW WIEGHT
enteral feeding (esp with formula - due to exposure to bacteria)
congenital heart disease
hypotension
86
Q

malrotation - presentation - tests

A

bilious vomiting + abd distention
can progress oto ischemia, bloody stools, perforation
upper GI contrast study is te gold standard (croskscrew pattern)
x-ray: gasless

87
Q

evaluation of bilious emesis in neonates

A

stop feeding, NG, IV fluids –> X-rays

  1. double sign –> duodenal atresia
  2. Free air, hematemesis, unstable vital –> sirgery
  3. Dilated loops –> contrast enema –> microcolon (meconium eleus), transition zone (Hirschsprung)
  4. NG tube in misplaced duodenum –> UPPER GI series –> Ligament of Treitz on the Right side –> malrotation
88
Q

pediatric constipation - RF

A
  1. initiation of solid food + cow milk
  2. toilet training
  3. school entry
89
Q

pediatric complciations - treatment

A

dietery fibers + water
limit cow’s milk
laxatives

90
Q

direct hyperbilirubinemia means

A

CBD more than 2 or more than 20% of bilirubin

91
Q

Biliary cysts - pathogenesis / diagnosis

A 
type 1 (MC): extrahepatic, sinlge cystic dilation of biliary duct 
- U/S / ERCP
92
Q

biliary cyst - clinical manifestation

A

triad: pain, jaundice, palpable mass

- usually before 10 years old

93
Q

biliary cyst - treatment

A

surgical resection to relieve obstruction + prevent malignant transformation

94
Q

Biliary atresia - diagnosis

A

U/S: absent or abnoarmal gallbladder
Hepatobiliaty scintigraphy
Liver biopsy
Intraoperative cholangiogram (glod standard): biliary obstruction

95
Q

biliary atresia - treatment

A

Kasai procedure: hepatoportoenterostomy

liver transplant

96
Q

risk for iron def anemia in infants

A

prematurity
iron def mother
cow’s milk before 1 year

97
Q

intussusception - indications for laparotoy

A
  1. perforation signs
  2. enema inefective
  3. pathologic lead point is identified
98
Q

DDX of regurgitation + vomiting in infants

A
  1. GERD
  2. Milk protein allergy
  3. Pyloric stenosis
99
Q

GERD - types

A

physiologic: asymptomatic, happy spitter
pathologic: failure to thrive, signif irritability, Sandifer syndrome

100
Q

GERD - management

A

physiol: reassurance, positional therapy
pathol: Thickened feeds, antiacids, if severe: PPI

101
Q

Breastfeeding failure jaundice vs breast milk jaundice regarding timing and clinical features

A
  1. Breastfeeding failure: 1 week, suboptimal breatfeeding, signs of dehydration
  2. Breast milk jaundice: start on day 3, peaks on 2nd week. adequate breast feeding, normal examination
102
Q

Breastfeeding failure jaundice vs breast milk jaundice regarding pathophysiology

A
  1. Breastfeeding failure: lactation failure –> decreased bilirubin elimination, increaed enterohepatic circulation
  2. breast milk jaundice: high levels of β-glucuronidase –> decongestate intestinal CB
    BOTH UCB
103
Q

how many breastfeeding the 1st month

A

8-12 times / day 10-20 mins per breast

104
Q

how many stools per day the 1st week

A

the same as days of life

105
Q

Milk- or soy-protein induced colitis - RF / prognosis

A

family history of allegies, eczema, asthma

spontaneous resolution by age 1

106
Q

milk- or soy-protein induced colitis - clinical features

A 
age: 2-8 weeks
regurgiation or vomiting
\+/- eczema
\+/- painless bloody stools 
NON IGE MEDIATED
107
Q

milk- or soy-protein induced colitis - treatment

A

elimiantion of milk + soy from maternal diet of exclusively breastfed infants
initiation of hydrolyzed formula in formula fed infants

108
Q

all patients with CF will develop

A

chronic rhinosinusitis

109
Q

suspect eosinophilic esophagitis - next step

A

2 months trial of PPI –> if not improvement –> endoscopy (furrows + circular rings) and biopsy (at least 15 eosinoph)
(dietary modification)

110
Q

triple bubble? / RF

A

jejunal atresia

- RF: cocaine and other vasoconstrictors

111
Q

swallowing of a coin

A

esophagus: if asymptomatic can be observed up to 24 hous –> if symptomatic or the time of ingestion is unknown –> remove by FLEXIBLE endoscopy
- stomach –> observation for 24 h

112
Q

cow milk vs cow mild based formula - the same?

A

not the same –> the 2nd is the appropriate if no breast feeding

113
Q

congenital umbilical hernia - clinical features / pathophysiology

A
  1. soft nontender bulge at umbilicus
  2. protrudes with increased abd pressure
  3. typically reducible
    - incomplete closure of abd muscles
114
Q

congenital umb hernia - management

A

observe (for spontaneous closure)

elective surgery at age 5

115
Q

pediatric GI - down is associated with

A
  1. hirsburg
  2. duodenal atresia
  3. imperforate anus
  4. umbilical hernia
  5. celiac
116
Q

Beckwith-Wiedemann syndrome - phyisical examination

A
  1. fetal macrosomia, rapid growth until late childhood
  2. omphalocele or umbilical hernia
  3. macroglossia
  4. hemihyperplasia
117
Q

Beckwith-Wiedemann syndrome - complications

A
  1. Wilms tumor

2. hepatoblastoma

118
Q

Beckwith-Wiedemann - surveillance

A
  1. serum α-fetoprotein
  2. abd/renal U/S
  3. monitor for hypoglycemia
119
Q

crying due to colics - next step

A

soothing and feeding techniques should be reviewed and parents should be emotionally supported and reassured

120
Q

x-ray - coffee bean sign

A

U-shaped apperance of the distended sigmoid loop in volvulus

121
Q

CF - typical level of obstruction in intestine

A

ileum

122
Q

CF - hearing loss

A

in 20% due to frequent treatment with aminoglycosides from gram (-) infection)

123
Q

Hirs vs CF regarding squirt sign

A

(+) only in hirschspung: forceful explusion of stool after rectal examination

124
Q

mechanism of physiologic jaundice

A
  1. high HCT
  2. low activity of UGT
  3. enterohepatic recycling is increased as the sterile newborn gut cannot break down bilirubin to urobilinogen
125
Q

GERD is common in infants due to

A

shorter esophagus, incomplete closure of the LES, greater time spent in the supine position

126
Q

Raye syndrome - jaundice?

A

usually no

127
Q

Batteries in GI

A

esophagus –> remove immedeiately under endoscopic guidance

distal to the esophagus- –> observe / stool examination and/or follow up x-rays to confirm excretion

128
Q

CF in neonata - management

A

hyperosmolar enema to break up the inspissated meconium and disolve the obstruction –> if unsuccessul –> surgery

pediatrics (16 decks)

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