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Peds I & II > GI > Flashcards

GI Flashcards

1
Q

Define esophageal atresia

A

Blind esophageal pouch w/ or w/o a fistulous connection between the proximal or distal esophagus & trachea

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2
Q

esophageal atresia clinical presentation

A
  1. Copious secretions
  2. Choking
  3. Cyanosis & respiratory distress
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3
Q

Trachoeoesophageal fistula distal to esophagus CXR findings

A

Gas present in bowel

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4
Q

EA WITHOUT fistula CXR findings

A

NO gas in bowel

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5
Q

EA treatment

A
  1. NG tube in proximal pouch on low intermittent suction
  2. Elevate head of bed to prevent reflux
  3. IV glucose
  4. Fluids & O2
  5. Surgery
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6
Q

Esophageal FB clinical presentation

A
  1. Asx=50%
  2. Dysphagia, odynophagia
  3. Drooling
  4. Chest or abdominal pain
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7
Q

What is the MC FB ingested?

A

Coin ingestion

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8
Q

Define GER

A
  1. Uncomplicated recurrent spitting & vomiting

2. Resolves spontaneously

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9
Q

Define GERD

A

Reflux causes 2ry sx’s or complications:

  1. Aspiration
  2. Pneumonia
  3. Failure to thrive
  4. GI bleeding
  5. Food refusal
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10
Q

What is the MC infant sx?

A

GER

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11
Q

GERD treatment

A
  1. Thickening feeds w/ oat cereal
  2. Milk free (& soy free) diet x 2wks.
  3. H2 blocker vs. PPI
  4. Surgery: Nissen Fundoplication (severe)

*reflux resolves spontaneously in 85% of affected infants by 12mo of age

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12
Q

What are the two MC complications of eosinophilic esophagitis (EoE)?

A
  1. esophageal food impactions

2. esophageal stricture

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13
Q

EoE si/sx’s

A
  1. Feeding dysfxn
  2. Vague non-specific GERD sx’s
  3. Long meal times: washing down food w/ liquids
  4. Avoidance of highly textured foods
  5. No response to medical &/or surgical GERD tx
  6. FH or PMH of atopy, asthma
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14
Q

EGD findings in EoE

A
  1. Esophageal mucosa w/ thickening, mucosal fissures, strictures & rings
  2. Esophagus sprinkled w/ white exudates=resembles candida
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15
Q

EoE treatment

A
  1. Elimination of food allergens

2. Swallowed topical steroids: Fluticasone

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16
Q

Define Pica

A
  1. Persistent eating of nonnutritive substance:Clay, Dirt, Hairballs, Ice, Paint
  2. Present @ least 1 month
  3. Inappropriate to developmental level
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17
Q

What is Pica associated with?

A

Iron and zinc deficiency

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18
Q

Pica treatment

A
  1. Address nutrient deficiency or lead poisoning

2. Behavioral therapy & family education

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19
Q

Define Rumination

A
  1. Repeated regurgitation and re-chewing of food
  2. At least 1 month
  3. More common 3 to 12 months
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20
Q

What is the MC inborn error of amino acid metabolism?

A

Phenylketonuira (PKU)

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21
Q

Define Phenylketonuira (PKU)

A

Autosomal recessive

Decreased activity of phenylalanine hydroxylase

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22
Q

What is the MC si/sx in Phenylketonuira (PKU)? 2nd MC?

A

Intellectual disability=MC

Epilepsy=50%

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23
Q

What race is Phenylketonuira (PKU) MC in?

A

Caucasians

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24
Q

Phenylketonuira (PKU) treatment

A
  1. Dietary restriction of phenylalanine and aspartame
  2. Tyrosine supplementation
  3. Elimination of all high-protein foods: meat, dairy, nuts, legumes
  4. Restrict starches
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25
Q

What is the MC food allergy?

A

Cow’s milk

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26
Q

What is the MC si/sx in food allergies?

A
  1. Urticaria

2. Angioedema

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27
Q

Food allergy treatment

A
  1. Avoidance and re-introduction annually
  2. Epinephrine
  3. H1 blockers
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28
Q

Define celiac disease

A

Immune mediated enteropathy triggered by gluten: Protein in what, rye and barley

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29
Q

RF’s for celiac disease

A
  1. Type 1 diabetes
  2. Down syndrome
  3. Turner syndrome
  4. Autoimmune thyroidititis
  5. Family hx of CD
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30
Q

GI manifestations in celiac dz

A
  1. Poor weight gain
  2. Chronic diarrhea
  3. Abd distention
  4. Irritability
  5. Anorexia
  6. Vomiting

*usually between 6-24mo of age (when gluten 1st introduced)

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31
Q

Non GI manifestations in celiac dz

A
  1. Delayed puberty/short stature
  2. Delayed menarche
  3. Unexplained Fe def anemia*
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32
Q

Celiac Dz diagnosis

A

serology &/or duodenal biopsy: villous atrophy w/ increased intraepithelial lymphocytes

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33
Q

Define omphalocele

A

Membrane covered herniation of the abdominal contents into the base of the umbilical cord

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34
Q

Who is omphalocele MC in?

A
  1. Mom’s of extreme maternal age: <20 or >40

2. Associated w/ chromosomal abnormalities

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35
Q

Define gastroschisis

A

Uncovered (no sac) intestine through small abdominal wall defect to the right of the umbilical cord

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36
Q

What environmental factors are associated with gastroschisis?

A
  1. illicit drugs: meth & cocaine
  2. link w/ aspirin & ibuprofen use during pregnancy
  3. Young maternal age
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37
Q

Define reducible hernia

A

Spontaneous or manual

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38
Q

Define incarcerated hernia

A

Not reducible

NO vascular compromise

39
Q

Define strangulated hernia

A

Vascular compromise

40
Q

What is the MC side in a diaphragmatic hernia

41
Q

What is diaphragmatic hernia associated with?

A

Polyhydramnios(excess amniotic fluid)= 50%

42
Q

diaphragmatic hernia si/sx

A
  1. Respiratory distress
  2. Scaphoid abdomen, barrel-shaped chest
  3. Signs of pneumothorax: decreased BS on ipsilateral side
43
Q

CXR findings in diaphragmatic hernia

A

bowel loops seen in chest w/ mediastinal shift to opposite side

44
Q

diaphragmatic hernia treatment

A
  1. Intubation, mechanical ventilation & decompression of the GI tract w/ OG tube
  2. Surgery
45
Q

What is the MC long term complication of diaphragmatic hernia?

A

Pulmonary HTN

46
Q

what hernia is the MC in children?

A

Indirect hernia

47
Q

Indirect hernia anatomical location

A
  1. Passes LATERAL to deep epigastric vessels
  2. Passes IN the Inguinal canal
  3. MCly Right sided
48
Q

Direct hernia anatomical location

A
  1. Passes MEDIAL and INFERIOR to deep epigastric vessels
  2. does NOT go through inguinal canal
  3. RARE in children
49
Q

What are the boundaries of the Hesselbach Triangle?

A

Laterally inferior epigastric artery
Medially lateral border of rectus abdomens
Inferiorly (base) inguinal ligament

50
Q

What are the complications of femoral hernias? Who is MC in?

A

MC=Females

Frequently become incarcerated or strangulated

51
Q

Who are umbilical hernias MC in?

A

full term, African American infants

52
Q

Who is pyloric stenosis MC in?

A
  1. Males
  2. First born children
  3. Whites
53
Q

Pyloric stenosis si/sx

A
  1. Projectile postprandial vomiting
  2. “Hungry vomiter”
  3. Oliver mass in RUQ=Hallmark sign*
54
Q

Pyloric stenosis diagnosis?

A

Abdominal (Pyloric) US: hypoechoic muscle ring >4mm thickness w/ a hyperdense center & a pyloric channel length

55
Q

Barium Upper GI finding in Pyloric Stenosis

A

Apple core or String Sign: long, narrow pyloric canal w/ a double track of barium

56
Q

Pyloric stenosis treatment

A

Surgical: pyloromyotomy

57
Q

What is duodenal atresia associated with?

A

Trisomy 21

58
Q

Abdominal x-ray findings in duodenal atresia

A

Double-bubble sign: Dilated stomach & proximal duodenum

59
Q

duodenal atresia si/sx

A

Bilious vomiting hours after birth

60
Q

duodenal atresia treatment

61
Q

What is the main goal of short bowel syndrome?

A

Promote growth-Many treatment options

62
Q

What is the MC cause of bowel obstruction in the first 2 yrs of life?

A

Intussusception

63
Q

What it the MC location of Intussusception?

A

starts just proximal to ileocecal valve

64
Q

What is the MC cause for Intussusception in children >6?

65
Q

Intussusception si/sx’s

A
  1. Cramping abd pain, diarrhea
  2. “Red current jelly”: pathognomonic
  3. Palpable right-sided sausage-shaped mass
66
Q

X-ray findings in Intussusception

A

“target sign”: 2 concentric radiolucent circles superimposed

67
Q

What is the most sensitive and specific diagnostic modality in Intussusception?

68
Q

What is both diagnostic and therapeutic with Intussusception?

A

Barium & air enema

69
Q

What is another name for Hirschsprung dz?

A

Congenital aganglionic megacolon

70
Q

What is the MC chromosomal abnormality associated w/ Hirschsprung disease?

A

Down syndrome

71
Q

Hirschsprung disease si/sx

A

Usually presents in infancy:

  1. Failure of the newborn to pass meconium
  2. Vomiting
  3. Abd distention
  4. Reluctance to feed
72
Q

Hirschsprung disease barium enema findings

A

Narrow distal segment w/ sharp transition to the proximal dilated

73
Q

Hirschsprung disease treatment

A

Surgical:

  1. Removal of aganglionic bowel-Temporary colostomy
  2. Surgical reconstruction
74
Q

What is the MC long-term complication of Hirschsprung disease?

A

Fecal incontinence

75
Q

What is the MC congenital anomaly of the GI tract

A

Meckel’s Diverticulum

76
Q

Define Meckel’s Diverticulum

A

Outpouching or bulge lower part of the small intestine

77
Q

What is the rule of two’s in Meckel’s Diverticulum?

A
  1. 2% of the population
  2. 2:1, M:F
  3. first 2 yrs of life=50% of complications occur then
  4. Within 2 feet from the ileocecal valve
  5. 2 inches in length
78
Q

Meckel’s Diverticulum clinical presentation

A
  1. Asymptomatic-usually
  2. Painless lower GI bleeding
  3. Mimic appendicitis
79
Q

Meckel’s Diverticulum diagnosis

A
  1. Arteriography or CT angiography

2. Meckel’s scan: radionuclide scan

80
Q

Define Pilonidal Cyst

A

Infxn of skin or subQ tissue at/near upper part of natal cleft of the buttock

81
Q

Pilonidal Cyst RF’s

A 
overweight/obesity 
local trauma or irritation
sedentary lifestyle or prolonged sitting
deep natal cleft 
family hx
82
Q

What are pinworms called?

A

enterobiasis

83
Q

Pinworm si/sx

A

intense anal pruritus

84
Q

Pinworm treatment

A

Pyrantel pamoate 11mg/kg (max 1g): Repeat after 2 weeks

*Tx everyone in the house

85
Q

Define encopresis

A

Repeated passage of feces into inappropriate places:

  1. @ least 3 months
  2. @ least 4 years of age
86
Q

encopresis treatment

A

Behavioral-educational tx

Biofeedback therapy

87
Q

Pharmacotherapy treatment in encopresis

A
  1. Suppositories & enemas: Miralax (initially)

2. Laxatives: Milk of magnesia (maintenance)

88
Q

Jaundice treatment

A
  1. Phototherapy: Unconjugated bilirubin absorbs light

3. Transfusion-if severe

89
Q

Define Gilbert’s Syndrome

A 
Familial hyperbilirubinemia:
Autosommal dominant (common)
90
Q

Who is Gilbert Syndrome MC in?

91
Q

What are the 4 primary organs that Cystic Fibrosis effects?

A
  1. Lung
  2. Pancreas
  3. Intestine
  4. Liver
92
Q

Complications of the pancreas in CF?

A
  1. Fat soluble vitamin deficiency
  2. Steatorrhea
  3. Malnutrition
93
Q

Complications of the intestine in CF?

A

CHO intolerance

Intussception

94
Q

CF treatment

A
  1. Pancreatic enzyme supplementations

2. Ursodiol: cholestasis tx

Peds I & II (8 decks)

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