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Pediatrics > GI > Flashcards

GI Flashcards

1
Q

MCC Bowel obstruction younger than 2

A

Intussusception

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2
Q

Intussusception - age range

A

3m to 3y

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3
Q

Intussusception - location

A

usually proximal to the ileocecal valve

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4
Q

Intussusception - risk factors

A

Conditions with lead points

  • Meckel’s
  • Intestinal lymphoma (>6y age)
  • Henoch-Schonlein purpura,
  • parasites
  • polyps
  • adeno- or rotavirus infection
  • Celiac dz
  • CF
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5
Q

Abrupt-onset, colicky abd pain, in other-wise healthy child. Flexed knees and vomiting. Triad: Abd pain, vomiting, and bloody mucus in the stools (currant jelly stool).
PE: palpable “sausage-shaped” RUQ mass, tenterness, +guaiac. Absence of bowel in RLQ.

A

Intussusception

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6
Q

U/S: target-sign

A

Intussusception

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7
Q

Tx: Intussusception

A

Correct any electrolyte abnormality
Check CBC for leukocytosis
Consider NG for decompression
Air-contrast barium enema (diagnostic in >95%, curative in >80%>
Surgical reduction and resection if unstable, peritoneal signs, or failed enema

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8
Q

Pyloric Stenosis - Risk Factors

A

Firstborn males

A/W TE fistulas, maternal h/o PS, erythromycin ingestion

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9
Q

Non-bilious vomiting beginning around 3 wks of age and progressing to projectile emesis

A

PS

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10
Q

Palpable olive-shaped, mobile, nontender epigastric mass. Visible gastric peristaltic waves

A

PS

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11
Q

Barium studies: “string sign”

A

PS (narrow pyloric channel). May also be described as a pyloric beak

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12
Q

Metabolic derangement in PS

A

hypochloremic, hypokalemic metabolic alkalosis (persistent loss of HCl).

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13
Q

Tx: PS

A

Correct dehydration/acid-base abnormalities

Surgical: pyloromyotomy

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14
Q

Meckel’s etiology

A

failure of the omphalomesenteric (vitelline) duct to obliterate.

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15
Q

Type of tissue in Meckel’s

A

heterotopic gastric tissue

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16
Q

MC congenital abnormality of the small intestine

A

Meckel’s

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17
Q

Rule of 2s

A 
Meckel's
MC in children under 2
2x MC in males
2 types of tissue (pancreatic and gastric)
2 in long
Found w/in 2ft of ileocecal valve
2% of the population
18
Q

Sudden, intermittent, painless rectal bleeding

A

Meckel’s

19
Q

Meckel’s complications

A

obstruction, diverticulitis (may mimic appendicitis), volvulus, and intussusception

20
Q

Dx: Meckel’s

A

Meckel scintigraphy scan (tc-99 pertechnetate) - detect ectopic gastric tissue
Plain films - useful for detecting obstruction and perforation

21
Q

Tx: Meckel’s

A 
Surgical excision (diverticulum with adjacent ileal segment - if actively bleeding.
Ulcers frequently develop in adjacent ileum
22
Q

Hirschsprung’s Dz

A

Congenital lack of ganglion cells in the distal colon. Uncoordinated peristalsis and dec motility.
A/W - males, Waardenburg’s syndrome, MEN type 2

23
Q

Failure to pass meconium within 48h. Bilious vomiting, FTT

A

Hirschsprung’s (less severe may present later in life with chronic constipation

24
Q

Abdominal distention and explosive discharge of stool following rectal exam. Or lack of stool in rectum. Or abnormal sphincter tone

A

Hirschsprung’s

25
Q

Barium enema: narrowed distal colon with proximal dilation

A

Hirschsprung’s (plain films reveal distended bowel loops with paucity of air in the rectum.

26
Q

Anorectal manometry: failure of the internal sphincter to relax after distention of the rectal lumen

A

Hirschsprung’s

27
Q

Hirschsprung’s dz - rectal bx

A

Required for definitive dx
Absence of myenteric (Auerbach’s) plexus and submucosal (Meissner’s) plexus
Hypertrophied nerve trunks enhanced with achetylcholinesterase stain.

28
Q

Tx: Hirschsprung’s

A

2-stage surgical repair

  1. diverting colostomy @ dx
  2. definitive pull-through procedure connecting remaining colon to rectum
29
Q

1st month of life: bilious emesis, crampy abd pain, distention, and blood or mucus in the stool

A

Malrotation with volvulus

30
Q

Malrotation with volvulus

A

Congenital malrotation of the MIDGUT
Cecum in the right hypochondrium
Formation of Ladd’s bands. Predispose to obstruction and constriction of blood flow.

31
Q

AXR: “bird-beak” appearance and air-fluid levels

A

Malrotation with volvulus (AXR may also appear normal

32
Q

Upper GI - abnormal location of LoT

A

Malrotation with volvulus

Study of choice - w/ stable pt

33
Q

Tx: Malrotation with volvulus

A

NG to decompress
IV hydration
Emergent surgical repair when volvulus is gastric
Surgery or endoscopy with volvulus is intestinal

34
Q

MC GI emergency in neonates

A 
Necrotizing enterocolitis (NEC)
A portion of the bowel undergoes necrosis
35
Q

Premature infant: first few days of life: feeding intolerance, delayed gastric emptying, abd distention, bloody stools

A

NEC

36
Q

Complications of NEC

A

intestinal perf, peritonitis, abd erythema, shock

37
Q

AXR: pneumatosis intestinalis, dilated bowel loops, portal venous gas, abd free air

A

NEC
intramural air bubbles, gas produced by bacteria in the bowel wall
Serial AXR - q6h

38
Q

Labs in NEC

A

nonspecific: hyponatremia, metabolic acidosis, leukopenia or leukocytosis with L shift, thrombocytopenia, and coagulopathy (DIC with prolonged PT/aPTT and +D-dimer

39
Q

Tx: NEC

A

NPO, OG for gastric decompression, correct dehydration and lytes, TPN, IV abx
Surgery: if perf or worsening AXR (usually an ileostomy with mucous fistula with later reanastomosis

40
Q

NEC - complications

A

stricture, short-bowel syndrome

Pediatrics (7 decks)

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