GI and Surgical Abdomen

Question 1

Name 2 risk factors for inguinal hernia

Answer 1

male sex and pre-term

Question 2

What is the treatment for an unincarcerated umbilical hernia?

Answer 2

none, wait to see if it resolves until age 5

Question 3

When does pyloric stenosis occur?

Answer 3

first 6 mos of life, usually at 1mth

Question 4

What are 2 risk factors and the most common sx for pyloric stenosis?

Answer 4

1st born, male, projectile vomiting (after each feeding)

Question 5

What is the classic triad in pyloric stenosis, seen on labs?

Answer 5

hypochloremia, hypokalemia, met. alkalosis

Question 6

True or false: intussusception presents w/abdominal tenderness.

Answer 6

FALSE!

Question 7

What is a late finding of intussusception and what does it indicate?

Answer 7

currant jelly stool, bowel necrosis

Question 8

What are 3 sx’s of intussusception?

Answer 8

vomiting, diarrhea, cramping abd. pain, lethargy/AMS, currant jelly stool

Question 9

How do you treat intussusception?

Answer 9

air/contrast enema, surgery if necrotic

Question 10

What is the MC site of intussusception?

Answer 10

ileocolic (ileum goes into cecum)

Question 11

What is the most useful test in acute appendicitis?

Answer 11

CT w/IV, oral, rectal contrast

Question 12

What is the most common indication for emergent surgery in children?

Answer 12

acute appendicitis

Question 13

What complication of appendicitis is more common in children/infants than adults?

Answer 13

perforation

Question 14

What is the Dx in an infant w/yellow or green emesis?

Answer 14

malrotation w/midgut volvulus until proven otherwise

Question 15

At what age does most volvulus occur?

Answer 15

1st month of life

Question 16

What are the patterns of stooling in breastfed vs formula fed infants?

Answer 16

breastfed up to 8x’s/d, formula 1-2. Mean is 4.

Question 17

T or F: absence of stools in 7-10d is pathologic in an infant

Answer 17

false, not uncommon

Question 18

________ constipation accounts for 95% of constipation

Answer 18

Functional, non-organic

Question 19

Give 3 examples of functional constipation

Answer 19

Diet changes: cow’s milk, solid foods, breast to formula; toileting; starting school

Question 20

Tx for functional constipation?

Answer 20

anticipatory guidance, lactulose (6mos +), prune juice, mineral oil, PEG, glycerin suppositories, AVOID enemas

Question 21

Give 3 examples of organic constipation

Answer 21

Hirshsprung’s dz, botulism, lead poisoning, cow’s milk, cystic fibrosis, hypothyroid, low birth wt, neuro disability, spinal dysraphism

Question 22

What’s the gold standard dx for Hirschsprung’s dz (aganglionosis)?

Answer 22

rectal biopsy

Question 23

Tx of Hirschsprung’s?

Answer 23

excision, re-anastomosis, colostomy, reversal

Question 24

Sx’s of hypothyroidism?

Answer 24

lethargy, hoarse cry, feeding problems, macroglossia, dry skin, umbilical hernia

Question 25

What test is used to diagnose Meckel’s diverticulum?

Answer 25

technetium (nuclear medicine scan–tags RBCs)

Question 26

What are s/sx’s of Meckel’s diverticulum?

Answer 26

painless bleeding (hematochezia), anemia

Question 27

What is a common cause of false negative stool guaiac test?

Answer 27

vitamin C

Question 28

Which test differentiates fetal hgb from maternal hgb in a child with hematemesis?

Answer 28

Apt test

Question 29

What are signs/sx’s of bacterial gastroenteritis?

Answer 29

blood/mucus in stool, WBCs on smear, abd pain, +/- fever, recent travel, contaminated food, contact w/reptiles

Question 30

Which type of bilirubin is always abnormal when elevated?

Answer 30

direct/conjugated hyperbilirubinemia

Question 31

What is biliary atresia?

Answer 31

obliteration or discontinuity of biliary duct, leads to obstructed bile output & jaundice (direct hyperbilirubinemia), progresses to liver failure, tx is surgery (Kasai procedure)

Question 32

If you are immunized against Hep B you will have positive what on labs?

Answer 32

positive anti-HBs = IMZ