GI Bleed

Question 1

premature baby GI bleed ddx

Answer 1

necrotizing enterocolitis

Question 2

necrotizing enterocolitis dx

Answer 2

xray shows pnematosis intestinalis

• air in wall of bowel

= NEC

Question 3

NEC tx

Answer 3

1. bowel rest NPO
2. IVF
3. TPN
4. IV abx (grm negativ, anarobes)

Question 4

infant with anal fissure

Answer 4

patho: tear anal mucosa

- in infant can be iatrogenic from rectal exam

Question 5

anal fissure dx

Answer 5

clinical

Question 6

anal fissure tx

Answer 6

reassurance

Question 7

anal fissure deep can..

Answer 7

suture but typically not worth it will heal on its own infant stool tends to be soft

Question 8

intussusception

Answer 8

telescoping bowel

vascular compromise

Question 9

abrupt sudden onset colicky abdominal pain knee chest position relief

Answer 9

intussusception

Question 10

currant jelly bloody BM diarrhea

Answer 10

intussusception or anything that causes bowel to die and slough off

Question 11

sausage shaped mass on exam RUQ

Answer 11

intussusception

Question 12

age intussusception

Answer 12

3 mo to 3 yrs

Question 13

intussusception dx

Answer 13

1. KUB upright
   - r/o perforation
   - r/o obstruction
   (by abscense of free air)
2. u/s sensitive, track resolution

Question 14

intussusception tx

Answer 14

air enema (again post KUB upright!! r/o emergencies)

Question 15

intussusception goes to surgery when there is…

Answer 15

1. a perforation
2. peritonitis
3. failure air enema

Question 16

u/s showing target sign

Answer 16

intussusception

Question 17

painless intermittent hematochezia (BRBPR)

Answer 17

meckle’s diverticulum

Question 18

meckles diverticulum is a ___

Answer 18

remnant of vitelline duct that has gastric contects with acid.. irritates bowel = bleed

Question 19

rules of 2

Answer 19

Meckels: 
2 years younger 
less than 2% pop 
2x males vs females 
2 ft from ileocecal valve 
about 2 inches

Question 20

other findings meckles

Answer 20

iron def anemia in male

fecal occult blood test

Question 21

Meckle’s diverticulum dx

Answer 21

technicium 99 scan

then surgery resection

Question 22

teen with meckles how dx?

Answer 22

CT scan better than T99

Question 23

when mom and dad say GI bleed? yet doesnt look like kid got rid of a ton of blood (not anemic etc…) what do you have to r/o?

Answer 23

Distractors
1. babies swallow mom’s blood: Apt test

2. recent bloody nose swallow = black stools
3. iron supplementation = black stool
4. beets
5. medications

Question 24

inflammatory bowel dz

Answer 24

chron’s

• watery diarrhea
• weight loss

ulcerative colitis
- bloody diarrhea

Question 25

chron’z dx

Answer 25

EGD
colonoscopy
skip lesions

Question 26

ulcerative colitis dx

Answer 26

colonoscopy

- continuous lesions

Question 27

ulcerative colitis tx

Answer 27

surgery curative

8 yrs from dx do a annual colonosocpy until surgery

Question 28

infectious colitis sx

Answer 28

fever

bloody BM

Question 29

infectious colitis dx

Answer 29

stool cultures

Question 30

milk protein allergy GI bleed tx

Answer 30

hydrolyzed formula

sx resolve