GI / GU Flashcards
1
Q
causes of acute abdomen
A
ischemia
obstruction
infection
functional
2
Q
Acute abdomen surgical emergancies
A
perforation, peritonitis, ischemic bowel, malrotation/volvulous, incarcerated inguinal hernia, appendicitis
3
Q
intussusception
A
- most common cause of acute abdomen in infants/peds
- peaks @ 3m
- telescoping of the bowel
- mostly idiopathic, less common post infection
- jelly stools, lethargic, poor feeds, palpable mass
- tx: air enema if early
4
Q
Pyloric stenosis
A
- idiopathic hypertrophy of pyloric muscle
- presentation: non bilious projectile vomiting following by hunger, dehydrated, hypochlormic, hypokalemic, metabolic alkalosis
- tx: NPO, IVF, electrolyte management
5
Q
malrotation/volvulus
A
- malrotation: arrest of normal rotation or embryonic gut
- associated with CHD, CDH,
- presentation: Bilious emesis, abdo distension, bloody stool, fever, ischemia of the bowel = peritonitis
- ** sure emerg
6
Q
Hirschsprungs disease
A
anal/rectal junction fails to innervate (sphincter cannot relax)
- T21 and CHD common
- s/s: no mec in 1st 24hrs, vomiting, abdo distension, diarrhea
7
Q
peritonitis
A
- commonly appendicitis
- c-diff, risk factor of ABX in past 3wks
- s/s: fever, rigours, abdo pn
8
Q
toxic megacolon
A
- colonic dilation (secondary to inflammatory bowel disease) + systemic toxicity
- s/s abdo distension, peritonitis, electrolyte disturbances, hypoglycaemia,
9
Q
Appendicitis
A
- common surgical emergency in child
- peaks 10-12, perforation is higher risk in children
- RLQ pn, vomiting, anorexia, fever
10
Q
cholecystitis
A
- less common
- fever, jaundice, RUQ (charcot’s triad)
- high WBC
11
Q
pancreatitis
A
- idiopathic
- obstructive: congenital, cholelithiasis, binary sludge
- toxin: etch
- infection: mumups
- trauma: handlebars
- s/s: pn after eating, fever
- predisposition to ARDS
12
Q
ACS
A
- sustain pathologic increased into-abdominal pressure
- 40-60% mortality , 1% of pics pts present with ACS
- s/s: abdo distension, olguria/anuria, resp deterioration, HD instability
- management: paralysis, sedation, NG/OG/enema, diuretics
13
Q
Testicular torsion
A
- Hx of trauma, fever, painful voiding, pn
- needs resolizon with 24hrs
14
Q
GI bleed
A
upper: prox to ligament of treitz
lower: distal
less commonly variceal
newborn: swallowed mater blood, breast milk, NEC
infants; esophagitis, coagulopathy
15
Q
what is hyperbilirubinemia
A
- Abo incompatibility
- polysythemia
- prematurity
- dehydration/poor feeding (not pooping)
16
Q
worst form of hyperbilrubiema
A
kernictorus
17
Q
Tx for hyperbilirubinemia
A
- phototherapy
- IVIG for ABO incompatibility
- albumin (billi binds to albumin)
- Judicous fluids
** risk of seizures and DIC
18
Q
newborn stomach capacity
A
20-30ml
19
Q
1m stomach capacity
A
200ml
20
Q
gastric emptying time of newborn
A
2-3hrs
21
Q
why is reflux common in neos
A
lower esophageal sphincter muscle tone is poor
**NG and suction prior to intubating
22
Q
what does polyhydramnios predispose pts to
A
lung maturity
gastic malformation
23
Q
scaphoid or flat stomach
A
diaphragmatic hernia
24
Q
asymmetric abdomen
A
nephrohydramenois, or enlarger organ
25
hyperactive bowel sounds
obstruction (normal 3-5 in 30 sec)
26
hypoactive
ileus
27
is splenomegaly in neonates normal
no
28
bilious vomit, limited gas in AXR is a sign of
upper GI obstruction (malrotation or volvulus)
29
++ Abdo distension, no mec in 24-48hrs, dilated bowel loops on AXR is a sign of
lower GI obstruction
30
NEC
bloody stool of prem
can happen in terms with hx of hypoxia (sSGA, HIE)
30% mortality
(severe inflammation of bowel leading to necrosis)
temp instability, feeding intolerance, low platelets
31
NEC transport considerations
```
NPO
intubation
fluids
ABX
inotropes
blood products
**can deteriorate quickly!!
```
32
what is bilirubin
breakdown of heme by liver (conjugation into water soluble form)
33
physiological jaundice
normal in term babies D3-7
34
jaundice in fist 1-2 days of persistant past 2wks
pathological jaundice
35
acute bilirubin encephalopathy
bilirubin can cross BBB
| lethargy, high pitch cry, arching, seizures
36
what does bilirubin bind to
albumin ( if low at risk of encephalopathy)
37
what is the TFI for phototherapy
120%
38
exchange transfusion
to prevent kernicterus in setting of critically high bills
extract infants blood via art line + infuse donor blood (normally double blood volume)
risks: infection, hemodynamic instability, electrolyte abnormalities, hypoglycaemia (K, Na, cal, glucose Q 1hr)
39
esophageal atresia sign
gastric tube curling, absent air in abdomen, excessive salivation, cyanosis with feeds, hard to see stomach on AXR
Risks: aspiration,
TX: NPO, prone, intubate, replogle, IV fluid
40
common T-21 GI abnormalities
- duodenal atresia
| - hurshprug
41
Duodenal atresia
- double bubble on AXR
- vomiting
- lack od distal gas
TX; NPO, intubation, NG
42
malrotation
interruption in normal process of rotation and fixation of gut
predisposition to volulus which is a surgical emergency
S/S: 1st month of life, bilious vomiting, lactic acidosis
DX: X-ray may be normal, duodenum visible on L not R
TX for x-port: NPO, NG, +/- ABX, IV fluids
43
Volvulus
complete obstruction causing necrosis distally
44
small bowel atresia
disruption of blood supply to small bowel
Dx: long air/fluid levels, 1st wk of life, bilious emesis, abdo distension, mucous stools, dilated small bowel loops of ARX
45
meconium ilieus
could be manifestation of CF, mec causing small bowel obstruction, may perf in utero causing calcification of GI tract
46
gastroschesis
defect of abdo wall allowing protrusion of bowel +/- stomach bladder and gonads
management: heat, higher TFI, sterile wrap, NPO, NG, monitor electrolytes, ABX, position R side to avoid vascular compression, monitor distal circulation to lower limbs
**no lower limb IV access no UV attempts
47
omphalocele
failure of abdomen content
48
pyloric stenosis
2-5wks, projectile non-bilious emasis, metabolic alkalosis (low cl, low K)
TX: fluid, electrolytes, ng
49
NEC
most common
risk: pre, formula fed, HIE, CHD, LBW
bacterial translocation into intestinal wall
