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ITT > GI / GU > Flashcards

GI / GU Flashcards

1
Q

causes of acute abdomen

A

ischemia
obstruction
infection
functional

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2
Q

Acute abdomen surgical emergancies

A

perforation, peritonitis, ischemic bowel, malrotation/volvulous, incarcerated inguinal hernia, appendicitis

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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
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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
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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
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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
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7
Q

peritonitis

A
  • commonly appendicitis
  • c-diff, risk factor of ABX in past 3wks
  • s/s: fever, rigours, abdo pn
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8
Q

toxic megacolon

A
  • colonic dilation (secondary to inflammatory bowel disease) + systemic toxicity
  • s/s abdo distension, peritonitis, electrolyte disturbances, hypoglycaemia,
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9
Q

Appendicitis

A
  • common surgical emergency in child
  • peaks 10-12, perforation is higher risk in children
  • RLQ pn, vomiting, anorexia, fever
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10
Q

cholecystitis

A
  • less common
  • fever, jaundice, RUQ (charcot’s triad)
  • high WBC
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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
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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
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13
Q

Testicular torsion

A
  • Hx of trauma, fever, painful voiding, pn

- needs resolizon with 24hrs

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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

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15
Q

what is hyperbilirubinemia

A
  • Abo incompatibility
  • polysythemia
  • prematurity
  • dehydration/poor feeding (not pooping)
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16
Q

worst form of hyperbilrubiema

A

kernictorus

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17
Q

Tx for hyperbilirubinemia

A
  • phototherapy
  • IVIG for ABO incompatibility
  • albumin (billi binds to albumin)
  • Judicous fluids

** risk of seizures and DIC

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18
Q

newborn stomach capacity

A

20-30ml

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19
Q

1m stomach capacity

A

200ml

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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
Q

hyperactive bowel sounds

A

obstruction (normal 3-5 in 30 sec)

26
Q

hypoactive

A

ileus

27
Q

is splenomegaly in neonates normal

A

no

28
Q

bilious vomit, limited gas in AXR is a sign of

A

upper GI obstruction (malrotation or volvulus)

29
Q

++ Abdo distension, no mec in 24-48hrs, dilated bowel loops on AXR is a sign of

A

lower GI obstruction

30
Q

NEC

A

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
Q

NEC transport considerations

A 
NPO
intubation
fluids
ABX
inotropes
blood products
**can deteriorate quickly!!
32
Q

what is bilirubin

A

breakdown of heme by liver (conjugation into water soluble form)

33
Q

physiological jaundice

A

normal in term babies D3-7

34
Q

jaundice in fist 1-2 days of persistant past 2wks

A

pathological jaundice

35
Q

acute bilirubin encephalopathy

A

bilirubin can cross BBB

lethargy, high pitch cry, arching, seizures

36
Q

what does bilirubin bind to

A

albumin ( if low at risk of encephalopathy)

37
Q

what is the TFI for phototherapy

A

120%

38
Q

exchange transfusion

A

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
Q

esophageal atresia sign

A

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
Q

common T-21 GI abnormalities

A
  • duodenal atresia

- hurshprug

41
Q

Duodenal atresia

A
  • double bubble on AXR
  • vomiting
  • lack od distal gas

TX; NPO, intubation, NG

42
Q

malrotation

A

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
Q

Volvulus

A

complete obstruction causing necrosis distally

44
Q

small bowel atresia

A

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
Q

meconium ilieus

A

could be manifestation of CF, mec causing small bowel obstruction, may perf in utero causing calcification of GI tract

46
Q

gastroschesis

A

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
Q

omphalocele

A

failure of abdomen content

48
Q

pyloric stenosis

A

2-5wks, projectile non-bilious emasis, metabolic alkalosis (low cl, low K)

TX: fluid, electrolytes, ng

49
Q

NEC

A

most common
risk: pre, formula fed, HIE, CHD, LBW
bacterial translocation into intestinal wall

ITT (17 decks)

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