GI peds continued

Question 1

causes of acute pancreatitis in kids

Answer 1

trauma (most common), infections (mumps, enterovirus, EBV, HIV, hepatitis A and B), congenital issues, SLE/CF
-Second most common cause is idiopathic

Question 2

causes of acute cholecystitis in kids

Answer 2

• rare in healthy kids

- may be seen in kids with sickle cell, CF, or prolonged TPN therapy

Question 3

what is encopresis

Answer 3

developmentally inappropriate release of stool unrelated to an organic etiology. encoparesis is usually associated with severe constipation- liquid stool leaks around a hard, retained stoom mass and is involuntarily released.

Question 4

what is delayed meconium passage? what is meconium ileus and why is it important?

Answer 4

delayed passage: meconium passage >48 hrs after birth
meconium ileus: bilious vomiting, abd distention, lack of meconium passage. usually associated with CF. radiographs show intestinal distention with minimal air fluid levels, but stool looks like “soap bubbles” (air trapped in meconium).
many kids with meconium ileus also have structural bowel defects

Question 5

etiology of upper GI bleeds in kids

Answer 5

• swallowing blood (mimics GI bleed- newborns following delivery, older kids following epistaxis)
• gastritis/ulcers, esp. in kids with severe illness, surgery, burns, or meds
• mechanical injury- mallory weiss tear, caustic or foreign body ingestion
• varices much rarer in kids

Question 6

lab studies in work up of upper gi bleed in kids

Answer 6

• hemoglobin and platelet
• coag studies
• serum transaminases
• BUN (elevated BUN suggests GI bleed)

Question 7

Necrotizing enterocolitis: epidemiology

Answer 7

-one of the most common surgical conditions in neonates, most frequent in preterms, and very common for babies <30 wks gestational age or those with pulmonary disease

Question 8

necrotizing enterocolitis: features

Answer 8

abdominal distention/tenderness, residual gastric contents, bloody stools, abdominal erythema

• may have acidosis and oliguria
• may cause thrombocytopenia, DIC, and death
• Consider in any neonate with feeding intolerance, rectal bleeding, or abd distention

Question 9

NEC: dx

Answer 9

abd distention, ari fluid levels, thickened bowel walls, pneumatosis intestinalis (air in bowel wall- important), venous portal gas.

Question 10

management of NEC

Answer 10

bowel rest, gastric decompression, TPN. treat shock.

may need surgery (ex lap) if penumoperitoneum, fixed loop on serial radiographs, positive paracentesis

Question 11

What is the most common cause of significant lower GI bleeds beyond infancy? What are the features of this condition?

Answer 11

juvenile polyps. bleeding is painless, intermittent, and streaky.

Question 12

treatment of juvenile polyps

Answer 12

colonoscopy with polypectomy

Question 13

classic presentation of meckel’s diverticulum

Answer 13

painless, acute rectal bleed in otherwise healthy child.

Question 14

ddx lower Gi bleed in a neonate

Answer 14

swallowed maternal blood, allergic colitis, NEC, hirschsprung’s disease, volvulus

Question 15

ddx lower GI bleed in kid 1 mo-2yr

Answer 15

anal fissure, allergic colitis, infectious colitis, hirschsprung, intussusception, meckel’s, vascular malformation, intestinal duplication

Question 16

ddx of lower gi bleed in 2-5 year old

Answer 16

infectious colitis, juvenile polyp, meckel’s HUS, HSP, swallowed blood, mallory weiss