GIT

Question 1

What are the common list of GIT differentials in pediatrics according to age?

Answer 1

Neonates, infants and toddlers:
Congenital causes, prematurity necrotizing enterocolitis, Hirschsprung disease and intestinal obstruction

School-age children:
Idiopathic constitution, infectious causes, functional abdominal pain and abdominal migraine

Adolescents: (conditions related to menstruation)
Testicular torsion, ovarian torsion, IBS and inflammatory bowel disease

Question 2

What is the most common GI emergency in neonates?

Answer 2

Prematurity necrotizing enterocolitis

Question 3

What are the common physical examination findings of acute abdomen?

Answer 3

Restlessness = colicky pain (as seen in obstructed viscous)

Abdominal rigidity = as seen in peritoneal process

Constant pain = strangulation of the gut or torsion

Question 4

What are the physical examination findings of intestinal obstruction?

Answer 4

High pitched bowel sounds, abdominal distension, tenderness and visible peristalsis at times.

Question 5

What are the physical examination findings of peritonitis?

Answer 5

Diminished or absent bowel sounds, abdominal wall rigidity, involuntary guarding and often rebound tenderness.

Question 6

What is the most common pediatric emergency?

Answer 6

Appendicitis

peak age 10-12 years of age

Question 7

What are the common clinical features of appendicitis?

Answer 7

1. Periumbilical pain that is then localized to the RLQ
2. Vomiting
3. Anorexia
4. Fever

Upon physical examination, there is tenderness to palpating at the McBurney point

Question 8

What is the most common cause of acute pancreatitis in children?

Answer 8

Blunt trauma

Question 9

What is the type of abdominal pain found with pancreatitis?

Answer 9

Periumbilical or epigastric area

Question 10

What signs can be seen in severe pancreatitis?

Answer 10

Grey turner sign or Cullen sign

Question 11

Which is more specific for acute pancreatitis, elevation of serum amylase or serum lipase?

Answer 11

Serum lipase

Other lab abnormalities may include leukocytosis, hyperglycemia, hypocalcemia, elevated transaminase and coagulopathy

Question 12

What is the most common method used for diagnosing and monitoring acute pancreatitis?

Answer 12

Abdominal US

Question 13

What is cholecystitis?

Answer 13

Inflammation of the gallbladder with transmural edema that may be associated with gallstones, or less commonly, without stones.

Question 14

What are predisposing conditions of cholecystitis?

Answer 14

Sickles cell disease, CF and prolonged TPN therapy

Question 15

Where does abdominal pain associated with cholecystitis localize to?

Answer 15

RUQ

Question 16

What is chronic abdominal pain?

Answer 16

Abdominal pain that occurs each month for at least 3 consecutive months.

Question 17

What is the classic presentation of functional abdominal pain?

Answer 17

Periumbilical pain

Question 18

What are organic causes of chronic abdominal pain?

Answer 18

Constipation 
Peptic ulcer disease 
Carbohydrate intolerance 
IBD 
Pancreatitis
Celiac disease 
H. Pylori infection 
GU disorders (e.g. pyelonephritis, hydronephrosis) 
Congenital structural abnormalities of the GI tract (e.g. malrotation, intestinal duplication, hernia)

Question 19

What are the normal stool patterns?

Answer 19

First week of life = 4x/day
1 year of age = 2x/day
4 years of age = 1x/day

Question 20

What is the most common form of constipation during childhood?

Answer 20

Functional fecal retention (FFR)

Question 21

What is the most common cause of organic constipation in an otherwise healthy child?

Answer 21

Hirschsprung disease (a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in functional obstruction)

Question 22

What is part of maintenance therapy of treating constipation?

Answer 22

Osmotic laxative (polyethylene glycol)

Question 23

What are causes of organic constipation?

Answer 23

Hirschsprung disease
Neuroenteric dysfunction (secondary to ischemia, trauma, spinal cord abnormality)
Medications (e.g. narcotics or sedatives)
Low-fiber feeding regimens
Anatomical abnormalities (e.g. stricture, adhesion, anteriorly displaced anus)
Systemic diseases (e.g. dehydration, celiac disease, hypothyroidism, CF, DM)
Infant botulism
Lead toxicity
Anorexia nervosa

Question 24

What is colic?

Answer 24

Crying that lasts >3 hrs/day and occurs >3 days/week

Question 25

When does colic begin and resolve?

Answer 25

Begins at 2-4 weeks and resolves by 3-4 months of age

Question 26

What are innocent cardiac murmurs?

Answer 26

Innocent murmurs result from turbulent but normal blood flow, are not caused by structural heart disease and have no hemodynamic significance.

Question 27

What are the types of innocent heart murmurs?

Answer 27

1. Still’s murmur (left ventricular outflow tract)
2. Pulmonic systolic murmur (systolic ejection murmur)
3. Venous hum