McGuffin- Peds GI- Melissa Flashcards

1
Q

How does a pediatric diaphragmatic hernia develop?
What is the most severe complication?
Which type is most common?
How does it present–auscultation? CXR, prenatal US, belly exam?

A

Trauma to diaphragm or failure of pleuroperitoneal folds to close –> pulmonary hypoplasia
- Most common in left posteriolateral quadrant (left pleuroperitoneal membrane)

Presentation: (Varies in severity, most severe below)

  • Severe Respiratory distress
  • Hear bowel sounds, not air in affected chest
  • Scaphoid (scooped out) abdomen
  • CXR = bowel in chest, NG tube in chest
  • Prenatal US = bowel in chest
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2
Q

What is Duodenal or Esophageal atresia; how does this happen?
When and how does it present?
With what genetic disorder is this typically associated?

A

Esophageal atresia- esophageal obstruction, possible TE fistula–> polyhydraminos

Duodenal Atresia- Failure of apoptosis–> no recanalization of duodenal lumen

Trisomy 21 assc

Presentation:

  • Polyhydraminos (^ uterus size wks 26-30)
  • BILIOUS VOMITING with FIRST FEED
  • Recurrent aspiration pneumonia (choke, cough, cyanosis)
  • XRAY = DOUBLE BUBBLE SIGN (air in stomach + just past pylors); coiled NG tube
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3
Q

Three diseases that present with bilious vomiting and how to differentiate them:

A

Occurs in obstructions Distal to Ampulla of Vater
Duodenal atresia–> presents with FIRST FEED

Malrotation of midgut volvulus–> presents LATER (not at first feed)

Hirschsprung Disease–> look for failure to pass myonium or chronic constipation

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4
Q

What is Gastroschisis?
How is it detected and how does it present?
How do we manage this?
What are some special concerns?

A

Defect in ventral abdominal wall b/w rectus mm’s lateral to umbilicus–> NO SAC; insides on the outside; usually on RT

  • Detected with neonatal US
  • SILO for staged repair after birth
  • Attn. Hydration, nutrition, infection
  • Feed with G tube for several mos
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5
Q

Whats Omphalocele?
How is it detected and how does it present?
How is it managed and what are some special concerns?
With what genetic disease is this defect associated?

A

Incomplete closure of umbilical ring:
Normal herniation of midgut @ wk 6–> FAILURE TO RETRACT in wk 10–> VAC-COVERED herniation through umbilicus

  • Detected on neonatal US
  • ^ AFP in amniotic fluid + mom’s blood
  • Asstd. with Trisomy 18 (Edward’s Syndrome)
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6
Q

Describe the PE findings for Edward’s syndrome:

Facial, MSK, cardio findings

A
  • *Triangular face w low-set, malformed EARS
  • clenched hands with index over middle, 5th over 4th
  • rocker bottom feet
  • PDA, VSD

**SO MANY OF THE TRISOMIES SOUND ALIKE. HERE’S A WAY TO REMEMBER IF YOU DIDNT ALREADY KNOW:
(E)DWARDS= 18, YEAR YOU CAN (E)LECT PRESIDENT & has low set (E)ARS!!! I have gotten questions right on uwolrd just by knowing Edwards= Ears.

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7
Q

What is the Penology of Cantrell and with which disease is it associated?

A

Associated with Ompohalocele:

  • omphalocele
  • diaphragmatic hernia
  • sternal cleft
  • ectopic cordis
  • intracardiac anomaly
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8
Q

What causes Hirschsprung disease?
How does it present (Xray, PE, etc.)
With what genetic anomaly is it associated?
How do we treat it?

A

Neural crest cell migration failure–> aganglionosis of bowel wall submucosa–> SEVERE CONSTIPATION –> Bowel rupture + sepsis possible!

Presentation:

  • Baby fails to pass meconium in first 48 OR older kid never poops without assistance (enema, etc.)
  • Distended abdomen, BILIOUS VOMITING, can’t fart
  • XRAY: DILATED bowel loops, No air in rectum
  • Trisomy 21
  • Tx by resecting affected portion of bowel
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9
Q

What is an Imperforate Anus?
How does it present and how is it treated?
What are some common associated malformations (2)?
With what genetic anomaly is it associated?

A

Improper descent–> Rectum ends in blind pouch–> DIMPLE ANUS (no hole)–> CAN’T POOP –> SURGERY

  • Associated with urogenital or urovaginal fistulas
  • Associated with Trisomy 21
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10
Q

VACTERL: What is this?

A

Common anomalies associated with Imperforate Anus:

Vertebral defects
Anal atresia 
Cardiac anomalies 
Traheoesophageal fistulas 
Esophageal atresia 
Renal anomalies 
Limb anomales
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11
Q

Neonatal jaundice: What are the two types?
When is this pathological?
What is benign?

A

DIRECT: conjugated hyperbilirubinimea; RARE; GREEN baby; evaluate for LIVER DISEASE

INDIRECT: undonjugated hyperbilirubinimea; COMMON; YELLOW baby

  • *Pathological jaundice happens within first 24hrs
  • *Benign jaundice is yellowing of skin and sclera that peaks bw days 3-5
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12
Q

What are some potential complications of severe neonatal jaundice?

What should one consider as causes (4)?

A

Lethargy, poor feeding, dehydration (remember capillary refill will be longer than 3 seconds)

  • *Consider in Pathologic Jaundice:
  • ^ RBC breakdown (hemolytic disease)
  • G6PD Deficiency in severe cases
  • Maternal sulfa drug use
  • Sepsis
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13
Q

How do we manage Hyperbilirubinimia?

A
  • Biliblanket for babies w bilirubin OVER 15mg/mL
  • OVER 20mg/mL bive biliblanket and phototherapy

This will change the conformation of bilirubin so that it can be excreted

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14
Q

What is Kernicterus and how does it happen?

What are 3 risk factors and 4 complications?

A
  • Hyperbilirubinimia OVER 20 mg/mL
  • Bilirubin deposited in basal ganglia

Risks: Hypoalbuminimia, Metabolic acidosis, Sepsis

Complicaitons:
Choreoathetosis, Hypotonia, Hearing loss, Seizures

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15
Q

Describe the pathogenesis of Malrotation of Midgut with Volvulus?
How does it present in babies and older kids?
What do you see on imaging + labs?

A

Failure of midgut to rotate counterclockwise 270 degrees as it returns to the abdominal cavity during WEEK 10 development –>
VOLVULUS (twists into itself) –> ISCHEMIC INJURY

  • Presents w vomiting, abdominal pain + distention
  • XRAY = DOUBLE BUBBLE sign, BIRDS BEAK at site of rotation
  • Metabolic acidosis (ischemic tissue–> ^ lactate)
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16
Q

How does acute appendicitis present?
What is seen on PE? Do we do imaging?
What testing should always be done in females?
How common is this?

A

1 Acute abdominal pain resulting in Emergency Surgery!

  • Fever, N/V/ Abdominal pain (Periumbilical–> LRQ)
    PE: Positive Tests–>
  • McBurney’s point
  • Obturator sign (internal rotation w hip and knee flexed),
  • Psoas sign (hip extension w knee flexed)
  • Rovsing’s Sign

**Always do B-hCG to rule out preggos in females
SKIP IMAGING; medical emergency
- CT is test of choice for RETROCECAL appendix

17
Q

How high appendicitis present in a pregnant patient?

A

Pain will be in URQ vs LRQ!

18
Q

What is gastroenteritis and how does it commonly present?
What is the most severe complication and what should you look for in patient Hx?
What is the management protocol?

A

Intestinal inflammation typically caused by virus
Presents w flu sx + N/V/D, abdominal pain + cramps

  • Most severe complication is DEHYDRATION (only reason to do labs is for electrolyte imbalance)
  • Give IV fluids; typically self limited within 72 hours
  • Look for hx of travel to places where diarrhea is common

**STACEE IN HONDURAS.

19
Q

What is the classic triad associated with Henoch Schonlein Purpura? What causes this Disease?

A

IgA mediated vasculitis of small vessels

CLINICAL TRIAD:

1) Abdominal pain
2) Hematuria
3) Palpable puritic purpura on bum and legs
* *Also can present with FEVER and JOINT PAIN

#1 VASCULITIS IN KIDDOS!!!!! 
**KNOW THIS DISEASE!!!!!
20
Q

How do we diagnose Hench Schonlein purport?

How do we treat it?

A
  • **Urinalysis: Casts, proteinuria, RBCs, WBCs
  • Biopsy of lesions is most accurate test (leukocytoclastic vasculitis)
  • ^ IgA is common but not diagnostic
  • Immunofluorescence: IgA, C3, Fibrin

Tx: Steroids for renal involvement; monitor BP and urine

21
Q

What are some potential complications associated with HSP? (2)

A
  • Intussusception

- Chronic Nephritis

22
Q
What is Intussusception? 
When in life does it present? 
Describe the sx. 
What do you find on PE? 
How is it diagnosed? 
Management?
A

Proximal bowel telescopes into distal bowel–> Ischemia
Typically occurs bw 6mos-3yrs

Symptoms

  • EPISODIC colicky pain (scream, draws knees up)
  • Blood currant jelly stool
  • Bilious vomiting

PE:

  • Palpable, SAUSAGE mass in LRQ (iliocolic = #1)
  • Tachycardia

Diagnosis :

  • CT or US
  • Enterografin enema = diagnostic and therapeutic

Treat with IV fluids, NG tube, surgery if necessary

23
Q

What is a “Lead point” and might they cause?

A

Lymphadenopathy, lymphoma, Mekel diverticulum, Polyp–> causes intussusception

24
Q

What is lactose intolerance and what kind of complications can it cause?
What do you find on PE?
How it it treated?

A

Inherited or acquired (post gastroenteritis, etc.) lactase deficiency in LACTASE within cells of SMALL INTESTINE

Symptoms: Abdominal cramps, bloating, farts, loose stool (osmotic diarrhea)

PE: distended, non-tender, tympanic abdomen w ^ bowel sounds

Tx: Lactase pills

25
Q

Are babies typically lactose intolerant?

A

No, babies that seem lactose intolerant typically have “milk protein intolerance”

26
Q

How common is Mekel Diverticulum?
What causes it?
How and when does it present?

A
#1 congenital GI anomaly: vitelline duct fails to regress 
2 RULE: 
-2yoa
-2in long
-2 feet from iliocecal valve
-2/3 have ectopic mucosa
-2 types of tissue (pancreatic + GI)
-2% become symptomatic 

Presents with PAINLESS bloody/ currant jelly stool +/- mild anema due to blood loss

27
Q

How do we diagnose Mekel diverticulum?

A
  • Mekel perfusion scan w technetium-99
  • Guaiac test for bloody stool
  • CBC +/- mild anemia
28
Q

How does pyloric stenosis present and what causes it?
When does it typically present and what are the sx?
What is found on PE?
How do we dx?

A

Unknown cause (~Macrolides)–> Elongation + thickening of pylorus muscle–> narrowed pyloric opening!

Symptoms (presents before 3 mos):

  • Infants will projectile vomit after EVERY FEED or…
  • Intermittent vomiting–> projectile vomiting by 4 wks
  • NONBILIOUS (obstruction proximal to ampulla of vater)

OLIVE SHAPED MASS in left epigastrium on PE
Dx with US to measure width and length of pyloric channel

29
Q

A mother brings her 2-week old infant to the hospital due to intractable projectile vomiting. She says that he was feeding well immediately after birth but now vomits twenty minutes after every feeding. He has not had a bowel movement in 24 hours. This is her first child and she is visibly nervous. Physical examination reveals a pale, dehydrated, and lethargic infant. On physical exam he is tachycardic, has a sunken fontanelle, and poor capillary refill. There is an olive like mass in the epigastrium. Which of the following is the most likely diagnosis?
A. Achalasia
B. Esophageal Stricture
C. Pyloric Stenosis
D. Tracheoesophageal fistula E. Zenker Diverticulum

A

Answer: C

30
Q

A 21-year-old man presents to the emergency department with a 12-hour history of abdominal pain. The patient describes the pain as 9/10 in severity. It started near his umbilicus, and has since moved to the right lower quadrant. There are no associating or relieving factors. The patient vomited once 5 hours ago and reports a lack of appetite. The patient denies hematemesis and hematochezia. Vital signs include a temperature of 100.9oF, a heart rate of 72/min, a respiratory rate of 17/min, and blood pressure of 121/82 mm Hg. Physical examination reveals point tenderness in the right lower quadrant and right lower quadrant pain with palpation of the left lower quadrant and right hip flexion. Rectal examination is normal. A complete blood count shows a white blood cell count of 14,000/mm3. What is the next best step in management?
A. Admit patient for observation
B. Computed tomography of abdomen to confirm diagnosis C. Discharge with instructions to return if no improvement D. Surgical evaluation and treatment
E. Ultrasound of abdomen to confirm the diagnosis

A

Answer: D

31
Q

A 4-year-old boy presents to the family medicine clinic for pre-surgery clearance before treatment for his recently diagnosed Meckel diverticulum. The patient feels fine at this time despite continuing painless bleeding from his rectum. Which of the following is a complication of an untreated Meckel’s diverticulum?
A. Anal fissures
B. Erythema nodosum
C. Intussusception
D. Pyoderma gangrenosum E. Toxic megacolon

A

Answer: C