Mehl. GI midgut volv., necr. enterocolitis 01-02 (1)

Question 1

Midgut. definition?

Answer 1

failure of rotation of proximal bowel

Question 2

Midgut. age?

Answer 2

almost always under age 1.

Question 3

Midgut. There is a volvulus Q on Peds CMS form 6 where they give a 5-month-old (age range more for intussusception), but they tell you overtly an upper-GI series is performed and show you the image of the corkscrew. They also explicitly say there are no masses. So I see this as: abdominal exam and imaging are buzzy + age not as reliable.

Answer 3

.

Question 4

Midgut. Vs intuss?

Answer 4

similar to intuss. but NO MASS

Question 5

Midgut. What instrumental finding?

Answer 5

Upper-GI series shows CORKSCREW APPEARANCE

Question 6

Midgut. abdominal exam?

Answer 6

Midgut volvulus is usually first month of life + has no overt mass.

Question 7

Midgut. imaging?

Answer 7

Upper GI series (HY)

Question 8

If abdominal x-ray is performed, dilated loops of small bowel with air-fluid levels may be seen in both. This is a non-specific finding and is buzzy for intestinal obstruction. Do
not confuse with air-fluid levels on CXR, which mean pulmonary abscess.

Answer 8

.

Question 9

Midgut Tx?

Answer 9

surgery

Question 10

Both intussusception and midgut volvulus can present with bilious vomiting, air-fluid levels on abdominal x-ray, bloody stools, and intermittent crying/vomiting/squatting.
Once again, they sound very similar. So I’ve more or less been able to converge on the combo of abdominal mass as most important, followed by buzzy imaging as second- most important, followed by age.

Answer 10

As example, USMLE will show you above image in 5-month old where you say, “Ok, that’s age more for intussusception.” But then they’ll tell you upper-GI series is performed + they show you the corkscrew –> clearly midgut volvulus, not
intussusception. Answer will be “failure of rotation of proximal bowel,” or “gut malrotation.”

Question 11

Necr. enterocolitis. in what patients? birth

Answer 11

Necrotic bowel occurring in premature neonates born <32 weeks’ gestation.

Question 12

Necr. enterocolitis. CP? one specific

Answer 12

pneumatosis intestinalis (air in bowel wall). resembles bubbles

Question 13

Necr. enterocolitis. USMLE will show you above image in kid born, e.g., at 26 weeks’ gestation, and then
answer is just necrotizing enterocolitis. Not hard.

Answer 13

.

Question 14

Necr. enterocolitis.
It’s to my observation necrotizing enterocolitis usually shows up as a wrong answer choice on NBMEs, where I see students pick it in, e.g., an adult, and I’m like, “Dude you
see that in fucking hyper-preemies.” And they’re like Oh. So you need to remember this as specifically a premature neonate condition.

Answer 14

.