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Peds > MTB 4 (GI) > Flashcards

MTB 4 (GI) Flashcards

1
Q

What is choanal atresia?

A

Membrane b/t nostrils and pharyngeal space

Prevents breathing during feeding

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2
Q

How does choanal atresia present?

A

Child turns

  • Blue when feeding
  • Pink when crying
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3
Q

How do we dx choanal atresia?

A

CT

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4
Q

Tx for choanal atresia?

A

Surgical intervention

  • perforate membrane
  • reconnect pharynx to nostrils
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5
Q

What is Hirschsprung dz?

A

Lack of innervation in distal bowel by Auerbach plexus

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6
Q

What dz is ass’d with Hirschsprung dz?

A

Down syndrome

MEN type II

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7
Q

What is the presentation of Hirschsprung dz?

A

Failure to pass meconium in first 48 hours
Or
At all.
Bilious vomiting, FTT

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8
Q

When do normal infants pass meconium?

A

90% within first 24 hours

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9
Q

How do we Dx Hirschsprung dz?

A

Barium enema reveals narrowed distal colon w/proximal dilation

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10
Q

What do we seen on plain xrays in Hirschsprung dz?

A

Distended bowel loops with lack of air in rectum

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11
Q

What is seen on anorectal manometry in Hirschsprung dz?

A

High pressure in anal sphincter

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12
Q

Definitive Dx is made with what for Hirschsprung dz?

A

Full thickness Bx

- lack of ganglionic cells in submucosa

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13
Q

Tx for Hirschsprung dz?

A

3-stage surgery

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14
Q

What is imperforate anus?

A

Opening of anus is missing

Rectum ends as blind pouch

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15
Q

What dz is ass’d with imperforate anus?

A

Down syndrome

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16
Q

Presentation of imperforate anus?

A

Failure to pass meconium
PE: no anus
Tx: surgery

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17
Q

What is CHARGE syndrome

A 
Coloboma of eye, CNS abnormalities
Heart defects
Atresia of choanae
Retardation of growth/development
Genital/urinary defect - hypogonadism
Ear anomalies/deafness
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18
Q

What is VACTERL syndrome?

A 
Vertebral anomalies
Anal atresia
Cardiovascular anomalies
Tracheoesophageal fistula
Esophageal fistula
Renal abnormalities
Limb anomalies
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19
Q

What is seen in a quad screen (2nd trimester) for Down syndrome?

A

Increased Inhibin-A, b-HCG

Decreased MSAFP, Estriol

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20
Q

Bilious vomiting on first day of life

A

Duodenal atresia

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21
Q

What is the cause of Duodenal atresia

A

Lack/absence of apoptosis -> improper canalization of lumen of duodenum

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22
Q

Presentation of Duodenal atresia?

A

In utero: polyhydramnios

Bilious emesis w/in hours after first feeding - first 12 hours of life

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23
Q

CXR finding of Duodenal atresia

A

Double bubble sign - air bubbles in stomach and duodenum proximal to atresia

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24
Q

Tx of Duodenal atresia

A
  1. IVF
  2. Electrolyte replacement - K+
  3. NGT bowel decompression
  4. Surgical duodenostomy
25
Q

Volvulus

A

Bowel obstruction - loop of bowel twisted on itself

26
Q

MC location of Volvulus

A

Midgut

Ileus

27
Q

Presentation of Volvulus

A

Vomiting
Colicky abdominal pain
distension
Passage of blood or mucus in stool

28
Q

What is seen on upper GI series of Volvulus

A

Multiple air fluid levels
Bird beak appearance
Abnormal location of ligament of Treitz

29
Q

Tx for Volvulus

A

Emergent surgical/endoscopic untwisting

30
Q

Best initial therapy for Volvulus

A

Endoscopic decompression

31
Q

Complication with Volvulus

A

Life-threatening sepsis from bowel necrosis w perforation

32
Q

Sausage shaped mass on palpation

A

Intussusception

33
Q

Presentation of Intussusception

A 
Currant jelly stool
Neuro signs
Abdominal pain
MC in first 2 years of life
RLQ sausage shaped mass palpated
34
Q

Intussusception pathophysiology

A

Telescoping of bowel into another segment of bowel

35
Q

Causes of Intussusception

A 
Polyp
Hard stool
Intestinal Lymphoma
Viral Infxn - Gastroenteritis
Meckels
Hematoma
Henoch Schloein
36
Q

What vaccination is contraindicated in Intussusception

A

Rotavirus

37
Q

MC location of Intussusception

A

Ileocecal Junction at RLQ

38
Q

Pt draws up legs twd abdomen, follwed by emesis initially non-bilious progresses to bilious?

A

Intussusception

39
Q

Best initial test for Intussusception

A

US shows doughnut sign or target sign

40
Q

Most accurate test for Intussusception

A

Barium enema

41
Q

When is barium enema CI in children?

A

Signs of
Peritonitis
shock
perforation

42
Q

Tx for Intussusception

A
  1. IVF
  2. Electrolytes - K, Ca, MG
  3. NGT decompression
  4. Barium enema = curative
  5. Surgery - If barium enema ineffective
43
Q

Management if target sign seen

A

Air enema

44
Q

Where does Meckel’s Diverticulum occur?

A

Small intestinal tract

45
Q

Meckel’s Diverticulum Rule

A 
Rule of 2's
2% of population affected
2 feet from ileocecal valve
2 types of ectopic tissue: gastric and pancreatic
2X as common in Males
2 Years of age or younger
2% symptomatic
2 inches long
46
Q

Presentation of Meckel’s Diverticulum

A

Sudden Painless rectal bleeding

47
Q

Most accurate test Meckel’s Diverticulum

A

Technetium 99 scintigraphy scan

48
Q

Tx for Meckel’s Diverticulum

A

Surgical removal of diverticulum

49
Q

Diarrhea w fever, abdominal pain, bloody diarrhea

A

Inflammatory diarrhea

50
Q

Diarrhea with vomiting, crampy abdominal pain, watery diarrhea

A

Noninflammatory

51
Q

Tx for diarrhea

A

Mild = Oral fluids
Severe = IVF
Can be isotonic crystalloid

52
Q

Necrotizing Enterocolitis presentation

A 
Premies w low birth weight
Vomiting and abdominal distension
Fever
Feeding intolerance
Bloody stools
53
Q

Dx for Necrotizing Enterocolitis

A

Abdominal Xray shows pneumatosis intestinalis = air w/in bowel wall
CT shows air in portal vein, dilated bowel loops
Frank or occult blood in stool

54
Q

What does CT show for Necrotizing Enterocolitis that has perforated

A

Pneumoperioteum

55
Q

Tx for Necrotizing Enterocolitis

A
  1. NPO - Bowel rest - discontinue feeding
  2. IVF Stat
  3. NGT bowel decompression
  4. Surgery to remove affected bowel
56
Q

What are indications for surgery in Necrotizing Enterocolitis

A

Perforation

Radiographic worsening on serial images

57
Q

Complications ass’d with Necrotizing Enterocolitis

A

Intestinal strictures

Short bowel syndrome

58
Q

Presentation of cyclical vomiting

A

Recurrent, self-limiting N/V
Absence of any cause
High incidence w parents w/ migraines

59
Q

Complications with cyclical vomiting

A

Anemia

Dehydration

Peds (6 decks)

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