MTB 4 (GI) Flashcards
What is choanal atresia?
Membrane b/t nostrils and pharyngeal space
Prevents breathing during feeding
How does choanal atresia present?
Child turns
- Blue when feeding
- Pink when crying
How do we dx choanal atresia?
CT
Tx for choanal atresia?
Surgical intervention
- perforate membrane
- reconnect pharynx to nostrils
What is Hirschsprung dz?
Lack of innervation in distal bowel by Auerbach plexus
What dz is ass’d with Hirschsprung dz?
Down syndrome
MEN type II
What is the presentation of Hirschsprung dz?
Failure to pass meconium in first 48 hours
Or
At all.
Bilious vomiting, FTT
When do normal infants pass meconium?
90% within first 24 hours
How do we Dx Hirschsprung dz?
Barium enema reveals narrowed distal colon w/proximal dilation
What do we seen on plain xrays in Hirschsprung dz?
Distended bowel loops with lack of air in rectum
What is seen on anorectal manometry in Hirschsprung dz?
High pressure in anal sphincter
Definitive Dx is made with what for Hirschsprung dz?
Full thickness Bx
- lack of ganglionic cells in submucosa
Tx for Hirschsprung dz?
3-stage surgery
What is imperforate anus?
Opening of anus is missing
Rectum ends as blind pouch
What dz is ass’d with imperforate anus?
Down syndrome
Presentation of imperforate anus?
Failure to pass meconium
PE: no anus
Tx: surgery
What is CHARGE syndrome
Coloboma of eye, CNS abnormalities Heart defects Atresia of choanae Retardation of growth/development Genital/urinary defect - hypogonadism Ear anomalies/deafness
What is VACTERL syndrome?
Vertebral anomalies Anal atresia Cardiovascular anomalies Tracheoesophageal fistula Esophageal fistula Renal abnormalities Limb anomalies
What is seen in a quad screen (2nd trimester) for Down syndrome?
Increased Inhibin-A, b-HCG
Decreased MSAFP, Estriol
Bilious vomiting on first day of life
Duodenal atresia
What is the cause of Duodenal atresia
Lack/absence of apoptosis -> improper canalization of lumen of duodenum
Presentation of Duodenal atresia?
In utero: polyhydramnios
Bilious emesis w/in hours after first feeding - first 12 hours of life
CXR finding of Duodenal atresia
Double bubble sign - air bubbles in stomach and duodenum proximal to atresia
Tx of Duodenal atresia
- IVF
- Electrolyte replacement - K+
- NGT bowel decompression
- Surgical duodenostomy
Volvulus
Bowel obstruction - loop of bowel twisted on itself
MC location of Volvulus
Midgut
Ileus
Presentation of Volvulus
Vomiting
Colicky abdominal pain
distension
Passage of blood or mucus in stool
What is seen on upper GI series of Volvulus
Multiple air fluid levels
Bird beak appearance
Abnormal location of ligament of Treitz
Tx for Volvulus
Emergent surgical/endoscopic untwisting
Best initial therapy for Volvulus
Endoscopic decompression
Complication with Volvulus
Life-threatening sepsis from bowel necrosis w perforation
Sausage shaped mass on palpation
Intussusception
Presentation of Intussusception
Currant jelly stool Neuro signs Abdominal pain MC in first 2 years of life RLQ sausage shaped mass palpated
Intussusception pathophysiology
Telescoping of bowel into another segment of bowel
Causes of Intussusception
Polyp Hard stool Intestinal Lymphoma Viral Infxn - Gastroenteritis Meckels Hematoma Henoch Schloein
What vaccination is contraindicated in Intussusception
Rotavirus
MC location of Intussusception
Ileocecal Junction at RLQ
Pt draws up legs twd abdomen, follwed by emesis initially non-bilious progresses to bilious?
Intussusception
Best initial test for Intussusception
US shows doughnut sign or target sign
Most accurate test for Intussusception
Barium enema
When is barium enema CI in children?
Signs of
Peritonitis
shock
perforation
Tx for Intussusception
- IVF
- Electrolytes - K, Ca, MG
- NGT decompression
- Barium enema = curative
- Surgery - If barium enema ineffective
Management if target sign seen
Air enema
Where does Meckel’s Diverticulum occur?
Small intestinal tract
Meckel’s Diverticulum Rule
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
Presentation of Meckel’s Diverticulum
Sudden Painless rectal bleeding
Most accurate test Meckel’s Diverticulum
Technetium 99 scintigraphy scan
Tx for Meckel’s Diverticulum
Surgical removal of diverticulum
Diarrhea w fever, abdominal pain, bloody diarrhea
Inflammatory diarrhea
Diarrhea with vomiting, crampy abdominal pain, watery diarrhea
Noninflammatory
Tx for diarrhea
Mild = Oral fluids
Severe = IVF
Can be isotonic crystalloid
Necrotizing Enterocolitis presentation
Premies w low birth weight Vomiting and abdominal distension Fever Feeding intolerance Bloody stools
Dx for Necrotizing Enterocolitis
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
What does CT show for Necrotizing Enterocolitis that has perforated
Pneumoperioteum
Tx for Necrotizing Enterocolitis
- NPO - Bowel rest - discontinue feeding
- IVF Stat
- NGT bowel decompression
- Surgery to remove affected bowel
What are indications for surgery in Necrotizing Enterocolitis
Perforation
Radiographic worsening on serial images
Complications ass’d with Necrotizing Enterocolitis
Intestinal strictures
Short bowel syndrome
Presentation of cyclical vomiting
Recurrent, self-limiting N/V
Absence of any cause
High incidence w parents w/ migraines
Complications with cyclical vomiting
Anemia
Dehydration
