Neonatal Gastroenterology

Question 1

True/False: If a water-soluble contrast study is negative, you can rule out an H-type fistula

Answer 1

False; the fistula off-shoots from the esophagus towards the trachea at an upward angle; if water-soluble contrast isn’t injected through the NG tube, you can miss an H-type fistula because the contrast won’t shoot up against gravity into the fistula to the trachea

Question 2

20% lipid emulsion has how many kcal/g of emulsion?

Answer 2

10 kcal/g of emulsion (9kcal/g of lipids + 1kcal/g of glycerin that is present in emulsion)

Question 3

Dextrose- how many kcal/g in TPN?

Answer 3

3.4kcal/g of carbs (dehydrated dextrose in TPN)

Question 4

Protein- how many kcal/g in TPN?

Answer 4

4kcal/g of protein

Question 5

Treatment for biliary atresia?

Answer 5

Kasai Portoenterostomy (ideally needs to be performed within the first 30-45 days of life to limit damage to the liver)

Question 6

True or False. Isolated biliary atresia is the most common cause of liver failure in childhood.

Answer 6

True. Keep in mind, biliary atresia can also present as part of a syndrome (usually one to do with ciliary dysfunction– think of situs inversus syndrome)

Question 7

What causes biliary atresia?

Answer 7

Unknown, though to be a prenatal inflammatory insult.

Question 8

What is a high sensitivity/specificity marker for biliary atresia after the first 30 days of age?

Answer 8

Matrix metalloproteinase-7 (indicative of high level of fibrosis after enough accumulation of bile acids– that’s why most effective after at least 30 days of age)