Pediatric EM

Question 1

neonate with GI bleeding DDx

Answer 1

unwell: malrotation with volvulus, necrotizing enterocolitis, coagulopathy; well: allergic proctocolitis, anal fissures, swallowed maternal blood

Question 2

infant/toddler with GI bleeding DDx

Answer 2

unwell: Meckel’s diverticulum, intussussception, vascular malformation; Well: allergic proctocolitis, gastritis, infectious colitis

Question 3

older child/adolescent with GI bleeding

Answer 3

unwell: IBD, cryptic liver disease, intestinal ulceration; well: gastritis, esophageal bleeding, juvenile polyps

Question 4

MGMT of neonate with GI bleeding

Answer 4

always serious despite how the pt looks!

Question 5

differentiating hematuria vs. uric acid crystals

Answer 5

uric acid crystals = orange/pink stained diaper

Question 6

What is Meckel’s Diverticulum

Answer 6

often seen as GI bleeding in toddlers; most common congenital malformation of GI tract, most common cause of GI bleeding in toddlers. it is a remant of the omphalomesenteric tract (long tube once connected the yolk sac to the lumen)

Question 7

What is the rule of twos in Meckel’s diverticulum?

Answer 7

presents by age 2, affects 2% of population, often 2 inches in length, found within 2 feet of ileocecal valve

Question 8

Imaging for Meckel’s Diverticulum?

Answer 8

not actively bleeding: technetium 99 scintigram (Meckel’s scan); actively bleeding - radiolabeled RBC scan (resuscitate and call surgeon)