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SBM IV GI > Pediatric GI > Flashcards

Pediatric GI Flashcards

1
Q

bilious emesis

A

BAD

DDx that we know of:

  • newborn - duodenal atresia
  • child - volvulus and malrotation
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2
Q
A

double bubble: air in proximal duodenum and stomach

duodenal atresia

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3
Q

what is duodenal atresia?

A

failure of lumen to re-canalize during 8-10th week of gestatio

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4
Q

tx duodenal atresia

A

place NG tube to decompress

surgery = definitive tx

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5
Q
A

esophageal fistula

  • no air in gut
  • NG tube gets stuck
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6
Q

clinical manifestations of esophageal fistula

A
  • polyhydramnios
  • excessive salivation, drooling
  • choking, coughing, cyanosis after first feeding
  • regurgitation
  • aspiration
  • respiratory distress
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7
Q

when does a baby w/ jaundice need a work-up?

A

>2 weeks

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8
Q

sx and labs of biliary atresia

A

Hx: pale/clay stools, dark urine, FTT

PE: jaudice starting at 2-3 weeks, icterus, firm/large liver, splenomegaly around 8 weeks

Labs: conj bili elevated, normal unconj bili

death if not tx

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9
Q

what is biliary atresia?

A

failure of fetus to develop an adequate pathway for bile to drain from liver to intestine

cause of 1/2 of all liver transplants

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10
Q

tx for biliary atresia

A

Kasai procedure: hepatoportoenterostomy - connect bowel lumen to porta hepatis containing bile duct remants

best if done in first 2 months of life

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11
Q

what is meckel’s diverticulum?

A

omphalomesenteric duct connecting midgut to yolk sac should involute by 8th week gestation. if failure –> DIVERTICULUM of heterotopic gastric mucosa

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12
Q

rule of 2s

A

Meckel’s diverticulum

  • occurs in 2% pop
  • only 2% of these cause a clinical problem
  • location: 2 feet proximal to ileocecal valve, 2 inches long
  • symptoms occur at 2 yrs
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13
Q

sx of meckel’s diverticulum

A

painless blood in stool of ~2 yr old

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14
Q

what is volvulus?

A

failure of midgut to appropriately reenter fetal abdomen

intestine becomes suspended by a stalk containing SMA –> midgut ischemia and infarction

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15
Q

pathophys of volvulus

A

midgut is predisposed to clockwise twisting of duodenum to transverse colon

65% present in 1st month of life, but may present at any age

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16
Q

sx and tx of volvulus

A

sx: abdominal distention, bilious vomiting suggests obstruction

volvulus –> bloody stools –> perforation –> peritonitis

older pts: intermittent cramping, abd pain, vomiting/diarrhea, constipation - more subtle

tx: surgical emergency! - Ladd’s procedure

17
Q

dark red currant jelly stool

A

intussusception

18
Q
A

typical image of volvulus

  • site of obstruction: 2nd portion of duodenum
  • “birds-bead” and cork screw
  • duodenojejunal junction should be on left of the spine to be normal
19
Q

tx intussussception

A

telescoping of small bowel in large bowel. can be fixed via enema – force pushes small bowel into position. usually does not reccur

20
Q

what age are solid foods introduced?

A

4-6 mo

but continue breast milk or formula until 1 yo

21
Q

typical age for intussusception

A

3

22
Q

causes of failure to thrive

A

Not enough in: undernutrition, mechanical

Too much out: diarrhea, vomit, high metabolic needs

inadequate absorption: GI anomalies, metabolic disorders

23
Q

gastroesophageal reflux

A

this is NORMAL - common problem in first 18 mo

no tx, just laundry. reassure parents.

cause: LES is a little untoned

24
Q

pyloric stenosis - sx

A

nonbilious vomiting starting at 2-4 weeks. emesis increases, becomes projectile. FTT.

Hypokalemic metabolic alkalosis

occasionally: palpable olive, visual peristalsis

25
Q

how to dx pyloric stenosis?

A

ultrasound

26
Q

tx for pyloric stenosis

A

correct electrolyte imbalance and dehydration

surgical pyloromyotomy

27
Q

actions needed to poop

A

relax external anal sphincter

increase intra-abdominal pressure

28
Q

Hirschprung’s Disease

A

lack of parasympathetic ganglionic cells in submucosa and myenteric plexis of colon –> lack of stimulus to relax external anal sphincter

can lead to megacolon

29
Q

functional constipation

A

aka fecal withholding

fight urge to defecate, sometimes due to pain

leads of encopresis: overflow of colon –> liquid leaks and fecal soiling

30
Q

tx for functional constipation and encopresis

A

clean out: meds, manual impaction

maintenance: educate, diet, retrain the bowel w/ timed toileting and pushing practice

SBM IV GI (26 decks)

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