Pediatric GI

Question 1

embryology: what structures for foregut, midgut and hind gut? blood supply?

Answer 1

F: esophagus, stomach, duodenum I + II - supplied by celiac. M: duodenum III + IV, proximal 1/2 transverse colon - superior mesenteric artery. H: distal colon to anus - inferior mes. artery. all drained by PVS

Question 2

clinical features of esophageal problems? (4)

Answer 2

swallowing difficulties (dysphagia or odynophagia). vomiting. aspiration. failure to thrive

Question 3

3 causes of esophagus problems

Answer 3

congenital abnormalities like TE fistula. gastroesophageal reflux. eosinophilic esophagitis.

Question 4

TE fistula?

Answer 4

communication between esophagus and trachea

Question 5

diagnosis and clinical findings for TE fistula?

Answer 5

prenatal fetal US: polyhydramnios. drooling, chocking, cyanosis with feeds, noisy breathing, resp. distress. massive abo distension when ventilating or bagging. inability to pass oral/nasal tube into stomach.

Question 6

management of TE fistula?

Answer 6

medical: stabilise, nutrition, pulm. care. surgical: restore esophageal continuity. emergency gastronomy to decompress abdo + gastronomy for nutrition.

Question 7

GER vs GERD?

Answer 7

GER = involuntary reflux into esophagus, and is physiologic. becomes GERD = pathologic if they have complications (which can be erosive or non-erosive). lots of GER in 6 mo olds, by 1 year should be very little reflux

Question 8

GERD: children often have ___ symptoms? ex?

Answer 8

atypical: recurrent abdo pain, heartburn, resp symptoms, regurg, retrosternal pain

Question 9

GI complications of GERD (6)

Answer 9

heartburn, dysphagia, food refusal, FTT, esophagitis, barrett’s esophagus (very rare)

Question 10

rep/ent complications of GERD?

Answer 10

laryngitis, sinusitis, chronic cough, repetitive pneumo, worsening of asthma and CG

Question 11

esophagitis: symptoms and signs?

Answer 11

hematemesis, anemia, heartburn, dysphagia, abdo pain, epigastric pain. no correlation between symptoms + endoscopic lesions

Question 12

investigations you can do

Answer 12

barium study, pH/impedance, endoscopy, gastric emptying

Question 13

managment of GER? GERD?

Answer 13

GER: feeding strategies + positioning (upright). GERD: acid suppression w/ H2 blocker/PPI, NG/NJ feeds, surgical fundoplications. considering other diagnoses if not responding

Question 14

other considerations w/ GER(D)

Answer 14

food allergy. anatonic/malrotation. hypertrophic pyloric stenosis. infections.

Question 15

eosinophilic esophagitis symptoms

Answer 15

dysphagia, food impaction, vomiting, abdo pain, feeding aversion, FTT

Question 16

pyloric stenosis

Answer 16

hypertrophy + hyperplasia of circular/longitudinal muscular layers of pylorus; edematous/thickened mucosa, dilated stomach

Question 17

pyloric stenosis: more common in? presentation when? symptoms + signs?

Answer 17

males. 3 weeks of life (1week to 5 mo). progressive projectile nonbilious vomiting in hungry infant, weight loss, lethargy, jaundice, epigastric distension. visible gastric peristalsis. firm mobile mass (olive). diminished stools. dehydration.

Question 18

investigations/diagnosis of pyloric stenosis

Answer 18

low Cl, K, metabolic alkalosis (because losing acid). US - 97% sn, 100% sp. can also do upper GI imaging in US not avail.

Question 19

pyloric stenosis is a _____. immediate treatment? then?

Answer 19

medical emergency: correct fluid loss, electrolytes, acid-base imbalance. then surgery is curative.

Question 20

primary features of small intestine disease?

Answer 20

abdo pain, vomiting, malabsoprtive features, protein losing enteropathy, occult or obvious blood loss.

Question 21

primary features of stomach disease?

Answer 21

abdo pain, vomiting, hematemesis, melena stools, FTT, peptic ulcers, pyloric stenosis

Question 22

3 small intestine diseases

Answer 22

celiac’s. intussussception (telescoping). meckel’s diverticulum

Question 23

presentation and diagnosis of celiac disease

Answer 23

weight loss, FTT, diarrhea/constipation, protuberant abdo, muscle wasting, iron def, diagnose with transglutaminase antibody (ATA) positive blood or tissue; can also do duodenal biopsy: shortened villi, elongated crypts, intraepithelial lymphocytes

Question 24

meckel’s: signs

Answer 24

PAINLESS RECTAL BLEEDING.

Question 25

meckel’s rule of 2’s

Answer 25

2% population. 2% symptomatic. 2:1 M:F. <2 years. 2 inches in length. 2 feet from ileocecal valve.