Pediatric GI Flashcards
1
Q
kids who get NEC
A
preterm, term infants with CHD, immunosuppression, umbilical venous catheter
2
Q
XR findings
A
EARLY: bowel thickening, fixed distension on serial exams
LATE: pneumatosis, portal venous gas, pneumoperitoneum
3
Q
NEC common location
A
iluem, RLQ right colon
4
Q
Football sign
A
pneumoperitoneum, air outlining falciform ligament
5
Q
Delayed complication of NEC
A
stricture
6
Q
progressive projectile nonbilious emesis in firstborn males
A
HPS; 3x less common in females
7
Q
Common age for HPS
A
2-12 weeks old
8
Q
Caterpillar sign
A
undulating contour of gastric wall peristalsing against pylorus on XR
9
Q
US criteria for HPS
A
wall thickness > 4 mm (echogenic mucosa to serosa) and channel lenght >16; 3.14; no feeds passing through pylorus
10
Q
treatment for HPS
A
pyloroplasty, electrolyte replacement
11
Q
Ddx for HPS
A
pylorospasm
12
Q
Appendicitis findings
A
> 6 mm swolleng incompressible blind-ending tubular structure in RLQ; possible echogenic appendiclolith
13
Q
Neonatal bilious emesis
A
midgut volvulus; nonobstructive gastroenteritis
14
Q
age of presentation for malrotation
A
75% within first month of life; 90% symptomatic within one year
15
Q
normal embryologic development of bowel rotation
A
270 counterclockwise around SMA; retroperitoneal course of duodenum; occurs 5-11th weeks
16
Q
most important anatomy to show on upper GI
A
C sweep of duodenum and duodenojejunal junction; left of the left sided pedicle of the duodenal bulb (L1)
17
Q
double bubble sign
A
duodenal obstruction; stomach and duodenal gas bubbles
18
Q
corkscrew appearance of bowel
A
twisted bowel seen in midgut volvulus
19
Q
Sublte findings associated with midgut volvulus
A
DJJ inferior to duodenal bulb, left of pedicle; cecum midline or in LLQ; inversion of SMA/SMV; whirlpool sign of mesenteric vessels
20
Q
treatment of malrotation with volvulus
A
Ladd procedure; volvulus reduction, resection of necrotic bowel, lysis of Laddbands
21
Q
most common location for intussusception
A
ileocolic location
22
Q
typical presentation of intussusception
A
colicky abdominal pain; current jelly stol, palpable RLQ mass
23
Q
types of intussusception
A
idiopathic from lymphoid tissue after viral infection; pathologic lead point (intestinal polyp, Mckel, lymphoma)
24
Q
target or pseudokidney sign
A
intussuception
25
Differential for intussusception
intussusception, colitis, intramural hematoma, HSP/trauma
26
treatment for intussusception
air vs contrast enema; air up to 120 mmHg; successful flush of air into small bowel; up to 3 attempts up to 3 minutes each.
27
Contraindications to pneumatic reduction
free air, peritoneal signs, septic shock
28
Esophageal atresia is associated with?
TEF
29
VACTERL stands for
Vertebral, anal atresia, cardiac, TEF, renal anomalieis, limb (radial ray) anomalies
30
Most common type of TEF
Type A; NG tube terminating in mid esophagus with air filled bowel from distal TEF
31
Fetal suspicion for TEF
polyhydramnios and lack of visualization of stomach
32
TEF associations
VACTERL, bronchus suis, tracheomalacia
33
obstruction of distal stomach
gastric atresia
34
cause for nonbilious vomiting that dos not get progressively worse
gastric atresia; HPS gets progressively worse; nonobstructive antral web
35
Single bubble sign
gastric atresia
36
Imaging of choice with bowel obstruction
XR, upper GI for proximal obstruction, lower GI/contrast enema for distal obstruction
37
Windsock deformity
Duodenal web, symptomatic when child begins to eat solid food
38
Double bubble sign
duodenal atresia, may also suggest midgut, annular pancreas, duodenal stenosis/web
39
Associations with duodenal atresia
Down syndrome, VACTERL, shunt vascularity cardiac lesions, malrotation, annular pancreas
40
Triple bubble sign
proximal jejunal atresia
41
Causes for jejunal atresia
in utero vascular insult
42
type of contrast for contrast enema
isotonic or hypertonic water soluble contrast (400 mOsm)
43
Definition of microcolon
abnormally small caliber (<1 cm)
44
Types of microcolon
meconium ileus, ileoal/colonic atresia, colonic Hirshprung, megacystic microcolon hypoperistalsis syndrome
45
Complications of meconium ileus
bowel obstruction, perforation, peritonitis, abdominal and scrotal calcs
46
earliest manifestation of CF
meconium ileus
47
imaging findings of meconium ileus
XR: distal obstruction with soap bubble lucencies in the RLQ
| Contrast enema: microcolun with multiple round filling defects in the distended ileum; smallest of all microcolons
48
Treatment of meconium ileus
gastrograffin enema, surgery if resistant
49
Ileal/colonic atresia imaging appearance
abrupt cutoff at the site of atresia; no filling defects
50
Small left colon syndrome or functional immaturity of the colon (FIC), meconium plug syndrome
most common diagnosis in failure to pass meconium; temporary functional immaturity of colonic ganglion cells; abnormal colon motlitiy
51
Infants who get small left colon
preterm neonates, neonates with moms with preeclampsia who received magnesium, diabetic
52
Imaging appearance of small left colon
small left colon, discrete transition at splenic flexure; filling defects = meconium plugs
53
Ddx small left colon
Hirschsprung with transitin at splenic flexure (does not hve a distensible rectum or resolve after enema)
54
aganglionoisis of distal bowel; distended distal bowel
Hirschsprung
55
consideration in neonates with bowel obstruction/colitis
Neonates with Hirschsprung may develop a form of eneterocolitis --> toxic megacolon; frank colitis in newborn is HD until proven otherwise
56
Associations with Hirschsprung
Down syndrome, less than duodenal atresia
57
Hirshsprung enema findings; rectosigmoid ratio
cone shaped transition zone; rectum normally has larger diameter than sigmoid; if the sigmoid is bigger than rectum, consider Hirshsprung
58
Megacystic microcolon intestinal hypoperistalsis syndrome
loss of bowel/bladder smooth muscle; fatal
59
Causes of childhood bowel obstruction
AAIIMM: appy, adhesions, internal/inguinal hernia, intussusception, Meckel, malrotation
60
Patent processus vaginalis complication
indirect inguinal hernia
61
Landmark for imperforate anus
puborectalis sling; high vs low; gender dependent
62
Association with high male anorectal malformation
posterior urethral valve/bladder fistula
63
Association with high female anorectal malformation
vaginal fistula
64
Treatment for high imperforate anus
colostomy, then definitive repair
65
association with low anorectal malformation
perineal fistula; treat with perineal anoplasty
66
Diagnosis of imperforate anus
infracoccygeal ultrasound
67
Conjugated/direct hyperbilirubinemia causes
biliary atresia, Alagille syndrome, bile acid synthetic defecs, metabolic disease, alpha 1 antitrypsin deficiency, infectious etioloties
68
Indirect/unconjugated hyperbilirubinemia
found in bloodstream; hemolytic jaundice; hepatitis
69
Imaging test of choice in conjugated hyperbilirubinemia
Tc 99m HIDA hepatobiliary scintigraphy; premedicate 5 days before with phenobarbital to stimulate hepatocytes
70
obliterative cholangiopathy of the intrahepatic and extraheatic bile ducts; obstructive jaundice
Biliary atresia
71
Triangle cord sign
The triangular cord sign is a triangular or tubular echogenic cord of fibrous tissue seen in the porta hepatis at ultrasonography and is relatively specific for the diagnosis of biliary atresia
72
Is gallbladder present with biliary atresai
suggestive of BA; gallbladder seen in 20% cases
73
NM findings of neonatal hepatitis
hepatobiliary scintigraphy: poor hepatic excretion, delayed hepatic clearance, variable bowel excretion
74
Types of primary pediatric liver tumors
epithelial/hepatocyte or mesencymal; liver mets
75
Cystic liver masses Mesencymal hamartoma
multicystic hamartomous lesion; developmental anomaly of the bile ducts, portal vein, and extramedullary hematopoeisis
76
Treatment for mesencymal hamartoma
surgical resection
77
presentation of mesenchymal hamartoma
enlarging abdominal mass; most diagnosed by ae2; no elevation of tumor markers
78
Choledocal cysts
saccular or fusiform dilation of bile ducts
79
gallbladder hydrops association
infection, inflammatory process (Kawasaki)
80
Classification of pediatric vascular malformations and neoplasms
High flow (AVM, AVF) or low flow lesions (venous malformation and lymphatic malformations)
81
High flow vascular neoplasm in pediatrics
Infantile hemangioma/hemangioendothelioma
82
Association with infantile hemangioma
Kasabach-Merit syndrome: vascular neoplasm, hemolytic anemia, consumptive coagulopathy
83
Types of infantile hemangiomas
focal, multifocal, diffuse; 60% occur in head and neck
84
Imaging findings of hemangioma
highly vascular, T2 hyperintense, T1 hypointense enhance peripherally with delayed fill-in; may have variable calcification, central necrosis, hemorrhage
85
Management of infantile hemangioma
most involute (if GLUT1 positive) although propranolol or surgery may be necessary if it causes CHF
86
Hepatoblastoma
malignant embryonal neoplasm; 3rd most common abdominal malignancy (after neuroblastoma and Wilms)
87
Association with hepatoblastoma
Beckweith Wiedemann (Q6 mo screening US), familiar adenomatous polyposis syndrome (FAPS), fetal alcohol syndrome
88
Tumor markers with hepatoblastoma
elevated AFP
89
Imaiging findings of hepatoblastoma
XR: RUQ calcification
CT: heterogenous solid enhancing mass; portain vein/hepatic vein invasion
90
HCC in kids
cirrhosis; alpha 1 antitrypsin deficiency, glycgen storage disease, tyrosinemia, biliar atresia, chronic viral hepatitis; elevated AFP
91
Malignant mesenchymoma
undifferentiateed embryonal sarcoma in kids 6-10 yo; AFP is negative
92
negative AFP with hepatic tumors
malignant mesenchymoma; hepatoblastoma, HCC positive
93
Common pediatric tumors that met to liver
Wilms, neuroblastoma
94
Remnant omphalomesenteric duct
Meckel diverticulum
95
Complications with Meckel
lead point for intussusception; GI bleeding (ectopic gastric mucosa)
96
omphalomesenteric duct connections
connect yolk sac via umbilicus
97
Complications of omphalomesenteric duct anomalies
umbilicoileal fistula, meckel diverticulum
98
Where is Meckel located
antimesenteric aspect of distal ileum; 2 feet from ileocecal valve
99
NM scan for Meckel
Tc99m pertecnetate scan; only positive of it contains ectopic gastric mucosa
100
Meconium spectrum
aspiration, ileus, plug, ileus-equivalent syndrome, peritonitis
101
Types of abdominal calcifications in peds
meconium peritonitis, pediatric neoplasm (neuroblastoma, teratoma, hepatoblastoma), adrenal hemorrhage, RUQ calcifications (gallstones, hepatoblastoma, hepatic TORCH infections)
