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CORE--Peds > Pediatric GI > Flashcards

Pediatric GI Flashcards

1
Q

kids who get NEC

A

preterm, term infants with CHD, immunosuppression, umbilical venous catheter

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2
Q

XR findings

A

EARLY: bowel thickening, fixed distension on serial exams
LATE: pneumatosis, portal venous gas, pneumoperitoneum

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3
Q

NEC common location

A

iluem, RLQ right colon

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4
Q

Football sign

A

pneumoperitoneum, air outlining falciform ligament

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5
Q

Delayed complication of NEC

A

stricture

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6
Q

progressive projectile nonbilious emesis in firstborn males

A

HPS; 3x less common in females

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7
Q

Common age for HPS

A

2-12 weeks old

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8
Q

Caterpillar sign

A

undulating contour of gastric wall peristalsing against pylorus on XR

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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

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10
Q

treatment for HPS

A

pyloroplasty, electrolyte replacement

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11
Q

Ddx for HPS

A

pylorospasm

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12
Q

Appendicitis findings

A

> 6 mm swolleng incompressible blind-ending tubular structure in RLQ; possible echogenic appendiclolith

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13
Q

Neonatal bilious emesis

A

midgut volvulus; nonobstructive gastroenteritis

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14
Q

age of presentation for malrotation

A

75% within first month of life; 90% symptomatic within one year

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15
Q

normal embryologic development of bowel rotation

A

270 counterclockwise around SMA; retroperitoneal course of duodenum; occurs 5-11th weeks

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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)

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17
Q

double bubble sign

A

duodenal obstruction; stomach and duodenal gas bubbles

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18
Q

corkscrew appearance of bowel

A

twisted bowel seen in midgut volvulus

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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

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20
Q

treatment of malrotation with volvulus

A

Ladd procedure; volvulus reduction, resection of necrotic bowel, lysis of Laddbands

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21
Q

most common location for intussusception

A

ileocolic location

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22
Q

typical presentation of intussusception

A

colicky abdominal pain; current jelly stol, palpable RLQ mass

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23
Q

types of intussusception

A

idiopathic from lymphoid tissue after viral infection; pathologic lead point (intestinal polyp, Mckel, lymphoma)

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24
Q

target or pseudokidney sign

A

intussuception

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25
Q

Differential for intussusception

A

intussusception, colitis, intramural hematoma, HSP/trauma

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26
Q

treatment for intussusception

A

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.

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27
Q

Contraindications to pneumatic reduction

A

free air, peritoneal signs, septic shock

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28
Q

Esophageal atresia is associated with?

A

TEF

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29
Q

VACTERL stands for

A

Vertebral, anal atresia, cardiac, TEF, renal anomalieis, limb (radial ray) anomalies

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30
Q

Most common type of TEF

A

Type A; NG tube terminating in mid esophagus with air filled bowel from distal TEF

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31
Q

Fetal suspicion for TEF

A

polyhydramnios and lack of visualization of stomach

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32
Q

TEF associations

A

VACTERL, bronchus suis, tracheomalacia

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33
Q

obstruction of distal stomach

A

gastric atresia

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34
Q

cause for nonbilious vomiting that dos not get progressively worse

A

gastric atresia; HPS gets progressively worse; nonobstructive antral web

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35
Q

Single bubble sign

A

gastric atresia

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36
Q

Imaging of choice with bowel obstruction

A

XR, upper GI for proximal obstruction, lower GI/contrast enema for distal obstruction

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37
Q

Windsock deformity

A

Duodenal web, symptomatic when child begins to eat solid food

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38
Q

Double bubble sign

A

duodenal atresia, may also suggest midgut, annular pancreas, duodenal stenosis/web

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39
Q

Associations with duodenal atresia

A

Down syndrome, VACTERL, shunt vascularity cardiac lesions, malrotation, annular pancreas

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40
Q

Triple bubble sign

A

proximal jejunal atresia

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41
Q

Causes for jejunal atresia

A

in utero vascular insult

42
Q

type of contrast for contrast enema

A

isotonic or hypertonic water soluble contrast (400 mOsm)

43
Q

Definition of microcolon

A

abnormally small caliber (<1 cm)

44
Q

Types of microcolon

A

meconium ileus, ileoal/colonic atresia, colonic Hirshprung, megacystic microcolon hypoperistalsis syndrome

45
Q

Complications of meconium ileus

A

bowel obstruction, perforation, peritonitis, abdominal and scrotal calcs

46
Q

earliest manifestation of CF

A

meconium ileus

47
Q

imaging findings of meconium ileus

A

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
Q

Treatment of meconium ileus

A

gastrograffin enema, surgery if resistant

49
Q

Ileal/colonic atresia imaging appearance

A

abrupt cutoff at the site of atresia; no filling defects

50
Q

Small left colon syndrome or functional immaturity of the colon (FIC), meconium plug syndrome

A

most common diagnosis in failure to pass meconium; temporary functional immaturity of colonic ganglion cells; abnormal colon motlitiy

51
Q

Infants who get small left colon

A

preterm neonates, neonates with moms with preeclampsia who received magnesium, diabetic

52
Q

Imaging appearance of small left colon

A

small left colon, discrete transition at splenic flexure; filling defects = meconium plugs

53
Q

Ddx small left colon

A

Hirschsprung with transitin at splenic flexure (does not hve a distensible rectum or resolve after enema)

54
Q

aganglionoisis of distal bowel; distended distal bowel

A

Hirschsprung

55
Q

consideration in neonates with bowel obstruction/colitis

A

Neonates with Hirschsprung may develop a form of eneterocolitis –> toxic megacolon; frank colitis in newborn is HD until proven otherwise

56
Q

Associations with Hirschsprung

A

Down syndrome, less than duodenal atresia

57
Q

Hirshsprung enema findings; rectosigmoid ratio

A

cone shaped transition zone; rectum normally has larger diameter than sigmoid; if the sigmoid is bigger than rectum, consider Hirshsprung

58
Q

Megacystic microcolon intestinal hypoperistalsis syndrome

A

loss of bowel/bladder smooth muscle; fatal

59
Q

Causes of childhood bowel obstruction

A

AAIIMM: appy, adhesions, internal/inguinal hernia, intussusception, Meckel, malrotation

60
Q

Patent processus vaginalis complication

A

indirect inguinal hernia

61
Q

Landmark for imperforate anus

A

puborectalis sling; high vs low; gender dependent

62
Q

Association with high male anorectal malformation

A

posterior urethral valve/bladder fistula

63
Q

Association with high female anorectal malformation

A

vaginal fistula

64
Q

Treatment for high imperforate anus

A

colostomy, then definitive repair

65
Q

association with low anorectal malformation

A

perineal fistula; treat with perineal anoplasty

66
Q

Diagnosis of imperforate anus

A

infracoccygeal ultrasound

67
Q

Conjugated/direct hyperbilirubinemia causes

A

biliary atresia, Alagille syndrome, bile acid synthetic defecs, metabolic disease, alpha 1 antitrypsin deficiency, infectious etioloties

68
Q

Indirect/unconjugated hyperbilirubinemia

A

found in bloodstream; hemolytic jaundice; hepatitis

69
Q

Imaging test of choice in conjugated hyperbilirubinemia

A

Tc 99m HIDA hepatobiliary scintigraphy; premedicate 5 days before with phenobarbital to stimulate hepatocytes

70
Q

obliterative cholangiopathy of the intrahepatic and extraheatic bile ducts; obstructive jaundice

A

Biliary atresia

71
Q

Triangle cord sign

A

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
Q

Is gallbladder present with biliary atresai

A

suggestive of BA; gallbladder seen in 20% cases

73
Q

NM findings of neonatal hepatitis

A

hepatobiliary scintigraphy: poor hepatic excretion, delayed hepatic clearance, variable bowel excretion

74
Q

Types of primary pediatric liver tumors

A

epithelial/hepatocyte or mesencymal; liver mets

75
Q

Cystic liver masses Mesencymal hamartoma

A

multicystic hamartomous lesion; developmental anomaly of the bile ducts, portal vein, and extramedullary hematopoeisis

76
Q

Treatment for mesencymal hamartoma

A

surgical resection

77
Q

presentation of mesenchymal hamartoma

A

enlarging abdominal mass; most diagnosed by ae2; no elevation of tumor markers

78
Q

Choledocal cysts

A

saccular or fusiform dilation of bile ducts

79
Q

gallbladder hydrops association

A

infection, inflammatory process (Kawasaki)

80
Q

Classification of pediatric vascular malformations and neoplasms

A

High flow (AVM, AVF) or low flow lesions (venous malformation and lymphatic malformations)

81
Q

High flow vascular neoplasm in pediatrics

A

Infantile hemangioma/hemangioendothelioma

82
Q

Association with infantile hemangioma

A

Kasabach-Merit syndrome: vascular neoplasm, hemolytic anemia, consumptive coagulopathy

83
Q

Types of infantile hemangiomas

A

focal, multifocal, diffuse; 60% occur in head and neck

84
Q

Imaging findings of hemangioma

A

highly vascular, T2 hyperintense, T1 hypointense enhance peripherally with delayed fill-in; may have variable calcification, central necrosis, hemorrhage

85
Q

Management of infantile hemangioma

A

most involute (if GLUT1 positive) although propranolol or surgery may be necessary if it causes CHF

86
Q

Hepatoblastoma

A

malignant embryonal neoplasm; 3rd most common abdominal malignancy (after neuroblastoma and Wilms)

87
Q

Association with hepatoblastoma

A

Beckweith Wiedemann (Q6 mo screening US), familiar adenomatous polyposis syndrome (FAPS), fetal alcohol syndrome

88
Q

Tumor markers with hepatoblastoma

A

elevated AFP

89
Q

Imaiging findings of hepatoblastoma

A

XR: RUQ calcification
CT: heterogenous solid enhancing mass; portain vein/hepatic vein invasion

90
Q

HCC in kids

A

cirrhosis; alpha 1 antitrypsin deficiency, glycgen storage disease, tyrosinemia, biliar atresia, chronic viral hepatitis; elevated AFP

91
Q

Malignant mesenchymoma

A

undifferentiateed embryonal sarcoma in kids 6-10 yo; AFP is negative

92
Q

negative AFP with hepatic tumors

A

malignant mesenchymoma; hepatoblastoma, HCC positive

93
Q

Common pediatric tumors that met to liver

A

Wilms, neuroblastoma

94
Q

Remnant omphalomesenteric duct

A

Meckel diverticulum

95
Q

Complications with Meckel

A

lead point for intussusception; GI bleeding (ectopic gastric mucosa)

96
Q

omphalomesenteric duct connections

A

connect yolk sac via umbilicus

97
Q

Complications of omphalomesenteric duct anomalies

A

umbilicoileal fistula, meckel diverticulum

98
Q

Where is Meckel located

A

antimesenteric aspect of distal ileum; 2 feet from ileocecal valve

99
Q

NM scan for Meckel

A

Tc99m pertecnetate scan; only positive of it contains ectopic gastric mucosa

100
Q

Meconium spectrum

A

aspiration, ileus, plug, ileus-equivalent syndrome, peritonitis

101
Q

Types of abdominal calcifications in peds

A

meconium peritonitis, pediatric neoplasm (neuroblastoma, teratoma, hepatoblastoma), adrenal hemorrhage, RUQ calcifications (gallstones, hepatoblastoma, hepatic TORCH infections)

CORE--Peds (7 decks)

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