Pediatric GI Diseases Flashcards
Understand the anatomic features and pathogenesis of Tracheo-esophageal fistula
failure of normal separation of intestinal and respiratory tracts; most cases also have esophageal atresia
presents with polyhydramnios, choking with feeds
surgery. There can be many varients
Understand the anatomic features and pathogenesis of Infantile hypertrophic pyloric stenosis
happens at gastroduodenal junction,
they show non-bilious projectile vomiting, associated with upper abdominal mass, usually presents around 3 wks of life
dx with H+P, ultrasound
tx surgery
Understand the anatomic features and pathogenesis of Meckel diverticulum
most common malformation of the small intestine–2% of population
abnormal remnant of vitteline duct
contains heterotopic gastric or pancreatic tissue
presents as obstruction, bleeding , and or inflammation
Dx- Technetium-99 scan and/or other imaging (US/CT)
Tx- surgical resection
Understand the anatomic features and pathogenesis of Omphalocele vs Gastroschisis
Omphalocele associated with advanced maternal age failure of intestines to return to abdomen following physiological herniation at wks 6-10 of development; *peritoneal and amniotic covering associated malformations Dx- often prenatal ultrasound Tx-surgery
Gatroschisis- paraumbilical abdominal wall defect in the rectus abdominus
no amniotic covering
no associated malformations
Understand the anatomic features and pathogenesis of Intestinal malrotation
abnormal rotation and fixation of intestinal tract
can occur on its own or it can complicate omphalocele, gastroschisis, etc.
presents as midgut volvulus and obstruction
(biliary vomiting)
Understand the anatomic features and pathogenesis of Gastrointestinal duplications/cysts
saccular cysts or tubular structures containing all layers of the normal bowel wall and gastrointestinal lining, which may or may not communicate with bowel
most frequent site of duplication is small intestine or colon
presnts incidentally or may cause bowel obstruction
Dx H+ P imaging, surgical exploration
Tx- surgery
Understand the anatomic features and pathogenesis of Intestinal stenosis/atresia
duodenal atresia most common, up to 40% of these have *downs syndrome
presumed vascular ischemic etiology
presentations- polyhydramnios, obstructive symptoms bilious vomiting
Dx- H and P imaging
Tx- surgery
Understand the anatomic features and pathogenesis of Imperforate anus/rectal agenesis
varying degrees of severity, frequently associated with fistula formation (perineum, bladder/urethra, vagina); up to 50% associated with other anomalies
Dx PE
Tx- surgery
Understand the underlying developmental abnormality in Hirschsprung Disease
RET gene
defect of enteric nervous system development resulting in absense of ganglion cells
presents as a failure to pass meconium/ poor stooling…if unrecognized, can progress to life threatening mega colon
Dx- H+P, imaging, biopsy (no gsnglion cells)
Tx- surgical resection of aganglionic segment
complications- short bowel syndrome
Understand the predisposing factors and proposed pathogenesis of Necrotizing Enterocolitis
complication of prematurity
presentation- feeding intolerance, abdominal distention, bloody stools
pathogenesis- multifactorial- enteric feeds, bacterial flora, immune immaturity, bowel hypoperfusion/ischemia (patent ductus arteriosus–is a risk factor
Tx- bowel rest, abx, surgical resection
complications- bowel strictures and short bowel synndrome
Compare and contrast allergic and reflux esophagitis
reflux incompeteant LE sphincter/hiatal hernia ph positive mild eosinophilia, distal esophageal involvement Tx- acid blockade
allergic
immunologic rxn to dietary allergen, incompletely understood.
pH probe- negative
marked eosinophilic infiltrate
submuscosal inflammation with fibrotic changes
distal and proximal esophagus
Tx- dietary mods, steroids
