Pediatric GI (Newman)

Question 1

problems with free unconjugated bilirubin

Answer 1

• can cross the blood brain barrier

- is toxic to CNS

Question 2

total serum bilirubin with visible jaundice early in life

Answer 2

> 5 mg/dL

Question 3

Is conjugated hyperbilirubinemia pathologic?

Answer 3

always

Question 4

describe breast feeding jaundice

Answer 4

function of dehydration and decreased excretion of bilirubin in the stool (more supply related) *nonpathologic

Question 5

describe breast milk jaundice

Answer 5

presence of bilirubin deconjugating enzymes in milk *nonpathologic

Question 6

What type of hyperbilirubinemia does blood group incompatibility cause?

Answer 6

unconjugated

Question 7

When to test for blood group incompatibility

Answer 7

if mom is type O or mom is Rh(D) negative

Question 8

How to test from blood group incompatibility

Answer 8

infants cord blood should be evaluated for:

1) direct Ab (Coomb’s test)
2) blood type
3) Rh determination

Question 9

What type of bilirubin is seen with biliary atresia

Answer 9

conjugated

Question 10

Signs and Sx of biliary atresia

Answer 10

1) cholestatic jaundice
2) hepatomegaly
3) acholic stools

Question 11

First phase acute bilirubin toxicity (timing and Sx)

Answer 11

• first 1-2 days
• poor suck
• high pitch cry
• stupor
• hypotonia
• seizures

Question 12

Second phase acute bilirubin toxicity (timing and Sx)

Answer 12

• middle of first week of life
• hypertonia of extensor muscles
• opisthotonus
• retrocollis
• fever

Question 13

Third phase acute bilirubin toxicity (timing and Sx)

Answer 13

• after first week of life

- hypertonia

Question 14

how does jaundice advance in newborns?

Answer 14

cephalo-caudally

Question 15

Assessing jaundice in newborns

Answer 15

• turn on lights and blanch skin with digital pressure

Question 16

Some risk factors for hyperbilirubinemia

Answer 16

• jaundice in 1st 24 hours
• previous sibling requiring phototherapy
• exclusive breastfeeding, not going well

Question 17

treatment of mild jaundice

Answer 17

• increase frequency of feedings

- continue breast feeding

Question 18

What does phototherapy do?

Answer 18

isomerizes bilirubin, making it water soluble

Question 19

describe GER

Answer 19

• passage of gastric contents into the esophagus

- the happy spitter

Question 20

describe GERD

Answer 20

• when symptoms or complications are present as a result of GER
• hard to feed, cry a lot, arch and scream, hard to gain weight

Question 21

Diagnosis of GER/GERD

Answer 21

• esophageal pH monitoring with impedance testing (direction of bolus movement)
• tells frequency of GER
• association of low esophageal pH with Sx

Question 22

Treatment of GERD

Answer 22

• kids sleep on back
• smaller amounts of food more frequently
• upright position during feeding and for 30-45 minutes after feeding
• medications (H2 antagonists)
• surgery

Question 23

Where does intussusception occur most frequently?

Answer 23

most are ileocecal: ileum invaginates into the colon at the ileocecal valve/junction

Question 24

Frequent physical exam finding with intussuception

Answer 24

palpable tubular mass in their abdomen (RUQ)

Question 25

Profile of a child with pyloric stenosis

Answer 25

• < 2 months old

- first born male

Question 26

Classic metabolic picture of child with pyloric stenosis

Answer 26

• hypochloremic
• hypokalemic
• metabolic alkalosis

Question 27

What is needed for a definitive diagnosis of hirshsprung

Answer 27

Rectal biopsy

Question 28

Findings suggestive of hirshsprungs

Answer 28

1) palpable stool throughout abdomen
2) empty rectal vault
3) of never having unassisted stooling

Question 29

Failure to pass meconium in first 24-48 hours of life

Answer 29

Hirshsprungs