Pediatric GI Pathology Flashcards
Is atresia/stenosis more common in foregut or hindgut?
More common in foregut.
What other abnormality often co-occurs with esophageal atresia?
Tracheo-esophageal (TE) fistula: Most commonly… Lower esophagus, disconnected from upper esophagus, has fistula with the trachea.
Clinical presentation of esophageal atresia (with TE fistula)? On X-ray?
Aspiration, regurgitation, respiratory distress with initial feeds.
X-ray shows absence of GI gas.
Take home point about clinical pattern of esophageal atresia (with TE fistula)?
Often occurs as part of syndrome with many abnormality, such as trisomies.
Duodenal stenosis causes?
Presentation?
Classic X-ray presentation?
Web, or annular pancreas.
Presents with vomiting +/- bile (depending on if before or after ampulla of Vater)
Double-bubble.
Broad cause thought to be behind most jejuno-ileal atresias?
Intrauterine vascular accidents
including volvulus, hernias, NEC
What’s the division line for high vs. low anorectal atresia?
What tends to happen in high vs. low atresia?
Division line is levator sling.
High: fistula with GU tract.
Low: fistula out through skin
Do gastrointestinal duplications usually communicate?
No, but they do usually share a wall.
and they’re usually on the mesenteric side of the bowel…
When to GI duplications cause symptoms?
When mucous secretions build up -> cysts -> compress normal bowel.
What side of the bowel are diverticula usually on?
the anti-mesenteric side (remember all that penetrating artery weakness stuff?)
Where do diverticula come from? Most common form?
Remnants of vitelline duct (to yolk sac).
Meckel’s diverticulum is most common.
What’s the problem with Meckel’s diverticulum?
50% are symptomatic and do weird shit like develop gastric mucosa, secreting acid that damages small bowel mucosa.
(This is screened for when there’s rectal bleeding in an infant.)
What are neurenteric remnants or cysts?
Most severe complication?
Connections between the intestine and spinal cord that failed to obliterate.
Most severe complication is chemical meningitis.
Why is volvulus more likely to happen when normal rotation of the bowel doesn’t happen?
Things such as the cecum don’t get fixed retroperitoneally as they normally would. They’re free floating, or fixed in a bad area, and cause problems.
2 main categories of primary pseudobstruction?
Enteric neuropathies (esp. Hirschsprung) Visceral myopathies
What does visceral myopathy affect in addition to intestinal motility?
Bladder contraction.
Secondary causes of pseudobstruction?
Infections (esp Chagas), toxic megacolon, connective tissue disorders, muscular dystrophies, nervous problems, endo problems, metabolic, etc. etc.
Where does Hirschsprung’s disease most often affect? How does this help for surgical treatment?
The distal hindgut.
Can cut out the affected, aganglionic bowel and bring remaining bowel to the anus.
What’s actually missing in Hirschsprung’s?
Ganglia. There is still some other nervous tissue in Meisner’s and Auerbach’s plexuses.
Who does necrotizing enterocolitis (NEC) affect?
Premature infants, most with very low birthweight.
4 most important contributing factors for NEC?
Intestinal ischemia
Intestinal immaturity
Bacterial colonization of gut
Enteral feeding
Signs of NEC? How does it look on radiology?
Abdominal distension, bloody stools, apnea.
Radiology: gas in bowel wall (pneumatosis)
What does the histology of NEC look like?
Ischemic necrosis of the mucosa.
What can happen when NEC heals?
Strictures and atresia.
Treatment of NEC?
Resect involved segments of colon. If too much gone, can have Short Bowel Syndrome.
(if too much is gone, must do TPN and transplant)
What’s intussusception? What’s the problem with that?
Invagination of one instestinal segnement into the other.
This constricts venous outflow, then arterial inflow -> ischemic necrosis.
Common presentation of intussusception?
Colicky, intermittent pain. If there’s necrosis, will often have blood stool.
Kids will often draw their knees up to their chest.
What are 3 things that can cause a “lead point” for intussusception?
Masses
Meckel’s Diverticulum
Lymphoid hyperplasia
Intestinal manifestations of CF?
Thick meconium that obstructs bowel (ileus -(sometimes)-> perforation -> meconium peritonitis).
Dilated Brunner’s glands with thick secretion.
Pancreas manifestations of CF?
Necrosis of acini of pancreas -> loss of exocrine function of pancreas.
Liver manifestations of CF?
High LFTs, hepatomegaly, steatosis, cirrhosis, gall stones.
