Pediatric GI Pathology

Question 1

Is atresia/stenosis more common in foregut or hindgut?

Answer 1

More common in foregut.

Question 2

What other abnormality often co-occurs with esophageal atresia?

Answer 2

Tracheo-esophageal (TE) fistula: Most commonly… Lower esophagus, disconnected from upper esophagus, has fistula with the trachea.

Question 3

Clinical presentation of esophageal atresia (with TE fistula)? On X-ray?

Answer 3

Aspiration, regurgitation, respiratory distress with initial feeds.
X-ray shows absence of GI gas.

Question 4

Take home point about clinical pattern of esophageal atresia (with TE fistula)?

Answer 4

Often occurs as part of syndrome with many abnormality, such as trisomies.

Question 5

Duodenal stenosis causes?
Presentation?
Classic X-ray presentation?

Answer 5

Web, or annular pancreas.
Presents with vomiting +/- bile (depending on if before or after ampulla of Vater)
Double-bubble.

Question 6

Broad cause thought to be behind most jejuno-ileal atresias?

Answer 6

Intrauterine vascular accidents

including volvulus, hernias, NEC

Question 7

What’s the division line for high vs. low anorectal atresia?

What tends to happen in high vs. low atresia?

Answer 7

Division line is levator sling.
High: fistula with GU tract.
Low: fistula out through skin

Question 8

Do gastrointestinal duplications usually communicate?

Answer 8

No, but they do usually share a wall.

and they’re usually on the mesenteric side of the bowel…

Question 9

When to GI duplications cause symptoms?

Answer 9

When mucous secretions build up -> cysts -> compress normal bowel.

Question 10

What side of the bowel are diverticula usually on?

Answer 10

the anti-mesenteric side (remember all that penetrating artery weakness stuff?)

Question 11

Where do diverticula come from? Most common form?

Answer 11

Remnants of vitelline duct (to yolk sac).

Meckel’s diverticulum is most common.

Question 12

What’s the problem with Meckel’s diverticulum?

Answer 12

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.)

Question 13

What are neurenteric remnants or cysts?

Most severe complication?

Answer 13

Connections between the intestine and spinal cord that failed to obliterate.
Most severe complication is chemical meningitis.

Question 14

Why is volvulus more likely to happen when normal rotation of the bowel doesn’t happen?

Answer 14

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.

Question 15

2 main categories of primary pseudobstruction?

Answer 15

Enteric neuropathies (esp. Hirschsprung)
Visceral myopathies

Question 16

What does visceral myopathy affect in addition to intestinal motility?

Answer 16

Bladder contraction.

Question 17

Secondary causes of pseudobstruction?

Answer 17

Infections (esp Chagas), toxic megacolon, connective tissue disorders, muscular dystrophies, nervous problems, endo problems, metabolic, etc. etc.

Question 18

Where does Hirschsprung’s disease most often affect? How does this help for surgical treatment?

Answer 18

The distal hindgut.

Can cut out the affected, aganglionic bowel and bring remaining bowel to the anus.

Question 19

What’s actually missing in Hirschsprung’s?

Answer 19

Ganglia. There is still some other nervous tissue in Meisner’s and Auerbach’s plexuses.

Question 20

Who does necrotizing enterocolitis (NEC) affect?

Answer 20

Premature infants, most with very low birthweight.

Question 21

4 most important contributing factors for NEC?

Answer 21

Intestinal ischemia
Intestinal immaturity
Bacterial colonization of gut
Enteral feeding

Question 22

Signs of NEC? How does it look on radiology?

Answer 22

Abdominal distension, bloody stools, apnea.

Radiology: gas in bowel wall (pneumatosis)

Question 23

What does the histology of NEC look like?

Answer 23

Ischemic necrosis of the mucosa.

Question 24

What can happen when NEC heals?

Answer 24

Strictures and atresia.

Question 25

Treatment of NEC?

Answer 25

Resect involved segments of colon. If too much gone, can have Short Bowel Syndrome.
(if too much is gone, must do TPN and transplant)

Question 26

What’s intussusception? What’s the problem with that?

Answer 26

Invagination of one instestinal segnement into the other.

This constricts venous outflow, then arterial inflow -> ischemic necrosis.

Question 27

Common presentation of intussusception?

Answer 27

Colicky, intermittent pain. If there’s necrosis, will often have blood stool.
Kids will often draw their knees up to their chest.

Question 28

What are 3 things that can cause a “lead point” for intussusception?

Answer 28

Masses
Meckel’s Diverticulum
Lymphoid hyperplasia

Question 29

Intestinal manifestations of CF?

Answer 29

Thick meconium that obstructs bowel (ileus -(sometimes)-> perforation -> meconium peritonitis).
Dilated Brunner’s glands with thick secretion.

Question 30

Pancreas manifestations of CF?

Answer 30

Necrosis of acini of pancreas -> loss of exocrine function of pancreas.

Question 31

Liver manifestations of CF?

Answer 31

High LFTs, hepatomegaly, steatosis, cirrhosis, gall stones.