Pediatric GI tract Flashcards
what do for de keeds
FIRST
a plain film abominal XR
to check for free air, obstruction, torsion
Then if needed a contrast x ray
pediatric GI probs
Esophageal atresia - completely closed off lumen of the esophagus - very often with a single or double fistula to the trachea - Trachoesophageal fistula
X ray findings of esophageal atresia with a lower tracheoesophageal fistula
If the lungs are connected to the esophagus somewhere below the atresia, the lungs will slowly fill the GI tract with gas. Air will be seen filling the intestinal loops.
When a contrast agent is attempted to be administered, the catheter will hit the atretic dead end of the esophagus.
Hypertrophic pyloric stenosis
Presents bombastically at 3-6 week infants. with FREQUENT PROJECTILE VOMITING, that is non-bilious
The pylorus is visible on Ultrasound clearly.
Enlarged, 15mm or more and thick walled, 3mm or greater thickness
Duodenal obstruction
From atresia or stenosis
Diagnosed by US:
distended stomach and duodenum proximally, showing the ‘Double Bubble’ sign.
with empty small intestines distally.
If it is atresia the distal intestines will have no gas in them,
stenosis they will have some air.
Volvulus
Symptoms: Bilious vomiting
The whirlpool sign on Doppler US.
The Mesenteric Vein and Artery are the vessels creating this sign.
Also there will be excessive small bowel loops on the right side of the stomach.
Meconium Ileus
In 10% of children with cystic fibrosis, and if it occurs CF should be highly suspected. Rarely occurs outside of it.
Symptoms:
Vomiting, Abdominal distension
Intestines are distended but LACK air fluid levels, due to the thick adhesive nature of the meconium.
Contrast enema examination will show a very narrow, non-used colon, and the contrast will be stopped at the terminal illeum,
Intususception
Target sign, can cause intestinal necrosis
Symptoms: Reccurent, colicy crying Distended intestines Palpable abdominal mass Vomiting Bloddy stool.
Treatment: Hydrostatic or pneumatic desinvagination are possible treatments, guided by ultrasound or fluoroscopy.
Any indications of Perforation or Peritonitis,are absolute contraindications.
In this case surgery must be performed immediately
Necrotizing enterocolitis
Vomiting, distended abdomen, bloody stool, acidosis, peritonitis, perforation
In early stages no signs are apparent on AXR.
Eventually:
Intestinal pneumatosis may be seen, with air bubbles in the intestinal submucosal or subserosal layers - from necrosis.
Free abdominal air.
Hirschsprung disease, congenital megacolon
No ENS function.
Symptoms are apparent right away, the baby never defecates the meconium.
X ray shows distended intestines with or without air fluid levels.
What is used to examine newborn Urogenital system
Ultrasound
MCU is gold standard
Miction cystourethrography
Aka Voiding cystourethrography
Contrast is administered into the urinary bladder via a catheter, and then voiding is examined by X ray fluoroscopy, to check for reflux into the ureters.
Sonocystography
Ultrasound contrast (lipid coated microbubbles) is administered to the bladder via catheter, and then the bladder and ureters are examined by US during urination to check for reflux.
Congenital obstructive uropathies examles
Uretreopelvic obstruction - Obstruction of the ureters high up right at the pelvis.
Distal urethral valve obstruction, at the level of the uretrovesicular junction. This one is more sever, causing more severe hyronephrosis and hyrouretereal dilation, pyelonephritis.
