PEDIATRIC Section 7: Luminal GI (Bowel Obstruction in an Older Child))

Question 1

Think about this when you talk about Obstruction in an OLDER child

Answer 1

AA-II-MM

Question 2

Most common cause of bowel obstruction in children >4y.o.

Answer 2

Appendicities

Question 3

What kind of hernia is common in kids?

Answer 3

Indirect hernias

Question 4

Describe indirect hernias

Answer 4

lateral to the inferior epigastric,

Question 5

What is the most common complication of Indirect hernias?

Answer 5

Incarceration

Question 6

The most common obstruction in 1 month-1 year

Question 7

Age range in Intussusception

Answer 7

90% between 3 months and 3 years don’t have lead points)

Question 8

What is the normal mechanism of Intussusception?

Answer 8

forward peristalsis resulting in invagination of proximal bowel (the intussusceptum) into lumen of the distal bowel (the intussuscipiens).

Question 9

Intussusception size?

Answer 9

They have to be bigger than 2.5 cm to matter (in most cases- these are enterocolic), those that are less than 2.0 cm are usually small bowel-small bowel and may reduce spontaneously within minutes.

Question 10

Diagnosis? Sign?

What is the other sign?

Answer 10

Intussusception

Target Sign

Other sign: Kidney sign

Question 11

Contraindications of Reducing Intussusception

Answer 11

Contraindications:
Free Air (check plain film)
Peritonitis (based on exam)

Question 12

Recurrence in reducing intussusception happens after?

Answer 12

72 hours

Question 13

Pressure in Reducing intussusception should NOT exceed ___ mmHg?

Answer 13

ressure should NOT exceed 120 mmHg

Question 14

what shoud be the next step step if they perforate and get tension pneumoperitoneum in Intussusception reduction?

Answer 14

Needle decompression

Question 15

this is a congenital diverticulum in the distal ileum

Answer 15

Meckels Diverticulum

Question 16

it is a persistent piece of the omphalomesenteric duct.

Answer 16

Meckels Diverticulum

Question 17

Remember this rule when you talk about Meckels Diverticulum

Answer 17

Rule of 2s

2% of teh population
2 types of heterotopic mucosa (gastric and pancreatic)
2 feet from the IleoCecal valve
2 inches LONG
2 cm in DIAMETER
Symptims before the child is 2

Question 18

If Meckels Diverticulum has gastric mucosa (the ones that bleed typically do), What should be seen?

Answer 18

it will take up Tc-Pertechnetate just like the stomach (hence the Meckel’s scan).

Question 19

What are the complications of Meckels?

Answer 19

• Can get diverticulitis in the Meckels (mimic appendicitis)
• GI Bleed from Gastric Mucosa (causes 30% of symptomatic cases)
• Can be a lead point for intussusception (seen with inverted diverticulum)
• Can Cause Obstruction

Question 20

Diagnosis?

Answer 20

Meckels Diverticulum