Pediatric Upper GI CIS - Tieman/Brandau Flashcards
Case child is triplet - C section birth
- mother - hypothyroid and diabetic
- intubation and surfactant for resp distress
APGAR - 6
- extubated 4 hours
- day 4 - oral feeding begins - starts coughing and choking**
NG tube unsuccessful
also maybe has - umbilical catheter
-also could be septic
chest x-ray - air
DDx - tracheoesophagus fistula
multiple deliveries
need team for each baby
antibiotic for sepsis in newborn
amoxicillin
gentamycin
CXR for RDS
ground glass
GER
gastroesophageal reflux
-normal process
50% infants 0-3 months
2/3 4-6 months
no tx necessary - infants will grow out by 2 years old
GERD
in small percentage infants
failure to thrive
esophageal spasms
diagnosis - difficult to make
-pH probe into esophagus
most common TEF
esophagus ends in blind pouch
-distal esophagus connected to trachea
85%
do CXR - should see air in abdomen
types of TEF
H type - normal esophagus with fistula to trachea
CXR for TEF
air in abdominal organs - if most common type**
no air - so no communication to lung and distal fistula of esophagus
polyhydramnios
obstruction in GI tract
-occurs in TEF
barium swallow
not good for TEF diagnosis
-barium bad for lungs
VACTERL
vertebral anorectal cardiac trachea esophagus renal limb
associated congenital abnormalities
before surgery for TEF fistula
look for other anomalies
-VACTERL associations
cardiac and renal are important**
Case 12yo F to ED abdominal pain, sharp severe, constant, no radiation, bilious nonbloody emesis
-no fever, diarrhea, bloody stools, or back pain
hypoactive bowel sounds
- slight guarding
- LLQ and RLQ tenderness
pregnancy test negative
peristaltic rushes
DDx - acute abdomen - requiring surgical consultation
-appendicitis, obstruction, etc.
peristaltic rushes - obstruction
Xray - air in abdomen
barium swallow - double bubble - duodenum on right side of abdomen
and volvulus - around superior mesenteric artery
malrotation with midgut volvulus
peristaltic rushes
bowels are moving against something
-mechanical obstruction
duodenum
normally on right to left
development of GI
two folds - duodenum and colon
duodenum posterior
colon anterior
malrotation with midgut volvulus
duodenum stays on right
colon stays LUQ
peritoneal bands - lads bands - obstruct duodenum
is emergency - need to do surgery
also take out appendix - bc cecum will be on left and appendicitis will be overlooked
Case 11 day old infant, projectile vomiting, after every feeding and still hungry, vomit bright yellow
- vaginal delivery, no fever, no coughs
- weight loss
DDx - pyloric stenosis
low chloride
high bicarb
hyperchloremic metabolic alkalosis
ultrasound - no pyloric stenosis**
not pyloric stenosis - bc bilious vomiting** beyond ampulla of vater
CXR - double bubble
barium swallow - duodenal atresia
surgery - concern for trisomy 21
hypochloremic metabolic alkalosis
loss of H ions - vomiting** renal H loss shift of H to intracellular space alkalotic agents contraction alkalosis
pathology hyperchloremic metabolic alkalosis
increased plasma bicarb - due to hydrogen loss
decrease in net renal bicarb excretion (rise in reabsorption)
increased reabsorptio of bicarb
1 decreased circulating volume
2 chloride depletion and hypochloremia
3 hypokalemia
pyloric stenosis
male predominate
multifactorial genetic complnent
cause unknown
erythromycin exposure possible
diagnosis - palpation of pyloric olive or ultrasound (highly sensitive and specific)**
olive of pylorus
diagnosis of pyloric stenosis
skilled palpation
right after vomiting
