Pediatric Upper GI CIS - Tieman/Brandau

Question 1

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

Answer 1

also maybe has - umbilical catheter
-also could be septic

chest x-ray - air

DDx - tracheoesophagus fistula

Question 2

multiple deliveries

Answer 2

need team for each baby

Question 3

antibiotic for sepsis in newborn

Answer 3

amoxicillin

gentamycin

Question 4

CXR for RDS

Answer 4

ground glass

Question 5

GER

Answer 5

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

Question 6

GERD

Answer 6

in small percentage infants

failure to thrive

esophageal spasms

diagnosis - difficult to make
-pH probe into esophagus

Question 7

most common TEF

Answer 7

esophagus ends in blind pouch
-distal esophagus connected to trachea

85%

do CXR - should see air in abdomen

Question 8

types of TEF

Answer 8

H type - normal esophagus with fistula to trachea

Question 9

CXR for TEF

Answer 9

air in abdominal organs - if most common type**

no air - so no communication to lung and distal fistula of esophagus

Question 10

polyhydramnios

Answer 10

obstruction in GI tract

-occurs in TEF

Question 11

barium swallow

Answer 11

not good for TEF diagnosis

-barium bad for lungs

Question 12

VACTERL

Answer 12

vertebral
anorectal
cardiac
trachea
esophagus
renal
limb 

associated congenital abnormalities

Question 13

before surgery for TEF fistula

Answer 13

look for other anomalies
-VACTERL associations

cardiac and renal are important**

Question 14

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

Answer 14

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

Question 15

peristaltic rushes

Answer 15

bowels are moving against something

-mechanical obstruction

Question 16

duodenum

Answer 16

normally on right to left

Question 17

development of GI

Answer 17

two folds - duodenum and colon

duodenum posterior
colon anterior

Question 18

malrotation with midgut volvulus

Answer 18

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

Question 19

Case 11 day old infant, projectile vomiting, after every feeding and still hungry, vomit bright yellow

• vaginal delivery, no fever, no coughs
• weight loss

Answer 19

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

Question 20

hypochloremic metabolic alkalosis

Answer 20

loss of H ions - vomiting**
renal H loss
shift of H to intracellular space
alkalotic agents
contraction alkalosis

Question 21

pathology hyperchloremic metabolic alkalosis

Answer 21

increased plasma bicarb - due to hydrogen loss

decrease in net renal bicarb excretion (rise in reabsorption)

Question 22

increased reabsorptio of bicarb

Answer 22

1 decreased circulating volume
2 chloride depletion and hypochloremia
3 hypokalemia

Question 23

pyloric stenosis

Answer 23

male predominate

multifactorial genetic complnent

cause unknown

erythromycin exposure possible

diagnosis - palpation of pyloric olive or ultrasound (highly sensitive and specific)**

Question 24

olive of pylorus

Answer 24

diagnosis of pyloric stenosis

skilled palpation

right after vomiting

Question 25

duodenal atresia

Answer 25

failure of recanalization

Question 26

trisomy 21

Answer 26

associated with duodenal atresia

jejunal/ileal - no associations

Question 27

omphalocele

Answer 27

covered with peritoneum

**with other congenital anomalies - endocardial cushion defects

Question 28

gastrochisis

Answer 28

not covered with peritoneum

failure to right of umbilicus

**not with other congenital anomalies

Question 29

tx omphalocele

Answer 29

can’t just shove guts back in - too much pressure bc small abdominal cavity

put bag around it - and gradually put it back in around 2-3 weeks

Question 30

visceral peritonitis

Answer 30

with gastrochisis bc no amnion covering