Peds GI

Question 1

What conditions is projectile vomiting associated with?

Answer 1

pyloric stenosis

increased intracranial pressure

Question 2

What conditions is bilious vomiting associated with?

Answer 2

anatomic obstruction - surgical emergency

Question 3

What does bloody vomiting suggest?

Answer 3

upper GI bleed

Question 4

newborn with bilious or nonbilious vomiting, delayed passage of meconium past 24 hrs of life, lack of ganglion cells

Answer 4

Hirschsprungs

Question 5

newborn with bilious or nonbilious vomiting, possible pneumatosis (air in intestinal wall), commonly premature

Answer 5

necrotizing enterocolitis

Question 6

0-3 month old, bilious vomiting, abdominal distension, KUB with paucity of bowel gas and corkscrew

Answer 6

malrotation with midgut volvulus - need emergency surgery

Question 7

0-3 month old, nonbilious vomiting, emesis w/i 30 min of feeding, worse in supine

Answer 7

Gastroesophageal reflux - only concern if has pain, cough, poor weight gain

Question 8

nonbilious vomiting, irritability, full anterior fontanelle, lethargy

Answer 8

child abuse

Question 9

3-12 month old, non bilious vomiting may progress to bilious, probs diarrhea, low grade fever

Answer 9

gastroenteritis

Question 10

3-12 month old, bilious vomiting, ab distension, paroxysms of ab pain followed by lethargy, air fluid levels or paucity of distal bowel gas on KUB, bloody stools, palpable sausage shaped mass in RUQ, crescent sign

Answer 10

intussusception - plain films, ultrasound, air contrast edema to diagnose
surgical management when not reduced with contrast enema

Question 11

3-12 month old, nonbilious vomiting, anterior fontanelle fullness

Answer 11

intracranial mass lesion

Question 12

fussy child during and after feedings, stereotypical movements of extension of head and stiffened extension of arms and legs

Answer 12

Sandifer syndrome - pain due to esophagitis from GER

Question 13

4 week old, nonbilious vomiting, hungry infant, projectile vomiting, exam with palpable epigastric mass (olive), hypokalemic hypochloremic metabolic alkalosis

Answer 13

pyloric stenosis - need surgical pyloromyotomy, diagnosis by ultrasound of pyloris or upper GI series

Question 14

excessive saliva, regurgitation, immediate nonbilious vomiting with first food, distension

Answer 14

esophageal atresia - diagnosis if attempt to pass catheter into stomach fails, CXR confirms, need surgical repair

Question 15

periumbilical ab pain migrating to RLQ associated with nausea, vomiting and fever

Answer 15

classic presentation of appendicitis, less commonly seen in children

Question 16

RLQ pain, vomiting, ab tenderness, guarding, elevated WBC, CRP, sterile pyuria

Answer 16

Appendicitis - diagnose by ultrasound or CT if US fails, broad spectrum antibiotics and surgical removal

Question 17

palpable purpuric rash on lower extremities, colicky abdominal pain, vomiting,bloody stool, maybe arthritis or arthralgia, renal dz

Answer 17

HSP - supportive treatment, lasts 4 weeks