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Clinical Disciplines II > Peds GI > Flashcards

Peds GI Flashcards

1
Q

Esophageal atresia: general and presentation

A
  • males
  • blind esophageal pouch with or without fistulous connection between the proximal or distal esophagus and trachea (usually distal*)
  • associated with polyhydramnios (excess amniotic fluid
  • choke and cough with oral feeding. copious secretions**, respiratory distress
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2
Q

Esophageal atresia: imaging

A

Transesophageal fistula = gas in the bowel

Esophageal atresia without fistula = No gas in bowel

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3
Q

Esophageal atresia: tx

A
  1. NG tube in the pouch
  2. Elevate head to prevent reflux
  3. IV glucose and fluids
  4. Surgery
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4
Q

Esophageal foreign body

A
  • most kids are asymptomatic

- symptoms include: dysphagia, odynophagia, drooling, regurgitation, chest or abdominal pain

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5
Q

What is the most common ingested foreign body?

A

coin

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6
Q

Describe the difference in how a coin will look on Xray between FB in esophagus or trachea?

A

Esophagus- heads and tails facing anterior and posterior

Trachea - heads and tails facing left and right

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7
Q

Button battery ingestion

A
  • may perforate in 2 hours

- must be removed surgically if not removed in 24-48 hours

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8
Q

When does GER become GERD?

A

when there are secondary complications or symptoms (ex. FTT, refusal, GI bleeding, upper or lower airway symptoms)

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9
Q

GERD: tx

A
  • reflux will often resolve spontaneously (85%) by 12 months
  • Thicken food with oat cereal
  • Trial milk and soy free diet for 2 weeks
  • Ranitidine***** (1st line)
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10
Q

Eosinophilic esophagitis: general

A
  • Males> females
    complications: 1. food impaction
    2. esophageal stricture
  • *No response to GERD treatment**
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11
Q

Eosinophilic esophagitis: diagnosis

A

Endoscopy (esophagogastroduodenoscopy)

  • mucosa thickening, fissures, strictures
  • **pinpoint white exudates (composed of eosinophils)*
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12
Q

EOE: tx

A
  • eliminate food allergens

- swallowed fluticasone (don’t rinse, and avoid eating for 30 min)

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13
Q

Pica

A
  • eating feces, clay, dirt, hairballs, ice, pain, sand for at least 1 month
  • associated with zinc and iron deficiency*
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14
Q

Pica labs

A

CBC, zinc level, lead level (if eating paint chips)

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15
Q

Rumination

A

repeated regurgitation and re-chewing food (for at least 1 month)

  • More common 3 -12 months
  • associated with depression and eating disorders
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16
Q

Which disease is associated with lactase deficiency, fat malabsorption, and protein malabsorption?

A

cystic fibrosis

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17
Q

Phenylketouria (PKU)

A

most common inborn error or amino acid metabolism
-Autosomal recessive
-Caucasians
-intellectual disability (MCC finding overall)
-Musty or mousy odor to body and urine**
Tx: avoid aspartame, phenylalanine (<6mg/dL a day). Eliminated high-protein foods

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18
Q

Celiac disease

A

-Gluten = wheat, rye, barley
-S/S: pain, bloating, constipation, dermatitis herpetiformis, poor weight gain**
delayed puberty or short stature*
-Unexplained Fe deficiency anemia*

19
Q

What blood test is elevated with gastroschisis and omphalocele?

A

AFP is elevated

20
Q

Omphalocele

A
  • membrane covered herniation of abdominal contents into the base of the umbilical cord
  • seen with US in 1st trimester
21
Q

Gastroschisis

A

-Uncovered intestine through abdominal wall defect to the RIGHT of the umbilical cord

22
Q

Diaphragmatic Hernia

A
  • Left sided (where the esophagus is)
  • Dx: prenatal ultrasound, bowel loops seen in chest cavity with mediastinal shift
  • associated with polyhydramnios [excess amniotic fluid]
  • scaphoid abodomen (sunken belly)
23
Q

Diaphragmatic hernia: complications

A
  1. Pulmonary HTN***
  2. Severe GERD
  3. Risk for hearing loss, poor growth
24
Q

Inguinal hernias

A

Indirect: Lateral to the epigastric vessels

  • MC than direct
  • Mostly right sided

Direct: Medial to the epigastric vessels
-RARE in children

25
Q

Hesselbachs Triangle

A
  1. inguinal ligament
  2. Inferior epigastric vessels
  3. Lateral border of rectus abdominis
26
Q

Femoral hernia

A

-Females
-Often become incarcerated or strangulated
Location: medial to femoral vein and lateral to lacunar ligament

27
Q

Umbilical hernias

A

-MC in african american infants

28
Q

Pyloric stenosis: General

A
  • muscular hypertrophy of the pylorus
  • 1st born children
  • Caucasian
  • Hungry and nurse avidly
  • projectile post prandial vomiting*****
  • Olive mass in right upper quadrant*****
29
Q

Pyloric Stenosis: Dx and TX

A
  1. Pyloric ultrasound
  2. Barium Upper GI –> string sign (or apple core)**

Tx: surgery

30
Q

Duodenal atresia: general

A
  • Trisomy 21*
  • Double-bubble sign on Xray*** (stomach and duodenum dilated)
  • Bilious vomiting hours after birth**
31
Q

Short Bowel Syndrome

A
  • reduced intestinal absorptive surface (diarrhea, dehydration, electrolyte/nutrient deficiency, excessive gas, foul ambling stool)
  • Usually after surgical resection of bowel
32
Q

Intussusception

A
  • telescoping of the bowel into another segment
  • MCC bowel obstruction in first 2 years of life
  • Idiopathic*
  • Red currant jelly**
  • Right sided sausage-shaped mass**
33
Q

Intussusception: Dx

A
  • Xray: “target sign” 2 concentric circles
  • Barium and air enema - therapeutic and diagnostic
  • US is most specific and sensitive modality**
34
Q

Hirschprung Disease

A
  • congenital megacolon
  • Trisomy 21 (Down syndrome)
  • Lack of neurons (aganglionic bowel)
  • Usual presentation: failure to pass meconium**, with vomiting and abdominal distention
  • foul ribbon stools in older kids
  • MC long-term complication is fecal incontinence
35
Q

Meckel’s Diverticulum

A 
MC congenital abnormality of the GI tract
Rule of TWOs:
-2% of population
-Males 2:1 
-within 2 feet of ileocecal valve
-2 inches in length

-Contain cells from the stomach and pancreas***

36
Q

Meckel’s Diverticulum: presentation

A

-Painless lower GI bleeding*

37
Q

Unconjugated hyperbilirubinemia

A
  • transient in new borns

- Low glucuronate activity at birth

38
Q

Physiologic Jaundice of the newborn

A

-can cause Kernicterus –>brain injury from high unconjugated bilirubin

Tx: bright lights (phototherapy) to make the unconjugated bilirubin more water-soluble

39
Q

Gilbert’s Syndrome

A
  • Mild autosomal dominant disorder
  • LFTs and liver biopsy normal
  • increase in unconjugated bilirubin after a 2 day fast (consistent with dx)
40
Q

Cystic Fibrosis

A
  • Affects 4 areas: 1. Lung, 2, Pancreas (fat soluble vitamin deficiency**), 3. Intestine (intussception, carb intolerance), 4. Liver
  • Sweat chloride test**
41
Q

Pilonidal cysts

A

-Ingrown hair with infection at the natal cleft of the buttock

42
Q

Enterobiasis (Pinworms)

A

-intense anal itching

Tx: pyrantel pamoate –> repeat in 2 weeks

43
Q

Encopresis

A

Involuntary or intentional defecation

  • at least 3 months
  • at least 4 yrs old

Tx: schedule toilet time after meals (gastrocolic reflex)

44
Q

Constipation

A

2 or more, for at least 2 months

  • <3 BMs per week
  • > 1 episode of encopresis/week
  • impaction of rectum with stool
  • passage of stool so large it obstructs the toilet
  • pain with defecation

Tx: prune, pear, peach “p”fruits

  • Miralax (polyethylene glycol)
  • Milk of magnesia

Clinical Disciplines II (15 decks)

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