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1. Disciplines 2 > Peds GI > Flashcards

Peds GI Flashcards

1
Q

What is esophageal atresia?

A

Blind esophageal pouch w/ our w/out fistula btwn proximal or distal esophagus & trachea

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2
Q

How does esophageal atresia present?

A

Polyhydramnios

Copious secretions, choking, cyanosis, resp. distress

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3
Q

What imaging do you use to dx esophageal atresia?

A

U/S –> MRI

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4
Q

What is the difference btwn EA w/ TEF vs w/out TEF?

A

TEF –> gas in bowel

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5
Q

How do you treat EA?

A

NG tube in proximal pouch w/ low suction

IVF, glucose, O2, elevate bed

Surgery

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6
Q

What % of esophageal foreign bodies pass spontaneously?

What % of people are asx?

A

80-90% pass

50% asx

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7
Q

Esophageal FB: What are sx?

A

Dysphagia, odynophagia
Drooling, regurgitation
Chest/abd pain

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8
Q

What is the MC infant syndrome?

A

GER

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9
Q

When does GER become GERD?

A 
When reflux causes secondary sx: 
FTT
Food refusal 
GI bleeding
Airway sx
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10
Q

What are RFs of GERD?

A

CF, asthma

Hx of hiatal hernia, repaired TEF

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11
Q

What are 3 complications of GERD?

A

Esophagitis
Recurrent pneumo
Dental erosions

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12
Q

How do you dx GERD?

A

H&P

Upper GI series

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13
Q

How do you treat GERD?

A 
Resolves spontaneously in 85%
Thicken feeds w/ oat cereal
Milk free diet
H2 blocker or PPI 
If severe --> Nissen Fundoplication
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14
Q

What are the 2 MC complications of eosinophilic esophagitis?

A

Esophageal food impactions

Esophageal stricture

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15
Q

What are sx of eosinophilic esophagitis?

A

Feeding dysfunction
Long meal times
No response to GERD tx**
Family hx of atopy, asthma, dysphagia, food impaction

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16
Q

How do you dx eosinophilic esophagitis?

A

EGD:

  • mucosal thickening, fissures, strictures, rings
  • white exudates (composed of eosinophils)*
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17
Q

How do you treat eosinophilic esophagitis?

A

Eliminate allergens

Swallowed topical steroids: 2 puffs fluticasone (do NOT rinse mouth or eat within 30 mins)

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18
Q

What 2 deficiencies are associated w/ PICA?

A

Iron & zinc

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19
Q

How do you classify PICA?

A

Eating nonnutritive substances for > 1 MONTH

Inappropriate to developmental level

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20
Q

What labs should be performed in suspecting PICA?

A

CBC
Zinc
Lead

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21
Q

What is rumination?

A

Repeated regurgitation & re-chewing food for > 1 month

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22
Q

How does rumination present?

A 
Malnutrition 
FTT
Wt loss
Bad breath
Tooth caries
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23
Q

What causes carbohydrate malabsorption?

A

Lactose intolerance (celiac, gastroenteritis)

Lactase deficiency (CF)

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24
Q

What causes fat malabsorption?

A

A/w CF

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25
What causes protein malabsorption?
A/w CF | Milk protein allergy**
26
What is the MC inborn error of amino acid metabolism?
Phenylketonuria (PKU)
27
What is the MC presenting sx of PKU?
Intellectual disability
28
How do you dx PKU?
Newborn screening
29
How do you tx PKU?
Restrict phenylalanine & aspartame
30
What are the MC food allergies?
``` Cows milk = #1 Fruits, veggies Eggs Fish Nuts Cereal ```
31
What are MC sx of a food allergy?
Urticaria & angioedema
32
How do you dx a food allergy?
In vivo IgE | In vitro igE (RAST)
33
How can you pharmacologically treat a food allergy?
Epi | H1 blockers
34
What is gluten?
A protein in wheat, rye, & barley
35
What are RFs of celiac disease?
Type 1 diabetes, down syndrome, turner syndrome, autoimmune thyroiditis, family hx
36
What are GI manifestations of celiac disease?
V/D, constipation, bloating, abd pain | Poor wt gain**
37
What are non-GI manifestations of celiac disease?
Delayed puberty or short stature Unexplained Fe deficiency anemia
38
How do you dx celiac disease?
Serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes)
39
What are complications of abdominal wall defects?
GERD Volvulus Malabsorption
40
What is an omphalocele?
Membrane covered herniation of the abd contents into the base of the umbilical cord
41
What is gastroschisis?
Uncovered intestine through abd wall defect to the right of the umbilical cord
42
What are the 4 types of hernias?
Inguinal (direct & indirect) Umbilical Femoral Diaphragmatic
43
Which type of hernia can cause vascular compromise?
Strangulated hernia
44
Which type of hernia is NOT reducible, but does NOT cause vascular compromise?
Incarcerated hernia
45
What are characteristics of a reducible hernia?
Spontaneous or manual
46
What side of the body are diaphragmatic hernias MC?
Left!
47
How are diaphragmatic hernias dx?
Prenatal U/S
48
How do diaphragmatic hernias present?
Polyhydramnios Resp distress Scaphoid abd Pneumothorax
49
What does a diaphragmatic hernia look like on CXR?
bowel loops in chest w/ mediastinal shift to opposite side
50
What are complications of a diaphragmatic hernia?
Pulmonary HTN** GER/GERD Behavior problems, hearing loss, poor growth
51
How do you treat diaphragmatic hernias?
Intubate, ventilate, decompress OG tube Surgery to reduce abd contents & close defect (delayed until after infant is stable)
52
Describe an indirect inguinal hernia
Passes LATERAL to deep epigastric vessels More common than direct, MC in kids RIGHT SIDED Goes THROUGH the inguinal canal
53
Describe a direct inguinal hernia
Passes MEDIAL & INFERIOR to deep epigastric vessels Does NOT go through inguinal canal Rare in kids
54
What are the boundaries of the Hesselbach triangle?
Lateral: inferior epigastric artery Medial: rectus abdominus Inferior: inguinal ligament
55
Which type of hernia frequently becomes incarcerated or strangulated? Which gender are these most common in?
Femoral Female
56
Umbilical hernias are MC in what population?
Full term, African American infants
57
What is pyloric stenosis?
Hypertrophy of the pylorus Gastric outlet obstruction
58
Which population is most affected by pyloric stenosis?
First-born, white male children
59
What are s/s of pyloric stenosis?
Projectile postprandial vomiting Hallmark = olive mass!
60
How do you dx pyloric stenosis? What is seen?
Pyloric U/S Barium upper GI: Apple core or string sign
61
How do you treat pyloric stenosis?
Pyloromyotomy
62
What condition is associated w/ duodenal atresia?
Trisomy 21
63
What are s/s of duodenal atresia?
Double bubble sign on abd xray Bilious vomiting hrs after birth
64
What are s/s of short bowel syndrome?
Usually occurs after surgical resection of intestine Generally related to malabsorptive state (dehydration, diarrhea, electrolyte deficiency, gas, foul stool)
65
How do you treat short bowel syndrome?
TPN Antacids, H2, PPI Abx STEP, Intestinal transplant
66
What is the MC cause of bowel obstruction in the 1st 2 years of life, esp. in males?
Intussusception
67
Where does intussusception typically start?
Proximal to ileocecal valve
68
What causes intussusception?
85% idiopathic
69
What are s/s of intussusception?
Red currant jelly stool (pathognomonic) | Palpable right-sided sausage shaped mass
70
How do you dx intussusception?
Abd xray: target sign Barium & air enema (diagnostic & therapeutic) U/S = most sensitive/specific
71
What is the MC presenting sign of Hirschsprung disease?
Failure to pass meconium
72
How do you diagnose Hirschsprung disease?
Rectal biopsy: lack of neurons Xray: dilated colon, absence of gas in pelvis Barium enema: dilated colon, narrow distal segment Anorectal manometry
73
What are complications of Hirschsprung disease?
Fecal incontinence ** Fecal retention Constipation Enterocolitis
74
What is the MC congenital anomaly of the GI tract?
Meckel's diverticulum
75
What makes up the "Rule of 2s" in Meckel's diverticulum? (5)
``` 2% of population M:F = 2:1 50% occurs in 1st 2 years Within 2 ft from ileocecal valve 2 inches in length ```
76
Meckel's diverticulum contains cells from...
stomach & pancreas
77
What are s/s of Meckel's diverticulum?
Usually asx PAINLESS lower GI bleeding Mimics appendicitis
78
How do you diagnose Meckel's diverticulum?
Arteriography or CT angiography Meckel's scan
79
If left untreated, jaundice of the newborn can lead to...
brain injury (due to unconjugated hyperbilirubinemia)
80
What is consistent w/ the diagnosis of Gilbert's syndrome?
Increase of 1.4mg of unconjugated bilirubin after a 2 day fast MC in males
81
What 4 areas does CF primarily affect?
Lung, pancreas, intestine, liver
82
What effect does CF have on the pancreas?
Causes fat soluble vitamin deficiency
83
What effect does CF have on the intestine?
Causes intussusception & carb intolerance
84
How do you treat CF?
Pancreatic enzymes Ursodiol (relieves cholestasis)
85
What are RFs of pilonidal cysts?
``` Overweight/obesity Trauma/irritation Sedentary lifesyle Prolonged sitting Deep natal cleft ```
86
How do you treat pinworms?
Pyrantel pamoate
87
What are the defining characteristics of constipation?
2 or more of the following for ≥ 2 months: 1. < 3BMs/wk 2. > 1 episode of encopresis/wk 3. Impaction of stool 4. Stool so large it clogs toilet 5. Retention posturing & fecal withholding 6. Pain w/ defecation
88
What causes constipation?
Dehydration, excessive milk intake, lack of fiber Antihistamines, narcotics Thyroid disease, cerebral palsy Anal fissures
89
How do you treat constipation?
Increase "p" fruits Miralax Milk of magnesium Lactulose

1. Disciplines 2 (11 decks)

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