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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
Q

What causes protein malabsorption?

A

A/w CF

Milk protein allergy**

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26
Q

What is the MC inborn error of amino acid metabolism?

A

Phenylketonuria (PKU)

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27
Q

What is the MC presenting sx of PKU?

A

Intellectual disability

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28
Q

How do you dx PKU?

A

Newborn screening

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29
Q

How do you tx PKU?

A

Restrict phenylalanine & aspartame

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30
Q

What are the MC food allergies?

A 
Cows milk = #1 
Fruits, veggies
Eggs
Fish 
Nuts
Cereal
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31
Q

What are MC sx of a food allergy?

A

Urticaria & angioedema

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32
Q

How do you dx a food allergy?

A

In vivo IgE

In vitro igE (RAST)

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33
Q

How can you pharmacologically treat a food allergy?

A

Epi

H1 blockers

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34
Q

What is gluten?

A

A protein in wheat, rye, & barley

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35
Q

What are RFs of celiac disease?

A

Type 1 diabetes, down syndrome, turner syndrome, autoimmune thyroiditis, family hx

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36
Q

What are GI manifestations of celiac disease?

A

V/D, constipation, bloating, abd pain

Poor wt gain**

37
Q

What are non-GI manifestations of celiac disease?

A

Delayed puberty or short stature

Unexplained Fe deficiency anemia

38
Q

How do you dx celiac disease?

A

Serology &/or duodenal biopsy (villous atrophy w/ increased intraepithelial lymphocytes)

39
Q

What are complications of abdominal wall defects?

A

GERD
Volvulus
Malabsorption

40
Q

What is an omphalocele?

A

Membrane covered herniation of the abd contents into the base of the umbilical cord

41
Q

What is gastroschisis?

A

Uncovered intestine through abd wall defect to the right of the umbilical cord

42
Q

What are the 4 types of hernias?

A

Inguinal (direct & indirect)
Umbilical
Femoral
Diaphragmatic

43
Q

Which type of hernia can cause vascular compromise?

A

Strangulated hernia

44
Q

Which type of hernia is NOT reducible, but does NOT cause vascular compromise?

A

Incarcerated hernia

45
Q

What are characteristics of a reducible hernia?

A

Spontaneous or manual

46
Q

What side of the body are diaphragmatic hernias MC?

A

Left!

47
Q

How are diaphragmatic hernias dx?

A

Prenatal U/S

48
Q

How do diaphragmatic hernias present?

A

Polyhydramnios
Resp distress
Scaphoid abd
Pneumothorax

49
Q

What does a diaphragmatic hernia look like on CXR?

A

bowel loops in chest w/ mediastinal shift to opposite side

50
Q

What are complications of a diaphragmatic hernia?

A

Pulmonary HTN**
GER/GERD
Behavior problems, hearing loss, poor growth

51
Q

How do you treat diaphragmatic hernias?

A

Intubate, ventilate, decompress OG tube

Surgery to reduce abd contents & close defect (delayed until after infant is stable)

52
Q

Describe an indirect inguinal hernia

A

Passes LATERAL to deep epigastric vessels
More common than direct, MC in kids
RIGHT SIDED
Goes THROUGH the inguinal canal

53
Q

Describe a direct inguinal hernia

A

Passes MEDIAL & INFERIOR to deep epigastric vessels
Does NOT go through inguinal canal
Rare in kids

54
Q

What are the boundaries of the Hesselbach triangle?

A

Lateral: inferior epigastric artery
Medial: rectus abdominus
Inferior: inguinal ligament

55
Q

Which type of hernia frequently becomes incarcerated or strangulated? Which gender are these most common in?

A

Femoral

Female

56
Q

Umbilical hernias are MC in what population?

A

Full term, African American infants

57
Q

What is pyloric stenosis?

A

Hypertrophy of the pylorus

Gastric outlet obstruction

58
Q

Which population is most affected by pyloric stenosis?

A

First-born, white male children

59
Q

What are s/s of pyloric stenosis?

A

Projectile postprandial vomiting

Hallmark = olive mass!

60
Q

How do you dx pyloric stenosis? What is seen?

A

Pyloric U/S

Barium upper GI: Apple core or string sign

61
Q

How do you treat pyloric stenosis?

A

Pyloromyotomy

62
Q

What condition is associated w/ duodenal atresia?

A

Trisomy 21

63
Q

What are s/s of duodenal atresia?

A

Double bubble sign on abd xray

Bilious vomiting hrs after birth

64
Q

What are s/s of short bowel syndrome?

A

Usually occurs after surgical resection of intestine

Generally related to malabsorptive state (dehydration, diarrhea, electrolyte deficiency, gas, foul stool)

65
Q

How do you treat short bowel syndrome?

A

TPN
Antacids, H2, PPI
Abx
STEP, Intestinal transplant

66
Q

What is the MC cause of bowel obstruction in the 1st 2 years of life, esp. in males?

A

Intussusception

67
Q

Where does intussusception typically start?

A

Proximal to ileocecal valve

68
Q

What causes intussusception?

A

85% idiopathic

69
Q

What are s/s of intussusception?

A

Red currant jelly stool (pathognomonic)

Palpable right-sided sausage shaped mass

70
Q

How do you dx intussusception?

A

Abd xray: target sign

Barium & air enema (diagnostic & therapeutic)

U/S = most sensitive/specific

71
Q

What is the MC presenting sign of Hirschsprung disease?

A

Failure to pass meconium

72
Q

How do you diagnose Hirschsprung disease?

A

Rectal biopsy: lack of neurons

Xray: dilated colon, absence of gas in pelvis

Barium enema: dilated colon, narrow distal segment

Anorectal manometry

73
Q

What are complications of Hirschsprung disease?

A

Fecal incontinence **
Fecal retention
Constipation
Enterocolitis

74
Q

What is the MC congenital anomaly of the GI tract?

A

Meckel’s diverticulum

75
Q

What makes up the “Rule of 2s” in Meckel’s diverticulum? (5)

A 
2% of population
M:F = 2:1
50% occurs in 1st 2 years
Within 2 ft from ileocecal valve 
2 inches in length
76
Q

Meckel’s diverticulum contains cells from…

A

stomach & pancreas

77
Q

What are s/s of Meckel’s diverticulum?

A

Usually asx

PAINLESS lower GI bleeding

Mimics appendicitis

78
Q

How do you diagnose Meckel’s diverticulum?

A

Arteriography or CT angiography

Meckel’s scan

79
Q

If left untreated, jaundice of the newborn can lead to…

A

brain injury (due to unconjugated hyperbilirubinemia)

80
Q

What is consistent w/ the diagnosis of Gilbert’s syndrome?

A

Increase of 1.4mg of unconjugated bilirubin after a 2 day fast

MC in males

81
Q

What 4 areas does CF primarily affect?

A

Lung, pancreas, intestine, liver

82
Q

What effect does CF have on the pancreas?

A

Causes fat soluble vitamin deficiency

83
Q

What effect does CF have on the intestine?

A

Causes intussusception & carb intolerance

84
Q

How do you treat CF?

A

Pancreatic enzymes

Ursodiol (relieves cholestasis)

85
Q

What are RFs of pilonidal cysts?

A 
Overweight/obesity 
Trauma/irritation 
Sedentary lifesyle 
Prolonged sitting 
Deep natal cleft
86
Q

How do you treat pinworms?

A

Pyrantel pamoate

87
Q

What are the defining characteristics of constipation?

A

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
Q

What causes constipation?

A

Dehydration, excessive milk intake, lack of fiber
Antihistamines, narcotics
Thyroid disease, cerebral palsy
Anal fissures

89
Q

How do you treat constipation?

A

Increase “p” fruits
Miralax
Milk of magnesium
Lactulose

1. Disciplines 2 (11 decks)

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