peds GI

Question 1

Non-bilious projectile vomiting, dehydration, poor weight gain, afebrile – often looking ill with hypochloremic metabolic alkalosis and Exam may reveal “olive” (thick pylorus)

Answer 1

hypertrophic pyloric stenosis

Question 2

hypertrophic pyloric stenosis

Answer 2

pyloric channel thickening that leads to gastric outlet obstruction. this causes vomiting and witht he loss of HCl leads to hypocholremic alkalosis with eventual hypokalemia

Question 3

treatment of hypertrophic pyloric stenosis

Answer 3

srugical- pyloromyotomy to relieve tightening

• prognosis is excellent

Question 4

intussusception

Answer 4

proximal segment of bowel telescopes into the distal portion bringing the mesentary with it causing venous and lymphatic congestion leading to edema, ischemia and perforation

Question 5

difference between adults and children with intussusception

Answer 5

addults have a leading point

Question 6

“Classic” case = male under 10 months old

• intermittent abdominal pain
  vomiting
  “currant jelly stool”-LATE finding!!
• may reveal palpable mass in right mid-abdomen (“palpable sausage”)

Answer 6

intussusception

Question 7

“doughnut” with hyperechoic mesenteric fat with vessels/nodes inside intussusception

Answer 7

intussusception

Question 8

classic diagnosis for intussusception and treatment

Answer 8

therapeutic enema:

1. Air (pneumatic) reduction = most popular, cleaner, less risk if perforates
2. Water-soluble contrast (hydrostatic) reduction= better than barium
   * Success 80-95% success with either

** surgery may be indicated

Question 9

recurrence with intussusception

Answer 9

yepppp

Question 10

constipation may be associated with hypothyroidism, celiac disease, electrolyte abnormalities, Hirschsprung’s disease, neurologic disease (cerebral palsy, spina bifida), others…

Answer 10

organic

Question 11

common between 6 months and preschool
trigger may be dietary transition – breastmilk to formula, liquids to solids, new food – and possibly milk allergy (especially in infants)

Answer 11

Functional constipation is the most common reason – no evidence of any organic disorder

Question 12

traumatic defecation, i do not want to poop

Answer 12

functional constipation

Question 13

prognosis of functional constipation

Answer 13

typically problematic x years, relapses >50%

affected children may become adults with IBS

Question 14

Aka: congenital aganglionic megacolon
Consistent with embryonic enteric neuronal plexus development…HD always involves the rectum and extends proximally to area
where cephalad caudad nerve development ends

Answer 14

Hirschsprung’s disease

Question 15

hirschsprung’s disease

1. arrest of
2. affects both
3. genetics
4. Adults appearance
5. delayed passage of
6. treatment

Answer 15

1. arrest of neural crest cell migration
2. affects both meissner’s submucosal and auerbach’s myenteric plexuses
3. half of familial cases and 15% sporadic related to mutation in RET proto-oncogene
4. short-segment
5. meconium
6. surgical- removal of affected portion

Question 16

hirschprung’s diease

Answer 16

affected colon loses ability to relax (NO and other por-relaxation peptides no effect) leading to narrowed, collapsed contracted distally but portion that is proximal is dilated normal

Question 17

Outpouching results from incomplete obliteration of vitelline (omphalomesenteric) duct – connecting the midgut to the yolk sac

Answer 17

Meckel’s diverticulum

THE most common congenital abnormality of the GI tract

Question 18

Meckel’s diverticulum layers

Answer 18

it is ocnsidered a true diverticulum containing all layers of the ileal wall

Question 19

Meckel’s diverticulum symptoms formation

Answer 19

the ectopic gastric mucosa within the diverticulum affects the parietal cells which secrete HCl which injures the neighboring tissue causing bleeding, abdominal pain and obstruction

Question 20

The Rule of Twos…

• Occurs in 2% of population
• M:F ratio of 2:1
• Within 2 feet of the ileocecal valve
• Can be 2 inches in length, 2cm wide
• Complications typically occur at < 2 years old
• Approx 2-4% develop complications

Answer 20

meckel’s diverticulum

Question 21

how is meckel’s diverticulum diagnosed

Answer 21

technetium-99m pertechnetate scan

Question 22

Omphalocele and Gastroschisis

Answer 22

congenital defects in the abdominal wall and both are usually identified prenetaly then surgical repair

Question 23

large central defect that involves the intestines, liver, and other organs are outside the abdomen in a sac

Answer 23

omphalocele

Question 24

smaller defect, NOT involving umbilicus, usually bit to the right, and NO sac, no liverassociated with intestinal atresia in 10%

Answer 24

gastroschisis

Question 25

bubbles of air in intestinal wall

Answer 25

necrotizing enterocolitis

**“pneumotosis intestinalis” = air within bowel wall. air may track up into portal venous system

Question 26

prevalence of necrotizing enterocolitis

Answer 26

common!!! 7% and has a mortality of 20-30%

Question 27

Typically presents within first 2 weeks, with onset of enteral feeding – abdominal distension, vital sign changes

Answer 27

consider Necrotizing enterocolitis !!!!!

Question 28

necrotizing enterocolitis factors

Answer 28

it may be involved with prematurity, microbial overgrowth, mucosal immaturity, vascular factors leading to infarction that causes transmural necrosis, hemorrhage, subserosal air increasing perforation risk

Question 29

prevention of necrotizing enterocolitis

Answer 29

getting infant closer to term gestation

Question 30

treatment of necrotizing enterocolitis

Answer 30

• bowel rest/antibiotics

- surgery

Question 31

what occurs in 10-35% of all cases mostly colonic origin in necrotizing enterocolitis

Answer 31

strictures