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CORE > Peds GI > Flashcards

Peds GI Flashcards

1
Q

necrotizing enterocolitis –> epidemiology?

A
  • preterm

- term: congenital heart dz, immunosupp, umbilical venous catheter

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2
Q

necrotizing enterocolitis –> cause?

A

combo of infxn & ischemia related to feeding

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3
Q

necrotizing enterocolitis –> MC location?

A

ileum & RLQ colon

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4
Q

necrotizing enterocolitis –> initial XR finding

A

loop of bowel:

  • wall thicken
  • fixed distention over serial exams
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5
Q

necrotizing enterocolitis –> MC complication

A

bowel stricture

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6
Q

hypertrophic pyloric stenosis –> epidemiology?

A

2-12wk M>F

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7
Q

hypertrophic pyloric stenosis –> US findings? (3)

A
  • thickened pylorus wall
  • increased pyloric channel length
  • gastric contents not pass thru
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8
Q

pylorospasm –> US findings?

A
  • normal pylorus

- gastric contents pass thru

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9
Q

infant –> appendicitis –> common or rare?

A

rare

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10
Q

volvulus –> clinical presentation?

A

neonatal bilious emesis

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11
Q

malrotation –> MOA?

A

embryogenesis –> bowel fail to normally rotate

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12
Q

malrotation –> potential complication? (2) why?

A
  • abnormal mesenteric fixation –> volvulus

- Ladd bands –> distal bowel obstruct

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13
Q

malrotation –> when present?

A

70% within 1mo

90% within 1yo

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14
Q

UGI –> eval for malrotation –> specific components to evaluate? (3)

A
  • C-sweep of duodenum
  • duodeno-jejunal jx: L of midline & at level of duodenal bulb
  • 2nd & 4th duodenum retroperitoneal & parallel
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15
Q

midgut volvulus:

  • MC XR appearance?
  • uncommon XR appearance?
A
  • MC XR appearance: mult dilated bowel loops

- uncommon XR appearance: duodenal obstruct –> double bubble sign

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16
Q

midgut volvulus –> classic UGI finding?

A

corkscrew appearance

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17
Q

malrotation –> cecum location?

A
  • more midline than normal

- LLQ

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18
Q

malrotation –> SMA & SMV location?

A

normal: right SMV, left SMA
malrotation: right SMA, left SMV

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19
Q

malrotation –> tx?

A

Ladd procedure:

  • reduce volvulus
  • lyse mesenteric adhesions (Ladd bands)
  • place small bowel on R, large bowel on L
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20
Q

intussusception –> MC location?

A

ileocolic

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21
Q

intussusception –> classic presentation?

A
  • colicky abd pain
  • currant jelly stool
  • palpable RLQ abd mass
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22
Q

intussusception –> idiopathic vs pathologic lead point –> epidemiology?

A
  • newborn: pathologic lead pt
  • 3mo-3.5yo: idiopathic
  • > 3.5yo: pathologic lead pt
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23
Q

neonate –> intussusception –> possible cause?

A

Meckel diverticulum

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24
Q

> 3.5yo –> intussusception –> possible cause?

A

lymphoma

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25
Q

bloody stool –> US demonstrate bowel wall thickening –> ddx? (3)

A
  • intussusception
  • colitis
  • intramural hematoma (d/t trauma, Henoch-Schonlein purpura)
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26
Q

intussusception –> tx?

A

air/contrast enema

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27
Q

intussusception –> tx enema reduction –> contraindication? (3)

A
  • free air
  • peritoneal signs
  • septic shock
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28
Q

esophageal atresia & tracheoesophageal fistula –> MC assoc synd?

A

VACTERL

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29
Q

VACTERL –> synd?

A
  • Vertebral segmentation anomaly
  • Anal atresia
  • Cardiac anomaly
  • TracheoEsophageal fistula
  • Renal anomaly
  • Limb (radial ray) anomaly
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30
Q

tracheoesophageal fistula –> MC type?

A

82% –> type A: proximal esophageal atresia & distal TEF

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31
Q

proximal esophageal atresia & distal TEF –> classic CXR appearance?

A
  • NG tube terminate mid-esophagus

- air-filled bowel (from TEF)

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32
Q

TEF –> assoc condition?

A

tracheal anomaly:

  • tracheomalacia
  • bronchus suis
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33
Q

in utero –> polyhydramnios & lack of visualization of stomach –> ddx? (1)

A

esophageal atresia

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34
Q

gastric atresia –> diagnostic imaging finding?

A

single bubble

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35
Q

clinical presentation –> hypertrophic pyloric stenosis vs gastric atresia?

A

vomiting:

HPS: progressively worse
gastric atresia: not worse

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36
Q

neonatal bowel obstruct –> when present?

A

24-48 day old

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37
Q

XR –> proximal bowel obstruction –> next imaging modality of choice for evaluation? why?

A

UGI –> differentiate midgut volvulus (emergent surg) vs atresia (non-emergent)

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38
Q

XR –> distal bowel obstruction –> next imaging modality of choice for evaluation?

A

LGI

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39
Q

proximal bowel obstruction –> tx?

A

surg

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40
Q

distal bowel obstruction –> tx?

A
  • surg

- medical

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41
Q

duodenal anomaly –> other assoc anomaly? (5)

A
  • Down
  • VACTERL
  • cardiac shunt lesion
  • malrotation
  • annular pancreas
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42
Q

duodenal atresia –> classic XR appearance?

A
  • double bubble: dilation stomach + proximal duodenum

- lack of distal bowel gas

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43
Q

double bubble + distal bowel gas –> ddx? (3)

A
  • midgut volvulus
  • annular pancreas
  • duodenal stenosis/web
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44
Q

jejunal atresia –> MCC?

A

in utero vascular insult

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45
Q

jejunal atresia –> classic XR appearance?

A

triple bubble

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46
Q

distal bowel obstruction –> surgical causes? (2)

A
  • distal atresia

- Hirschsprung dz

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47
Q

distal bowel obstruction –> medical causes? (2)

A
  • meconium ileus

- fxal immaturity

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48
Q

what is microcolon?

A

abnormally small caliber (<1cm) colon –> d/t disuse

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49
Q

microcolon –> secondary to proximal vs distal bowel obstruction? why?

A

distal

proximal bowel –> secrete succus entericus –> prevent microcolon

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50
Q

microcolon –> MCC? (2)

A
  • meconium ileus

- ileal atresia

51
Q

microcolon –> ddx? (4)

A
  • meconium ileus
  • ileal atresia
  • total colonic Hirschsprung
  • megacystic-microcolon-hypoperistalsis synd
52
Q

meconium ileus –> assoc calcifications can be seen where? (2) why?

A
  • peritoneal
  • scrotal

perforation –> meconium peritonitis –> calcifications

53
Q

meconium ileus –> classic XR appearance?

A
  • distal obstruction (mult dilated bowel)

- RLQ soap bubble lucencies

54
Q

meconium ileus –> indicates what condition?

A

100% –> cystic fibrosis

55
Q

meconium ileus –> LGI appearance? (2)

A
  • microcolon

- mult rounded filling defects (inspissated meconium)

56
Q

meconium ileus –> tx?

A

water-soluble enema –> loosen inspissated meconium

57
Q

fail to pass meconium –> MC condition?

A

small left colon (fxal immaturity of the colon, meconium plug synd)

58
Q

small left colon –> MOA?

A

colonic ganglion cells –> temporary fxal immaturity –> distal colon abnormal motility

59
Q

small left colon –> risk factors? (3)

A
  • preterm
  • maternal Mg for preclampsia
  • maternal diabetes
60
Q

small left colon –> microcolon or no microcolon?

A

no microcolon

61
Q

small left colon –> XR finding?

A

distal bowel obstruct

62
Q

small left colon –> LGI finding?

A
  • small left colon
  • discrete transition pt at splenic flexure
  • filling defects in small left colon –> meconium plugs
63
Q

small left colon w discrete transition pt at splenic flexure –> ddx? (2) how to differentiate? (2)

A

small left colon:

  • rectum distend
  • resolve w enema

Hirschsprung dz:

  • rectum nondistend
  • not resolve w enema
64
Q

Hirschsprung dz –> anus is always involved –> T/F?

A

T

65
Q

Hirschsprung dz –> continuous or scattered bowel involvemt?

A

continuous

66
Q

Hirschsprung dz –> possible complication?

A

1/3 –> enterocolitis, similar to NEC –> toxic megacolon

67
Q

Hirschsprung dz –> XR finding?

A

distal bowel obstruction

68
Q

Hirschsprung dz –> LGI finding

A
  • dilated proximal bowel
  • narrow distal bowel
  • tapered “cone-shaped” transition
69
Q

Hirschsprung dz –> rectum:sigmoid ratio?

A

<1

70
Q

what is megacystic microcolon intestinal hypoperistalsis synd?

A

congenital loss of bowel & bladder smooth muscle fx:

  • absent intestinal peristalsis
  • microcolon
  • distended nonobstructed urinary bladder
71
Q

childhood bowel obstruction –> ddx? (6)

A

AAIIMM:

  • appendicitis
  • adhesions
  • internal/inguinal hernia
  • intussusception
  • Meckels
  • malrotation
72
Q

indirect inguinal hernia –> MOA?

A

patent processus vaginalis –> peritoneal comm to scrotum

73
Q

imperforate anus –> role of imaging? preferred imaging modality?

A

clinical dx

eval level of obstruct: high/low relative to puborectalis sling (however, this is usu determined clinically)

infracoccygeal US

74
Q

high anorectal malformation –> assoc anomalies? (3)

A
  • GU-rectal fistula
  • lumbosacral anomaly
  • VACTERL
75
Q

high anorectal malformation –> type of GU-rectal fistula –> M vs F?

A
  • M: rectum to post urethra or bladder

- F: rectum to vagina

76
Q

low anorectal malformation –> assoc anomaly? (1)

A

perineal fistula

77
Q

neonatal –> unconj hyperbili –> cause?

A

physiologic jaundice of newborn

78
Q

neonatal –> conj hyperbili –> cause? (2)

A
  • biliary atresia

- neonatal hepatitis (ie Alagille synd, bile acid synthetic defect, metabolic dz, AAT1 def, infx)

79
Q

neonatal –> conj hyperbili –> goal of imaging? preferred imaging modality?

A

Tc-99m-HIDA hepatobiliary scintigraphy –> differentiate biliary atresia vs neonatal hepatitis

80
Q

neonatal –> conj hyperbili –> premedication for HIDA scan? why? when?

A

5 days of phenobarbital –> stimulate hepatocyte activity

81
Q

biliary atresia –> natural progression if untx?

A

progressive cirrhosis –> early childhood death

82
Q

biliary atresia –> HIDA findings? (3)

A
  • normal hepatic tracer uptake
  • normal hepatic clearance
  • no excretion into small bowel
83
Q

biliary atresia vs neonatal hepatitis –> US appearance?

A

cannot differentiate

sometimes absent GB –> suggest biliary atresia

84
Q

biliary atresia –> tx?

A

Kasai portoenterostomy:

  • excise entire extrahep biliary tree
  • jejunal loop anastomose to liver
85
Q

neonatal hepatitis –> HIDA findings?

A
  • poor hepatic excretion
  • delayed hepatic clearance (>12hr)
  • variable bowel excretion
86
Q

primary cancers w liver mets? (4)

A
  • neuroblastoma
  • Wilms tumor
  • sarcoma
  • Burkitt lymphoma
87
Q

what is mesenchymal hamartoma?

A

developmental anomaly (not neoplasm) –> multicystic hamartomatous lesion –> malformed bile ducts, portal vein fragmts, extramed hematopoiesis –> benign

88
Q

mesenchymal hamartoma –> when present?

A

neonate

89
Q

what is gallbladder hydrops? predisposing condition? (2)

A

pathologically distended GB

  • infx
  • systemic inflamm (ie Kawasaki)
90
Q

vascular neoplasm vs malformation?

A

neoplasm: new cell growth
malformation: disorganized vasc; no cell growth

91
Q

high flow vascular malformation/neoplasm? (3)

A
  • infantile hemangioma
  • AVM
  • AV fistula
92
Q

low flow vascular malformation? (2)

A
  • venous malformation

- lymphatic malformation

93
Q

adult –> hepatic hemangioma –> are actually venous malformation, T/F?

A

T

94
Q

pediatric –> MC vascular hepatic tumor

A

infantile hemangioma & hemangioendothelioma

95
Q

infantile hemangioma vs hemangioendothelioma?

A

hemangioma: benign
hemangioendothelioma: usu benign –> can mets

96
Q

infantile hemangioma & hemangioendothelioma –> assoc synd? (1)

A

Kasabach-Merritt synd

97
Q

Kasabach-Merritt synd –> synd? (3)

A
  • vascular neoplasm
  • hemolytic anemia
  • consumptive coagulopathy
98
Q

infantile hemangioma & hemangioendothelioma –> potential complication? (1)

A

25% –> congestive heart fail

99
Q

infantile hemangioma & hemangioendothelioma –> MRI appearance (3)

A
  • highly vascular
  • T2 hyper
  • enhance peripheral –> delayed fill-in
100
Q

infantile hemangioma & hemangioendothelioma –> conventional angiography finding?

A
  • enlrg celiac axis

- aorta distal to celiac trunk –> narrow

101
Q

infantile hemangioma & hemangioendothelioma –> tx?

A
  • most spontaneously involute within 1st yr of life
  • BB –> accel involution
  • surg if CHF
102
Q

3 MC childhood abd malig

A

1) neuroblastoma
2) Wilms tumor
3) hepatoblastoma

103
Q

hepatoblastoma –> when present, younger/older/same as infantile hemangioma?

A

slightly older

104
Q

hepatoblastoma –> assoc synd? (3)

A
  • Beckwith-Wiedemann
  • familial adenomatous polyposis synd
  • fetal alcohol synd
105
Q

Beckwith-Wiedemann –> screen for what? how often?

A

hepatoblastoma –> q6mo

106
Q

hepatoblastoma –> what lab is elevated?

A

alpha-fetoprotein (AFP)

107
Q

hepatoblastoma –> classic XR finding?

A

RUQ calcification

108
Q

hepatoblastoma –> CT appearance?

A
  • predominantly solid heterogeneous enhancing liver mass

- like to invade portal & hepatic veins

109
Q

pediatric –> cirrhosis –> causes? (5)

A
  • AAT1 def
  • glycogen storage dz
  • tyrosinemia
  • biliary atresia
  • chronic viral hepatitis
110
Q

HCC –> imaging appearance?

A
  • heterogeneous hepatic mass
  • early arterial enhance
  • rapid washout
111
Q

HCC –> AFP elevated or normal?

A

elevated

112
Q

undifferentiated embryonal sarcoma (malig mesechymoma) –> epidemiology?

A

6-10yo

113
Q

undifferentiated embryonal sarcoma (malig mesechymoma) –> AFP elevated or normal?

A

normal

114
Q

liver mets –> primary? (2)

A
  • neuroblastoma

- Wilms tumor

115
Q

Meckel diverticulum –> MOA?

A

omphalomesenteric duct –> incomplete regress

116
Q

Meckel diverticulum –> pediatric –> potential complication? (2)

A
  • GI bleed (if contain ectopic gastric mucosa)

- lead pt –> intussusception

117
Q

Meckel diverticulum –> adult –> potential complication? (2)

A 
#1 SBO
#2 Meckel diverticulitis
118
Q

what is omphalomesenteric duct?

A

duct –> connect intestine to umbilicus/yolk sac

119
Q

omphalomesenteric duct –> incomplete regress –> complication? (2)

A
  • # 1 Meckel diverticulum

- umbilico-ileal fistula

120
Q

Meckel diverticulum –> rule of 2’s?

A
  • 2% population
  • symptomatic before 2yo
  • 2ft from ileocecal valve
121
Q

rectal bleed –> suspect Meckel diverticulum –> imaging of choice?

A

Tc-99m pertechnetate scan

122
Q

Tc-99m pertechnetate scan –> what tissue does it detect?

A

gastric mucosa

123
Q

pediatric abd neoplasms w calcifications (3)

A
  • neuroblastoma
  • teratoma
  • hepatoblastoma
124
Q

pancreatoblastoma –> age?

A

1-8yo

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