Peds GI dz

Question 1

Tracheoesophageal Fistula (info)

Answer 1

Failure of normal separation of intestinal and respiratory tracts
Most common 84-87% have ESOPPHAGEAL ATRESIA and fistula b/w trachea and distal esophagus
H-type: direct connection between espohagus and trachea (presents with ASPIRATION)
Half to 2/3 have other assoc probs (esp. cardio defects)

Question 2

Tracheoesophageal Fistula (pres/diagnx/treat)

Answer 2

Prenatal: POLYHYDRAMINOS (too much amniotic fluid as can;t pass through tract, no stomach gas on US)
Postnatal: CHOKING WITH FEEDS, inability to swallow oral secretions
Diagnx: H&P, feeding tube stuck in upper GI tract
Treat: surgery

Question 3

Infantile Hypertrophic Pyloric Stenosis (IHPS)

Answer 3

M:F, 4:1
Hypertrophy and hyperplasia of pylorus –> near complete obstruction –> dilation of proximal stomach
Pres: NON-BILIOUS, PROJECTILE VOMITING (70%) assoc with ABDOMINAL MASS (60-80%) present around 3 WKS OF LIFE
Diagnx: H&P, US
Treat: Surgery (pyloromyotomy)

Question 4

Meckel Diverticulum (What is it? & Rule of 2)

Answer 4

Abnormal remnant of the vitelline duct (connecting yolf sac and intestine)
Most common (2% of population)
Present at age 2
2 inches long, 2 feet into small bowel
2:1, M:F

Question 5

Meckel Diverticulum (pres/diagnx/treat)

Answer 5

Usually asymptomatic
Obstruction (35%) for neonates
Bleeding (40%) for older kids
Inflammation (17%)
Diagnx: CT/US, heterotopic gastric or pancreatic tissue in 50%, Technetium-99 scan of gastric musoca
Treat: surgical resection

Question 6

Omphalocele

Answer 6

Failure of intestine to return to abdomen following physiologic herniation (6-10 wks)
Assoc with advanced maternal age (30-50% have other congenital abnormalities
Pres: bowel outside body with peritoneal and amniotic covering (UNLIKE gastrochisis - no covering or assoc defects)
Diagnx: prenatally on US
Treat: Surgery (STAGED procedure putting contents back into abd cavity)

Question 7

Malrotation

Answer 7

Abnormal rotation and fixation on intestinal tract (week 10) - in isolation or complicating omph. or gastroschisis
BILIOUS VOMITING, midgut volvulus/obstruction
Diagnx: H&P, imaging, surgical exploration
Treat: Surgery

Question 8

Duplications/Cysts

Answer 8

Saccular (cystic) or tubular structures containing al layers of normal bowel wall and GI lining (may or may not communicate with bowel)
May cause obstruction, usually found incidentally
Diagnx: H&P, imaging
Treat: surgery

Question 9

Intestinal Stenosis/Artresia

Answer 9

Vascular (ischemic etiology), duodenal most common, 40% have Down Syndrome
Pres: POLYHYDRAMNIOS; obstructive sx: BILIOUS VOMIT
Diagnx: H&P, imaging
Treat: Surgery

Question 10

Imperforate Anus/Rectal Agenesis

Answer 10

Assoc with fistula formation (about half assoc with other abnormalities)
Range: thin membrane covering anus –> complete agenesis of rectum
Diagnc: PE (check in newborn screen)
Treat: Surgery (can have lifelong complications)

Question 11

Hirschprung Dz

Answer 11

M:F, 4:1
Defect in ENS, absence of ganglion cells (needed for peristalsis), RET gene mutation
FAILURE TO PASS MECONIUM
massvie dilation of intestinal lumen, if missed can lead to life threatening megacolon
Diagnx: H&P, imaging, no ganglion cells on biopsy
Treat: surgical resection of aganglionic region
CAN GET SHORT BOWEL SYNDROME IF HAVE LONG SEGMENT DZ

Question 12

Neonatal Necrotizing Eneterocolitis

Answer 12

complication of prematurity
Terminal ileum, cecum, right colon
Pres: Feeding intolerance, abd distention, bloody stools, within FIRST 10 d of LIFE, often after hypoxemia of boewl –> ischemia and necrosis
Diagnx: necrotic tissue on path
Treat: MEDICAL: bowel rest (TPN ) and ABX, also surgical resection (can get strictures or short bowel syndrome)

Question 13

Esophagitis (two types)

Answer 13

BOTH PRESENT AS HEARTBURN sx
Reflux: relaxed LES/hiatal hernia, MILD intraepithelial eosinophilic infiltr, DISTAL, pH probde POSITIVE, treat with acid blockade
Allergic/Eosinophilic: Immune rxn to dietary allergen, MARKED intraepithelial eosinophilic infiltr, laso PROXIMAL espohagus, pH probe NEGATIVE, treat with steroids (PO or INH) & dietary modification

Question 14

Non-bilious vs Bilious vomit

Answer 14

Non: more proximal obstruction
Bilious: most distal obstruction (past where bile duct empties into GI tract)

Question 15

Other common peds dz

Answer 15

IBD (teenagers)
Celiac Dz
Heliobacter gastritis (less common than in adults)