Sketchy Path: Congenital GI Disorders

Question 1

What symptoms are common with pyloric stenosis?

Answer 1

Projectile non-bilious vomiting after feeding

Question 2

When does pyloric stenosis present?

Answer 2

1 month of life - takes time for pylorus to become significantly stenosed
(well muscled man feeding baby with stomach bottle)

Question 3

What do you see on physical exam for pyloric stenosis?

Answer 3

Olive shaped mass and peristalsis can be seen thru abdominal wall

Question 4

Gastrochesis is defined as what?

Answer 4

Periumblical herniation of the abdominal contents thru the abdominal wall
(Kid with silly string spraying on other kids sotmach)

Question 5

Omphalocele is defined as?

Answer 5

Failure of the GI content to return to the abdomen

Question 6

Omphalocele contrasts gastrochesis how?

Answer 6

Omphalocele herniates thru umbilicus (unlike gastrochesis) and is covered by peritoneum (unlike gastrochesis)
(Elephant hand punching thru kids shirt)

Question 7

Congenital diaphragmatic hernia can cause what in a developing fetus?

Answer 7

Pulmonary hypoplasia and pulmonary HTN due to compression of the lungs by abdominal organs
(Herniating jack in the box pushes kids lung shirt up)

Question 8

How to newborn babies present when have congenital diaphragmatic hernia?

Answer 8

Respiratory distress

Question 9

TE fistulas are a result of what?

Answer 9

Failure of septation of the tracheoesophageal tube

4th-5th week

Question 10

What is the most common type of TE fistula?

Answer 10

Type C

Esophagus ends in blind pouch

Question 11

What symptoms can be seen with type C TE?

Answer 11

Non-bilious vomiting
Aspiration pneumonia
Distended abdomen filled with air

Question 12

When you see a TE fistula need to think of what other congenital Syndrome?

Answer 12

VACTERL
Vertebral anomaly
Anal/rectal malformation
Cardiac Malformation
Esophageal malformation
Renal anomalies
Limb deformity
(girl from the slide looks broken)

Question 13

Duodenal Atresia symptoms include?

Answer 13

Bilious emesis since beyond where bile enters the duodenum

Question 14

What is the common xray finding in duodenal atresia?

Answer 14

Double bubble sign

two kids playing in the bubbles

Question 15

Duodenal atresia is assc with what other syndrome?

Answer 15

Down Syndrome

Question 16

Meckel Diverticulum occurs due to what?

Answer 16

Failure of the viterlline duct to obliterate

Meckel hecklers jeckling the violin player

Question 17

What usually causes symptoms of a Meckel Diverticulum?

Answer 17

Ectopic tissue usually ectopic gastric mucosa

stomach shaped violen

Question 18

Most common presenting symptom in infants with Meckel diverticulum?

Answer 18

Melena due to gastric ectopic tissue eroding the mucosa

black tar next to violinist

Question 19

How is Meckel Diverticulum diagnosed?

Answer 19

Technetium 99m pertechnetate scan picks up ectopic gastric mucosa
(technique book for violinist)

Question 20

What causes Hirschprungs disease?

Answer 20

Failure of migration of the neural crest cells to the distal colon
(Girl with crest shield on a horse spring ride that is unplugged)

Question 21

What are the symptoms of Hirschprung’s?

Answer 21

Failure to pass meconium with megacolon proximal to affected area
(dilated coil)

Question 22

What happens when you stick your finger in a babys rectum with Hirschprung’s disease?

Answer 22

Feces explodes out

Question 23

When the abdominal contents return to the abdominal cavity during development how much are they rotated?

Answer 23

270 counterclockwise

Question 24

Malrotation can lead to what forming in the abdominal cavity? What does this cause?

Answer 24

Ladd bands; the cecum is now located in the URQ and still attempts to connect to the retroperitoneum this can cause intestinal obstruction of the duodenum
(Ladd bands constricting little kids stomach and he vomits)

Question 25

Necrotizing enterocolitis only occurs in what population?

Answer 25

Premature and underweight babies

Question 26

What is the hypothesized cause of necrotizing enterocolitis?

Answer 26

Immature immune system causes invasion of pathogens when feeding begins

Question 27

What is the pathopneumonic xray sign for necrotizing enterocolitis?

Answer 27

Pneumotosis intestinalis
(air in the bowel wall)