PEDIATRIC Section 7: Luminal GI (SPECIAL TOPICS)

Question 1

Extra-abominal evisceration of neonatal bowel (sometimes stomach and liver) through a paraumbilical wall defect.

Answer 1

Gastroschisis

Question 2

Herniated bowel loop through the ventral body wall NOT surrounded by a membrane

Answer 2

Gastroschisis

Question 3

Herniated bowel loop through the ventral body wall Surrounded by a membrane (peritoneum)

Answer 3

Omphalocele

Question 4

Herniated bowel loop through the ventral body wall + Normal Umbilicus - poistioned to the left of the defect (Defect is on the right)

Answer 4

Gastroschisis

Question 5

Herniated bowel loop through the ventral body wall + Umbilicus contains hemiated bowel, and therefore is NOT normal

Answer 5

Omphalocele

Question 6

Herniated bowel loop through the ventral body wall + Defect is on the right

Answer 6

Gastroschisis

Question 7

Herniated bowel loop through the ventral body wall + Defect is midline

Answer 7

Omphalocele

Question 8

Herniated bowel loop through the ventral body wall + with rare associated anomalies

Answer 8

Gastroschisis

Question 9

Herniated bowel loop through the ventral body wall + High Association with Cardiac (50%) defects and Chromosomal Abnormalities

Answer 9

Omphalocele

Question 10

What associated anomalies are common in omphalocele?

Answer 10

Trisomy 18
Turners
Klinefelters
Beckwith-Wiedemann,
Pentalogy of Cantral

Question 11

Herniated bowel loop through the ventral body wall + good outcome

Answer 11

Gastroschisis

Question 12

Herniated bowel loop through the ventral body wall + Intenstinal atresias

Answer 12

Gastroschesis

Question 13

Herniated bowel loop through the ventral body wall + Cause: environmental

Answer 13

Gastroschesis

Question 14

Herniated bowel loop through the ventral body wall + Genetic

Answer 14

Omphalocele

Question 15

What is Pentalogy of Cantrell

Answer 15

Question 16

What is an Enteric Duplication cyst?

Answer 16

developmental anomalies (failure to canalize)
DONT have comminication with GI lumen

Question 17

Where are enteric duplication cysts commonly found?

Answer 17

Ileal region (40%)

Question 18

Enteric Duplication cysts can cause what condition?

Answer 18

In Utero Bowel obstriuction/Perforation

Question 19

Diagnosis?

Answer 19

Enteric Duplication Cyst

Question 20

If you have a random cyst in the abdomen you need to ask yourself what?

Answer 20

“does this have gut signature? ”

Question 21

WTF is gut signature?

Answer 21

It’s alternating bands of hyper and hypo echoic signal - supposedly representing different layers of bowel.

Question 22

Cyst wih Gut Signature =

Answer 22

Enteric Duplication Cyst

Question 23

Cyst without Gut signature

Answer 23

Omental Cyst

Question 24

30% of the time, Enteric Duplication cysts are associated with what anomalies?

Answer 24

Vertebral anomalies

Question 25

This is a cause of bowel obstruction in an older kid (20 year old) with cystic fibrosis (CF)

Answer 25

DIstal Intestinal Obstruction Syndrome

Question 26

This is sometimes called the “meconium ileus equivalent, ” why?

Answer 26

DIstal Intestinal Obstruction Syndrome

because you end up with a distal obstruction (as the name implies) secondary to dried up thick stool.

Question 27

DIstal Intestinal Obstruction Syndrome commonly involves what part of the colon?

Answer 27

Ileum/right colon

Question 28

Self-limiting, usually viral inflammatory condition o f mesenteric lymph nodes. It is a classic clinical mimic of appendicitis.

Answer 28

Mesenteric Adenitis

Question 29

cluster of large right lower quadrant Ivmph nodes.

Answer 29

Mesenteric Adenitis

Question 30

immature bowel mucosa (from being premature or having a heart problem), and you get translocated bugs through this immature bowel.

It’s best thought o f as a combination o f ischemic and infective pathology.

Answer 30

Necrotising Enterocolitis (NEC)

Question 31

Necrotising Enterocolitis (NEC)!

Who gets it?

Answer 31

• Premature Kids (90% within the first 10 days of life)
• Low Birth Weight Kids ( < 1500 grams)
• Cardiac Patients (sometimes occult) - they can be full term
• Kids who had perinatal asphyxia
• Hirschsprung Kids that go home and come back - they present around month 1.

Question 32

most definitive finding of NEC

What do you look for?

Answer 32

Pneumatosis

Look for Portal Venous Gas Next

Question 33

the region most affected by NEC

Answer 33

terminal ileum / right colon - Focal dilated bowel

Question 34

Describe the small bowel in NEC

Answer 34

Featureless small bowel, with separation (suggesting edema).