GI

Question 1

Anatomically explain difference between meconium plug and meconium ileus?

Answer 1

meconium plug functional immaturity of colon
meconium ileus involves distal ileum

Question 2

Does biliary atresia occur in intra or extrahepatic bile ducts?

Answer 2

Extrahepatic

Question 3

Does duodenal atresia or annular pancreas appear first?

Answer 3

Both have bilious emesis

Question 4

How do you treat meconium plug syndrome?

Answer 4

Contrast enema is the investigation of choice and is often diagnostic and therapeutic.

Question 5

How does volvulous occur?

Answer 5

Volvulus occurs because the narrow mesenteric base, which develops due to malrotation, allows the small bowel to twist around the superior mesenteric artery.

Question 6

Is it rarer to have other intestinal anomalies with omphalocele or gastroschisis?

Answer 6

Gastroschisis has intestinal anomalis like atresias

omphaloceles extra intestinal manifestations, other problems

Question 7

Terminal ileum has critical role in reabsorptin of what ?

Answer 7

B12, bile acids

Question 8

What are Ladd’s bands?

Answer 8

fibrous bands that form between cecum and right posterior retroduodenal peritoneum

Question 9

What does contrast enema show in meconium plug syndrome?

Answer 9

visualizes meconium against colonic wall, creating a double contrast impression.

Question 10

When does duodenal atresia occur (embryo)?

Answer 10

failure of recanilization during 8th -10th week. usually occurs 2nd part of duodenom

Question 11

Where do partial small bowel obstructions occur?
In order of occurence

Answer 11

distal ileum 36%
proximal jejunum 31%
distal jejumum 30%
proximal ileum (13%)

Question 12

where does spontaneous intestinal perforation occur?

Answer 12

Terminal ileum

Question 13

what causes midgut volvulous?

Answer 13

defect in counterclockwise rotatoin of small intestine around SMA during protrusion through yolk sac

causes displacement of cecum to right upper abdominal quarter and obstruction of duodenum by Ladd’s band

Question 14

what does midgut volvulous show on imaging?

Answer 14

paucity of gas throughout with few scattered air-fluid levels
doppler shows abnormal relation of superior mesentric vessels to the superior mesenteric artery

Question 15

Which of the following is a common late complication seen in neonates who undergo repair of esophageal atresia?

Answer 15

GERD

Question 16

How does Diabetes contribute to meconium plug syndrome?

Answer 16

neonatal hypoglycemia stimulates the autonomic nervous system. Increased stimulation of the sympathetic nervous system causes a decrease in intestinal movement, which accelerates the development of meconium plugs.

hypoglycemia induces the pancreas to secrete glucagon. In turn, glucagon decreases peristalsis in the left colon.

Question 17

What is most common cause of liver failure and need for transplant in newborn?

Answer 17

Neonatal hemochromatosis

Question 18

What are electrolyte findings in pylorics stenosis

Answer 18

hypochloremic, hypokalemic metabolic alkalosis

Question 19

What might cause triple bubble sign?

Answer 19

Jejunal atresia

Question 20

Xray can be nonspecific for volvulus, but on barium what will you see that can be diagnostic.?

Answer 20

cecum in upper right quadrant and not lower right quadrant

Question 21

What is the MCC association with microcolon?

Answer 21

maternal diabetes

Question 22

How is Hirschprung’s Diagnosed?

Answer 22

looking for ganglionic cells, or absence there of
by pattern of acetylcholinesterase staining

Question 23

At what age is definitive treatment of Hirschprung

Answer 23

10kg or 1 year old

Question 24

Deviations of the uro-rectal septum can lead to …

Answer 24

persistent cloaca
rectovesical fistula
rectourtethral fistula

Question 25

what does urorectal septum do?

Answer 25

divides cloaca into 2 parts
ventral (urogential sinus)
dorsal (anorectal canal)

Question 26

All patients with gastroschisis have what finding?

Answer 26

abnormal rotation and fixation
(malrotation)

Question 27

When does omphalocele occur?

Answer 27

11 weeks GA if abodminal contents do go back into cavity
or at 18 weeks if somatic folds fail to create abdominal wall

Question 28

What is MCC additional anomaly seen in omphalocele?

Answer 28

Cardiac Defect

Question 29

How does Alagille cholestasis differ from biliary atresia?

Answer 29

Intrahepatic duct problem with Alagile
Extrahepatic duct problem with biliary atresia

Question 30

Multinucleated Giant cells are pathognomonic for what?

Answer 30

neonatal hepatitis

Question 31

What is transit time of ELBW vs term infant?

Answer 31

ELBW 2-4 days
Term 12 hours to 1 day

Question 32

What usually comes first Apnea or Reflux?

Answer 32

Usually an apneic episode will happen prior to reflux episode

Question 33

Answer 33

Question 34

Answer 34

Question 35

When does fistula occur in TE Fistula, how?

Answer 35

at 5 weeks, fistula occurs due to abnormal posterior positioning of TE septum, resulting in a connection.

if it’s isolated occurs at 8 weeks, when esophagus fails to recanalize during 8th week of development