2.05 Pediatric GI (Chapman + Viscerosomatics)

Question 1

Sympathetic T3-T6

Answer 1

Esophagus

Question 2

SYM T5-T9

Answer 2

Celiac ganglia, stomach, duodenum, pancreas, liver, GB, spleen

Question 3

SYM T10-T11

Answer 3

Superior mesenteric ganglia
Appendix, cecum, kidneys, gonads
Ascending colon, 1/2 transverse colon, etc.

Question 4

SYM T12-L2

Answer 4

Inferior mesenteric ganglia
Bladder, prostate, sex, remainder colon, lower ureters

Question 5

What is the PARA innervation for 1/2 transverse colon, descending colon, sigmoid, rectum, lower ureter, bladder, prostate, and sex organs (not gonads) ?

Answer 5

Pelvic Splanchnic

Question 6

Upper GI Tract SYM spinal levels?

Answer 6

T5-T9

Question 7

Middle GI SYM spinal cord level?

Answer 7

T10-11

Question 8

Appendix/Cecum SYM spinal cord levels?

Answer 8

T10-T11

Question 9

Lower GI SYM spinal levels?

Answer 9

T12-L2

Question 10

Anterior aspect of sternum Chapman point?

Answer 10

Pylorus

Question 11

Posterior aspect Rib 10 on right lateral to costotranverse junction?

Answer 11

Pylorus

Question 12

Intercostal space between Rib 8 and Rib 9
OR
IC space between Rib 9 and Rib 10
OR
IC space between rib 10 and Rib 11

(All near the cartilage junction)

Answer 12

Small intestine

Question 13

IT space of T8 and T9
OR
IT space of T9 and T10
OR
IT space T10 and T11

All between SP and TP tip

Answer 13

Small intestine

Question 14

Superior aspect of Rib 12 tip on the Right

Answer 14

Appendix

Question 15

IT space T11 and T12 on the right

Answer 15

Appendix

Question 16

Lateral aspect femur within 1 in from patella 1-2 inch wide space

Answer 16

Colon

Question 17

Triangular area: TP of L2 tip, to L4 Tp, iliac crest

Answer 17

Colon

Question 18

Lesser trochanter of femur Chapman point

Answer 18

Rectum

Question 19

Chapman point on sacrum, close to ilium, at lower end of iliosacral joint

Answer 19

Rectum

Question 20

What is the classic serology of pyloric stenosis?

Answer 20

Hypochloremic, hypokalemic, metabolic alkalosis

Question 21

Intermittent colicky pain, currant jelly stool, bilious emesis, abdominal mass, blood per rectum?

Answer 21

Intussusception

Question 22

Most accurate first diagnostic for intussuception?

Answer 22

Ultrasound

Question 23

What is both diagnostic and therapeutic for intussusception?

Answer 23

Air contrast enema

Question 24

What this the first line therapy for functional constipation?

Answer 24

Polyethylene glycol

Question 25

Most common cause of constipation in children?

Answer 25

Functional constipation (behavioral/fear)

Question 26

What form of Lactase deficiency is the most common in population?

Answer 26

Secondary lactase deficiency (underlying enteropathy)

Question 27

What is diagnostic for a carb malabsorption disorder?

Answer 27

Lactose breath hydrogen test

Question 28

What are symptoms of carb malabsorption?

Answer 28

Cramping, bloating, diarrhea with acidic watery stools and flatulence

Question 29

Congenital enzyme deficiency condition presenting in infancy more common in native Alaskans and Greenlanders?

Answer 29

Sucrose-isomaltase deficiency

Question 30

What is the management plan for functional constipation?

Answer 30

Fam education, diet education, meds, and behavioral modification

Question 31

20 month old with rectal bleeding and no pain? What would you consider in diagnosis?

Answer 31

Meckels Diverticulum

Question 32

What kind of surgery used to treat Meckels?

Answer 32

Ileal surgical resection

Question 33

What is the Meckel’s rule of 2?

Answer 33

2% population, 2:1 M>F, 2ft proximal ileum, 2cm diameter, common before 2 yo, 2 types tissue (pancreatic + gastric)

Question 34

Textbook projectile non-bilious vomiting full term infant 3-6 weeks?

Answer 34

Pyloric stenosis

Question 35

Diagnostic test for pyloric stenosis?

Answer 35

Ultrasound

Question 36

What is the recommended daily intake of fiber?

Answer 36

5 + #Age = total grams

Question 37

What are some organic causes of constipation?

Answer 37

Hirschsprung Dx, neuroenteric dysfunction, medications (narcotics/sedatives), low fiber feeding regiments, anatomic abnormal, systemic Dx (CF, celiac, DM), infant botulism, lead toxic, anorexia

Question 38

Where is the Meckels diverticulum commonly located?

Answer 38

Anti mesenteric border of ileum

Question 39

“Coil spring sign” on air contrast associated with?

Answer 39

Intussusception

Question 40

“Target sign” on abdominal US ?

Answer 40

Intussusception

Question 41

Classic Intussusception triad?

Answer 41

Bilious emesis, abdominal mass, and blood per rectum (20%)

Question 42

Most common Intussusception location?

Answer 42

Terminal ilium into the proximal bowel

Question 43

“String sign” on upper GI contrast ?

Answer 43

Pyloric stenosis

Question 44

Highest sensitivity test for pyloric stenosis?

Answer 44

Ultrasound

Question 45

“Olive” palpable just right above the umbilicus?

Answer 45

Pyloric stenosis

Question 46

Proposed pathology of pyloric stenosis?

Answer 46

Failed migration of neural crest cells leading to inability to relax = hypertrophy

Question 47

anterior Chapman point for stomach acid?

Answer 47

IC BTW rib 5 and Rib 6 close left to sternum

Question 48

Anterior Chapman point for stomach motility?

Answer 48

IC space Rib 6 and Rib 7 left to sternum