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Clin Med I- GI > PEDIATRICS > Flashcards

PEDIATRICS Flashcards

1
Q

3 week firstborn baby presents with projectile vomiting of milk, palpable “olive” in RUQ. The child is dehydrated seen by sunken fontanelles and dry mucous membranes. The child vomits, then feeds again, vomits, feeds again, etc. Dx and tx

A

Pyloric stenosis, check with US- tx is to correct electrolytes, replace intravascular volume, and pyloromyotomy

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2
Q

Most common surgical disorder of infancy

A

pyloric stenosis

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3
Q

Pyloric stenosis causes …

A

hypertrophy of the circular and longitudinal muscles of the pylorus (separates stomach from duodenum)

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4
Q

Bilious emesis in baby with pyloric stenosis

A

EMERGENCY

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5
Q

15 year old patient presents with RLQ pain over the last 24 hours. Pain has been getting worse. N/V. No rectal bleeding. Pain precedes nausea. PE indicates tenderness at McBurney’s point, unilateral guarding, and Rovsing’s sign (referred pain). Dx and Tx?

A

Acute appendicitis seen with CT contrast. Tx- urgent surgery

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6
Q

1 year old wakes up crying and screaming at night, then falls back asleep. These episodes repeat throughout the night. Infant often lifts legs up. There is pallor, sweating, and dehydration. Mass palpable on exam in abdomen. Child may also have vomiting and Currant jelly stools later on. Dx?

A

Intussesception

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7
Q

What are the late findings of intussusception if you do not treat right away?

A

Currant jelly stools and vomiting

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8
Q

What is the most common cause of obstruction in children between 6 months and 2 years of age?

A

intussusception

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9
Q

what occurs in intussusception

A

a part of the intestine invaginates over in another part of intestine- may cause restriction of vascular flow and bowel necrosis (obstruction that limits blood flow to that area)

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10
Q

Tx of intussusception

A

Correct electrolytes, volume, BARIUM OR AIR ENEMA used to diagnose and treat

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11
Q

How does Hirschprung’s disease work

A

lack of innervation of distal colon causing constipation- failure of cephalocaudal migration of the parasympathetic myenteric nerve cells into the distal bowel

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12
Q

Is obstruction in hirschprung’s disease functional or structural?

A

functional- affected area fails to relax in response to distention, causing backup- constipation

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13
Q

Newborn presents with bilious emesis, distension, irritability, chronic constipation. Xray shows dilated loops of bowel. Barium enema shows change in calibur from normal to aganglionic bowel segments

A

Hirschprung’s disease

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14
Q

Dx and tx of Hirschprung’s disease

A

MUCOSAL BIOPSY needed to establish diagnosis- look for aganglionosis in mucosa. Xray shows dilated loops of bowel. Barium enema can also confirm- change from normal to aganglionic segments. Tx- surgery to remove affected segment (single stage laparoscopic procedure)

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15
Q

Rectal exam in infant with Hirschprung’s disease

A

Passage of flatus and stool and decompression

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16
Q

PE in older children with Hirschprung’s

A

CHARACTERISTIC- abdominal pain and chronic constipation. passage of stool reuires more effort. rectum typically empty, sigmoid palpable across lower abdomen

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17
Q

Most common and serious GI disorder of premature infants

A

Necrotizing enterocolitis

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18
Q

What is Necrotizing enterocolitis characterized by?

A

mucosal necrosis, ulceration, sloughing of intestinal mucosa

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19
Q

Premature newborn presents with bloody stools, abdominal distension, lethargy, apnea, bradycardia, abdominal wall erythema. Xray shows dilated bowel, pneumatosis, air in portal vein, and free air. thrombocytopenia, and low or high WBC count. Dx?

A

Necrotizing enterocolitis

20
Q

What diagnostic study should NOT be performed in NE?

A

contrast studies

21
Q

Absolute indication of surgery in NE

A

Pneumoperitoneum

22
Q

Tx in NE

A

bowel resection with exteriorization of the ends of the bowel. Infants less than 1500g, RLQ irrigation and drainage

23
Q

Patient presents with painless rectal bleeding, purulent discharge from umbilicus, peritonitis. Obstruction occurs 2 ft. of ileocecal valve. Dx?

A

Meckel’s diverticulum with Technetium 99 scan and CT

24
Q

Abnormality of omphalomesenteric or vitelline duct is

A

Meckel’s diverticulum

25
Q

Meckel’s diverticulum, remnant of…

A

embryonic yolk sac

26
Q

What is the main problem with getting Meckel’s diverticulum

A

may contain ectopic tissue (gastric, pancreatic) which can lead to ulceration

27
Q

Tx of meckel’s diverticulum

A

surgical

28
Q

Most common reason for obstruction in infancy:

A

small bowel volvulus or adhesive bands (Ladd’s bands)

29
Q

different types of malrotatin that can occur

A

nonrotation, incomplete, reversed rotation, or anomalous fixation of the mesentery

30
Q

Ladd’s bands present or absent in which malrotations?

A

Absent in Nonrotation, Ladd’s bands in others (except reversed)

31
Q

Infant presents with bilious vomiting. Xray shows double bubble sign. UGI shows duodenum on R and obstruction with duodenal distension. Dx?

A

Malrotation

32
Q

SMA in different malrotations

A

Nonrotation-midgut is suspended from SMA/V. Incomplete- cecum fixed near SMA. Reversed- Duodenum is anterior to SMA. anamalous fixation of mesentery- SMA syndrome- compression of third part of duodenum by AA

33
Q

Which malrotation causes obstruction of right colon and rotates in clockwise direction

A

reversed

34
Q

which malrotations are prone to volvulus d/t short, narrow mesentery

A

incomplete and nonrotation

35
Q

Complications of malrotation

A

obstruction, peptic ulceration, malabsorption

36
Q

tx of malrotation

A

ladd’s bands are divided, intestine twisted, appendix removed, cecum placed in LLQ, duodenum straightened

37
Q

abdominal wall defect- viscera covered in a sac of peritoneum and amnion

A

Omphalocele

38
Q

Omphalocele associated with…

A

genetic abnormalities, CHF, beckwith-wiedmann, pentaology of cantrell, prune belly syndrome

39
Q

Tx of omphalocele

A

bowel returned to abdomen slowly in “silo”, defect is repaired. NOT emergency or urgency

40
Q

Abdominal wall defect through which uncovered viscera protrude

A

Gastroschesis

41
Q

Location of gastroschesis

A

To the right of the umbilicus

42
Q

Tx in gastroschesis

A

URGENT REPAIR d/t loss of domain. Silo applied

43
Q

Important to save umbilical cord in…

A

both gastroschesis and omphalocele

44
Q

chest indented inwards

A

pectus excavatum

45
Q

bird chest outward

A

pectus carinatum

Clin Med I- GI (10 decks)

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