Gen Med Pediatric

Question 1

Bilious Vomit (yellow Green) is:

Answer 1

Obstruction until otherwise proven

Refer for endoscopy ASAP

Question 2

Projectile Vomit (consistent, not ill)

Answer 2

Pyloric Stenosis

Fine/Not Fussy always projectile vomits after eating & wants to eat again

Not sick but likely not gaining well

Image of Choice is Sonogram, looking for target sign if no hemetemesis

Question 3

Pyloric Olive

Answer 3

Hypertrophied Pyloric Sphincter

Cause of Pyloric Stenosis

May be palpable in epigastric

Surgury required

Question 4

Rx Pyloric Stenosis

Answer 4

Surgery

Question 5

Infantile/childhood Hematemesis

Answer 5

911

Refer for endoscopy asap

Question 6

Common GERD causes in nursing baby

Answer 6

Dairy & Beef & Smoking in the house

Question 7

Uncomplicated GERD fixes

Answer 7

• Sit baby up after eating for 1/2 hr
• Try soy, Try non-soy
• -thicken formula w/oat cereal, not rice
• If nothing works, try 2wk PPI trial use Nexium
• If that doesn’t work, refer for endoscopy

Question 8

Target Sign on Sonogram

Answer 8

Pyloric Stenosis
or
Intussception “target, bulls eye or coiled sprain”

Question 9

Hemetemesis

Answer 9

Complicated GERD
or
Volvulus

Refer for endoscopy ASAP

Question 10

Sm bowel invagination, usually near ileocoecal valve

Answer 10

Intussusception

• Under 3
• Sudden Onset
• Current Jelly Stool
• Happy Between Episodes

Question 11

Rx for Projectile Vomit/Pyloric Stenosis

Answer 11

Pyloromyotomy

Question 12

Intussusception Rx

Answer 12

Pneumatic Air Enema Thru Rectum

Surgery if that doesn’t work

Question 13

Knees Up & Screaming
Belly Distended
Fine between episodes

Answer 13

Intussusception

invagination of sm bowel into cecum

Question 14

Intussusception Triad

Answer 14

• Sausage Shaped Mass in Belly palpable
• Pain
• Current Jelly Stool

Question 15

Happy Pukers

Answer 15

Pyloric Stenosis

Check for Olive

Refer for sonogram / target sign

Question 16

Suspect Volvulus

Answer 16

X Ray asap, don’t stop to sonogram w/barium

Question 17

Rule of 2

Answer 17

Meckel's Diverticulum:
2 yrs or younger
2% of the population
2 feet from the ileocoecal valve
2 inches long

Question 18

Most common cause of Obstruction up to age 2-3

Answer 18

Intussusception - 911!!!

- Endoscopy    - NG Tube    - IV Fluids    - Pneumatic Air Enema or Barium from Rectum

You CAN have intussusception with no obstruction

Question 19

Meckel’s Diverticulum Image of choice

Answer 19

Nuclear Scan, 80% diagnostic

If negative and you have painless lower GI bleed that may look like Appendicitis but Appendix is fine on the nuclear scan
Go to Arteriography

Question 20

Meckel’s Rx

Answer 20

Decompress Bowel if obstructed

Augmentin/Flagyl & PPI

Divertiulectomy or Resection/Anastamosis

Question 21

Bowel winds 270 degrees around Ligament of Treitz

Answer 21

Intestinal Malrotation

Volvulus -911

Question 22

Malrotation Study of Choice

Volvulus Study of Choice

Answer 22

Upper GI w/Barium for Malrotation

Stat X-Ray for Volvulus, no time!! then to OR
LADD procedure untwists & appendectomy

Question 23

Vomiting bile (green digestive fluid)
Drawing up the legs.
Abdominal pain.
Swollen abdomen.
Diarrhea.
Constipation.
Rectal bleeding.
Failure to thrive.

Answer 23

Volvulus

X-Ray

LADD Procedure

Question 24

Painless lower GI Bleed in kids

Appedicitis-y but CT of appendix is good Think:

Answer 24

Merkel’s Diverticulum

Rule of 2’s

Question 25

Happy Spitter

Answer 25

Uncomplicated Infant GERD Happy Projectile Vomiter is Pyloric Stenosis

Question 26

Corkscrew on Upper GI w/Barium

Answer 26

Intestinal Malrotation you probably did an X-Ray if you had biliary vomit or hematemesis and suspected Volvulus.

Question 27

Neonate

Answer 27

1-28 days

Question 28

Neonate doesn't pass Meconium in first 2 days of life and Belly Distended & Bilious Vomit "Squirt Sign" or "Blast Sign" on pinky DRE

Answer 28

Hirchsprung Disease Congenital loss of Myenteric Nerve Bed in distal Sigmoid, loss of peristalsis Get X-Ray, look for air above the Sigmoid Refer for REctal Biopsy to DX Colonectomy is RX

Question 29

painless bleeding from the rectum

Answer 29

Meckel's Divertiuculum - One of the Most common congenital abnormalities. - Usually Asymptomatic found on scan for something else or looks like appendicitis - Arises from incomplete separation of fetal bowel from the placenta - Rule of 2's - Nuclear Scan to image or arteriography. Capsule endography not so great as diverticula can be large and capsule can get stuck there. - Bowel Abx regimen but substitute Augmentin for Cipro in kids, give Abx prophylactically and in actual diverticulitis.