GI Flashcards
(31 cards)
cyclic vomiting syndrome is a diagnosis
vegan diets result in deficiency of what 2 vitamins?
Vitamin D!!! and vitamin B12!!!
NORMAL levels of amino acids and protein
on cows milk protein
concerned as regurgitates a small amount of formula after each feed
weight been tracking on 25th percentile since birth
no other complaints
next step in management?
reassurance + positioning therapy! = upright after meals
GERD in infant! which is common
NOT cows milk protein intolerance!! as no eczema, bloody stools or poor weight gain
all exclusively breastfed infants must receive what supplementation?
iron and vitamin d!!!
15 month old
chronic constipation
rectal exam results in expulsion of stool (abnormal rectal exam/squirt sign)
abdominal distention
stool occult blood testing is positive
next step in management?
contrast enema!!! -> narrow and dilated region (rectosigmoid transition zone!) in keeping with hirschprungs!! blood may be due to anal fissures or hemorrhoids from constipation. delayed passage of meconium seen. increased rectal tone!!/tight anal canal
NOT meckels as chronic constipation or abnormal rectal exam wont be seen. rather abnormal rectal bleeding or abdominal pain if it acts as a lead point for intussuception
10 day old. bilious vomiting.!! abdominal distension. AXR shows dilated bowel loops!! and air fluid levels. last bowel movement 24 hours ago. essentially SBO in a neonate. stool occult blood positive. BUT normal rectal examination!. = MIDGUT VOLVULUS
in such cases intestinal ischemia and necrosis can cause GI bleed, septic shock and perforation.
patient described has firm distended abdomen (peritonism) and is hemodynamically unstable.
next step in management?
emergency explorative laparotomy!!!
IF stable, first line wouldve been -> UPPER GI SERIES (axr with contrast)
billious vomiting +dilated bowels + normal rectal exam -> think volvulus!
not contrast enema as this is done for hirschprungs or intussuception which can both cause bilious emesis and signs of intestinal perforation but positive rectal test in HD, and intusucception occurs from 6-36 months
Cant be meckels as doesnt cause bilious vomiting
NOT necrotising enterocolitis as more common in preterm and AXR will show pneumatosis intestinalis!!
prosprandial emesis and VISIBLE peristaltic waves!
hypochloremic hypokalemic metabolic acidosis
diagnosis and management
hydration and replacemnt of electrolytes!!
then pylomylotomy
pyloric stenosis
14 yo. acute left sided abdominal pain. hypotension. blood shows anemia. US reveals free fluid in abdomen.
patients would most likely have had what exposure recently?
Viral infection! eg infectious mono!!
atraumatic splenic rupture!!!!
can even be seen with malignancy
HD mechanism?
failure of neural crest migration during fetal development
meconium ileum mechanism = insipated/thickened meconium becomes impacted -> mechanism in Cystic fibrosis related delayed meconium passage. anal tone is normal, contrast to HD.
in recurrent intussuception where a pathologic lead point is expected, next step in managment?
nuclear scintigraphy!! with technetium scan
to rule out meckels!!
toddler refusing solid foods and only wanting liquid food. cant advance from liquids to solids. poor weight gain
normal swallow study
eczema present
next step in management?
endoscopy with esophageal biopsy!!!
eosinophillic esophagitis most likely!!
management= dietary modification to avoid triggers
duodenal atresia seen and signs of downs syndrome. next step in management?
ng decompression + surgical repair!!!! -.> preoperative echo required
not karyotype as not urgent
most likely cause of acute pancreatitis in a healthy child but extrahepatic cystic mass is?
biliary cyst! -> RUQ pain jaundic and RUQ mass may be present, or asymptomatic
pancreatitis due to abnormal pancreatobiliary junction.
other rfs: cholangitis, stone formation
what type of allergy is cows milk protein intolerance?
NON-IGe!!! mediated
Bilious emesis and normal AXR. next step in workup?
Upper GI contrast series to rule out volvulus
gastrochisis causes elevated alpha feto protein levels!!!
1 month old baby. breastfed only
stools streaked with blood and mucus last 3 days. everything eelse normal
FIPAP (Food protein induced allergic proctocolitis) - caused by protein in patients diet from breastmilk or formula. cows milk! and soy most common causes. non ige mediated
can occur in breastfed infants too! -> so you need to restrict dairy and soy from maternal diet and if formula fed, switch to hydrolyzed formula.
jejunal atresa presents with bilious vomiting and abdominal distention. triple bubble sign and gassless colon seen on imgaging. prenatal exposure to cocaine and vasoconstrictive substances = risk factor
infant straining and crying prior to passing normal soft stool but is otherwise healthy most likely has infant dyschezia managent is reassurance and observation.
when would you do further workup?
hard stools, poor growth, delayed passage of meconium, abnormal physical exam eg abnormal rectal tone or severe abdominal distention
red blood on the outside! of stools + anal fissure is in keeping with constipation vs cows milk protein intolerance which has blood mixed in with stool.
management of infant constipation?
prune!! or apple juice puree!!
thick sticky stool, colon appears diffusely narrow (microcolon) NOT dilated (contrast HD). + intestinal perforation.
essentially picture of meconium ileus painted. patient is at increased risk of which comorbidity?
chronic rhinosinusitis!!!
Patient has CF
10 month old. bright red stools. intermittent abdominal pain. tiredness
exposure to sick contacts but fecal testing is negative for leukocytes!!
most likely diagnosis?
Next step in management?
intussuception
Air enema with Ultrasonography!! - used for diagnosis and treatment
NOT upper GI contrast series which is used for volvulus.
Giardia mechanism of causing diarrhea?
local epithelial disruption!!!!
->malabsorption -> oily foul smelling diarrhea
infantile colic is crying for no apparent reason for >3hours a day for at least 3 days a week
management?
soothing techniques!
