GI

Question 1

When is hyperbilirubinemia pathological?

Answer 1

First day of life
Rises >5mg/dL/day
Above 19.5mg/dL in term child
When direct bili rises >2mg/dL at any time

Question 2

Most serious complication of neonatal jaundice

Answer 2

Kernicterus.
Deposition of bili into basal ganglia.
Hypotonia, seizures, choreoathetosis, hearing loss

Question 3

Ix for hyperbilirubinemia

Answer 3

ABO and Rh incompatibility, peripheral blood smear and retic count for hemolysis

Question 4

Esophageal atresia-definition, presentation

Answer 4

Esoph ends blindly. TEF in nearly 90%
Presents with vomiting after first feed or choking/coughing with cyanosis.
Poss Hx of polyhydramnios
Recurrent aspiration pneum

Question 5

Pathophys-pyloric stenosis

Answer 5

Sphincter hypertrophy. Usu idiopathic

Not commonly found at birth; becomes more pronounced by first month of life or as late as 6/12

Question 6

Presentation and findings-pyloric stenosis

Answer 6

Non-bilious projectile vomiting

Hypochloremic, hypokalemia metabolic acidosis. K+ loss worsens from aldosterone release in response to hypovolemia

Question 7

Signs of pyloric stenosis

Answer 7

String sign on upper GI series
Olive sign on abdo palpation
Shoulder sign: filling defect in antrum due to prolapse of muscle inward
Mushroom sign: hypertrophic pylorus against duodenum
Railroad track sign: excess mucosa in pyloric lumen resulting in two columns mucosa

Question 8

Choanal atresia

Answer 8

Membrane b/w nostrils and pharyngeal space that prevents breathing when feeding.
Associated with CHARGE syndrome
Turn blue when feeding, pink when crying

Question 9

CHARGE syndrome

Answer 9

Coloboma of eye/CNS abnormalities
Heart defects
Atresia-choanae
Retardation of growth and devel
GU defects e.g. hypogonadism
Ear anomalies and/or deafness

Question 10

Hirschsprungs

Answer 10

Lack Auerbach plexus causes constant contracuture of muscle tone.
Freq assoc w/ Downs.
Boys: girls = 4:1
Do not pass meconium in first 48 hrs or at all.
Extreme constipation followed by LBO
Rectal exam shows extremely tight sphincter and inability to pass flatus
3 stage curative sx

Question 11

Imperforate anus

Answer 11

Rectum ends in blind pouch; conservation sphincter.
Unknown cause but assoc with Down’s.
Part of VACTERL.
Don’t pass meconium

Question 12

Prototype finding of duodenal atresia

Answer 12

Bilious vomiting

Question 13

Duodenal atresia

Answer 13

Lack or absence apoptosis, leading to improper canalization of duodenal lumen
Assoc w/ annular pancreas and Downs

Question 14

CXR findings in duodenal atresia

Answer 14

Double bubble

Question 15

Treatment-duodenal atresia

Answer 15

Fluids, electrolytes. NGT to decompress bowel.

Sx-duodenostomy

Question 16

Volvulus

Answer 16

Vomiting, colicky abdo pain.
Mult air fluid levels.
Bird beak appearance on upper GI series at site rotation
Tx-sx or endoscopic untwisting

Question 17

Intussusception

Answer 17

Currant jelly stool. Sausage-shaped mass, neuro sxs, abdo pain. Caused by polyp, hard stool, or lymphoma.
May be viral.
Bilious vomiting
Assoc with rotavirus vaccine, HSP

Question 18

Signs-inflamm diarrhea

Answer 18

Fever, abdo pain, poss bloody diarrhea

Question 19

Signs-noninflamm diarrhea

Answer 19

Vomiting, crampy abdo pain, watery diarrhea

Question 20

Tx necrotizing enterocolitis

Answer 20

Abx, IV fluids, NGT. If medical management not successful, sx to remove affected bowel

Question 21

Presentation necrotizing enterocolitis

Answer 21

Severely premature baby w/ low birth weight, vomiting, abdo distention, fever.
Frank or occult blood can be seen in stool.

Question 22

AXR-necrotizing enterocolitis

Answer 22

“Pneumotosis intestinalis”-air within bowel wall

Question 23

MOA-necrotizing enterocolitis

Answer 23

Bowel undergoes necrosis, bacteria invade intestinal wall.

Question 24

Bile stained vomit

Answer 24

Intestinal obstruction

Question 25

Projectile vomiting

Answer 25

Pyloric stenosis

Question 26

Vomiting at end paroxysmal coughing

Answer 26

Pertussis

Question 27

Vomiting + Abdo distention

Answer 27

Intestinal obstruction, incl strangulated inguinal hernia

Question 28

Vomiting + Blood in stool

Answer 28

Intussusception | Gastroenteritis-salmonella, campylobacter

Question 29

Vomiting + FTT

Answer 29

GERD Celiac Other chronic GI conditions

Question 30

Appendicitis

Answer 30

Anorexia, vomiting, abdo pain, flushed, oral fetor, low grade fever, persistent tenderness, guarding Lies still, knees flexed If no signs perforation, Abx and elective sx (give time to decrease inflamm).

Question 31

Malrotation/volvulus

Answer 31

Signs obstruction +/- strangulation Bilious vomiting in first few days life Abdo pain Tenderness from peritonitis/ischemic bowel Contrast study whenever bile stained vomit to assess rotation Urgent laparotomy if vascular compromise. Untwist volvulus, mobilize duod

Question 32

mesenteric adenitis

Answer 32

Isolated non-specific inflamm mesenteric LNs Dx of exclusion Sxs: abdo pain (non-specific, self-limiting 24-48hrs), D&V, nausea, fever Rule out appendicitis (USS, CRP, WCC) Conservative management, painkillers Can be caused by Yersinia

Question 33

Recurrent abdo pain

Answer 33

Sufficient to interrupt normal activities, >3/12 10% kids Psychogenic, somatization (stress, anxiety). Need to rule out infection, stones, tumors, IBS, abdo migraine, Meckel's, sickle, DM, porphyria, Crohns/UC, celiac, Pb, HSP, pancreatitis, etc.

Question 34

Red flag sxs in constipated child

Answer 34

Failure to pass meconium in first 24 hrs life FTT/growth failure Gross abdo distention Abn lower limb neurology (lumbosacral path) Signs spina bifida Perianal bruising or multiple fissures (sexual abuse) Perianal fistulae, abscesses, or fissures (perianal Crohn's) Abn appearance anus

Question 35

Anal fissure-causes, sxs

Answer 35

Causes: Idiopathic, Constipation Sxs: severe anal pain (tearing, cutting, burning before/after defecation), PR bleed bright red blood, itchy bum

Question 36

Crohn's-sxs

Answer 36

``` Abdo pain, diarrhea, weight loss, ?bloody stools Growth failure, delayed puberty Systemic sxs (fever, lethargy, weight loss) Extra intestinal: oral lesions, perianal skin tags, anterior uveitis, arthralgia, erythema nodosum, pyoderma gangrenosum ```

Question 37

UC-sxs

Answer 37

PR bleeding, diarrhea, colicky pain Weight loss and growth failure less common than Crohn's Extraintestinal: erythema nodosum, pyoderma gangrenosum, arthritis

Question 38

Meckel's diverticulum

Answer 38

``` Rule of 2s: 2 inches long 2 feet from ileocecal valve 2 types tissue (gastric hence blood) Presents by 2 years of age 2% of population ```

Question 39

Meckel's-dx

Answer 39

Technecium scan--increased uptake by gastric mucosa

Question 40

Meckel's-sxs

Answer 40

Severe rectal bleeding--neither bright nor melena. | Can also present with intussusception, volvulus, or diverticulitis

Question 41

Diaphragmatic hernia

Answer 41

Failure of diaphragm to fuse properly. Abdo organs migrate upwards into chest Can be posterolateral, anterior (Morgagni's), or hiatus (via esophageal aperture) Can cause pulmonary hypoplasia Most diagnosed pre-natally on USS. Mother may have polyhydramnios Surgical repair after NG tube and suction

Question 42

Inguinal hernia

Answer 42

Patent processus vaginalis (indirect) RF: male, prematurity Sxs: intermittent swelling in groin or scrotum on straining, cyring. Infant may be unwell with irritability and vomiting Tx: analgesics and gentle compression. If can't reduce then emergency sx

Question 43

Hydrocele

Answer 43

``` Abnormal collection fluid in remnant processus vaginalis usu disappears in 1-2 years Transilluminates Nontender Surgery if persists beyond 18-24mo ```

Question 44

Biliary atresia

Answer 44

Extrahepatic ducts obliterated (inflamm and fibrosis) Persistent jaundice, pale stools, dark urine FTT, abn LFTs (esp GGT) USS to differentiate from neonatal hepatitis Tx: Abx to prevent cholangitis, ursodeoxycholic acid to encourage bile flow, fat soluble vit supplementation, sx (portoenterostomy)

Question 45

Gastro-esophageal reflux disease (GERD)

Answer 45

Common in infancy Inappropriate relaxation LES as result functional immaturity RFs: predominantly fluid diet, horizontal posture, short intra-abdominal length esoph, CP/neurodevel disorder, pre-terms (esp if pre-existing bronchopulm dysplasia), post esoph atresia/diaphragmatic surgery Tx: most resolve. Feed thickening, 30 degrees head up after feeds, ranitidine/PPI if severe, Domperidone (enhance gastric emptying)