GI

Question 1

Imperforate anus pathogenesis?

Answer 1

No anal opening

Question 2

Imperforate anus associated with?

Answer 2

VACTERL

Question 3

How to diagnose imperforate anus?

Answer 3

Clinical, then upside down babygram to determine whether to fix

Question 4

How to treat imperforate anus?

Answer 4

Upside down babygram to see where rectum is. If far, make colostomy and fix before toilet training. If close, fix today.

Question 5

Hirschsprung’s Disease Pathogenesis

Answer 5

No auerbach’s plexus due to decreased migration of neurons

Question 6

How does hirschsprung’s patient present?

Answer 6

Failure to pass meconium or chronic constipation which is explosive after a DRE.

Question 7

How to diagnose hirschsprung’s disease?

Answer 7

Babygram shows dilated loops of bowel with normal segment.

Full thickness rectal biopsy, can also do barium enema or anal manometry

Question 8

How to treat hirschsprung disease?

Answer 8

Resection of bad colon

Question 9

Meconium ileus pathogenesis?

Answer 9

Cystic fibrosis

Question 10

How does mec ileus present?

Answer 10

FTPM, no prenatal screen.

Bilious emesis

Question 11

How to diagnose mec ileus?

Answer 11

Babygram shows ground glass with dilated loops of bowel

Question 12

How to treat mec ileus?

Answer 12

Gastrographin enema

Question 13

Voluntary constipation patient presentation?

Answer 13

Constipation with intermittant diarrhea and encopresis

Question 14

How to diagnose voluntary constipation/

Answer 14

Xray shows a colon full of stool

Question 15

How to treat voluntary constipation?

Answer 15

Laxatives then disimpaction in OR under anesthesia

Question 16

Malrotation pathogenesis?

Answer 16

Volvulus

Question 17

Patient presentation with malrotation?

Answer 17

Normal uterine course presents with bilious emesis

Question 18

How to diagnose malrotation?

Answer 18

X-ray shows double bubble sign with a normal gas pattern beyond. This is ominous. Barium swallow shows birds beak duodenum

Question 19

How to treat malrotation?

Answer 19

Surgery

Question 20

Duodenal atresia/annular pancreas pathogenesis?

Answer 20

Failure of duodenum to recanalize or failure of pancreas to fuse properly.

Question 21

How does patient with duodenal atresia or annular pancreas present?

Answer 21

With bilious emesis, but polyhydramnios in utero.

Duodenal atresia happens with downs, annular pancreas does not.

Question 22

Pathogenesis of Intestinal Atresia

Answer 22

Vascular accident in utero (cocaine)

Question 23

How does patient with intestinal atresia present?

Answer 23

+/- polyhydramnios, bilious emesis

Question 24

How to diagnose intestinal atresia?

Answer 24

Double bubble sign on x-ray with multiple air fluid levels beyond

Question 25

How to treat intestinal atresia?

Answer 25

Resect dead bowel.

Question 26

Pyloric stenosis patient presentation

Answer 26

Patient feeds normally for ~3 weeks, then projectile nonbilious vomiting with an olive shaped mass

Question 27

How to diagnose pyloric stenosis

Answer 27

CMP shows decreased K, decreased Cl, increased pH and donut sign

Question 28

How to treat pyloric stenosis?

Answer 28

Myomectomy

Question 29

Necrotizing enterocolitis pathogenesis?

Answer 29

Prematurity

Question 30

Necrotizing enterocolitis patient presentiation

Answer 30

Premature baby with bloody BM at first feeding

Question 31

How to diagnose necrotizing enterocolitis

Answer 31

Pneumatosis intestinalis on XR

Question 32

How to treat necrotizing enterocolitis?

Answer 32

NPO, IVF, TPN, IV antibiotics

Question 33

F/u for NEC?

Answer 33

Check for retinopathy, interventricular hemorrhage, respiratory distress syndrome

Question 34

How to treat anal fissures?

Answer 34

Reassurance

Question 35

Intussuception pathogenesis

Answer 35

Telescoping section of bowel, vascular comprimise

Question 36

Patient presentation of intussuception

Answer 36

abrupt onset of colicky pain, knees to chest, sausage mass with currant jelly stool.

Question 37

How to treat intussuception?

Answer 37

Air enema is diagnostic and therapeutic

Question 38

Meckel's Diverticulum pathogenesis

Answer 38

Most common cause of lower GI bleed in children. Vitelline duct. True diverticulum

Question 39

How does patient with meckel's present?

Answer 39

Painless lower GI bleed, FOBT+, BRBPR

Question 40

How to diagnose meckel's?

Answer 40

Technicium 99

Question 41

How to treat meckels?

Answer 41

Resection

Question 42

Causes of prehepatic jaundice?

Answer 42

Hemolysis

Question 43

Causes of posthepatic jaundice?

Answer 43

Biliary atresia, sepsis, metabolic syndromes

Question 44

Features of unconjugated bilirubin

Answer 44

Fat soluble, can't get excreted into urine, can cross BBB, can cause Kernicterus

Question 45

Features of conjugated bilirubin

Answer 45

Water soluble, can get excreted into urine, so causes darkening, doesn't cause BBB, cannot cause kernicterus.

Question 46

Physiologic vs pathologic jaundice onset and resolution

Answer 46

Phys onsets >72 H, pathologic onsets 1 week if normal or >2 if premie

Question 47

Physiologic vs pathologic jaundice D bili content and rise

Answer 47

Physiologic jaundice has D bili 10. Rise for physiologic jaundice is 5 points/day.

Question 48

Tests to order to work up physiologic jaundice?

Answer 48

Coombs (to see if there's isoimmunization with Rh or ABO incompatibility). Hgb (to see if there's a blood transfusion from twin-twin or mom-baby with delayed clamping) Reticulocyte count (to check for hemorrhage/hemolysis like in G6PD, pyruvate kinase deficiency or hereditary spherocytosis) If all negative, then breast jaundice.

Question 49

Breast feeding vs breast milk jaundice

Answer 49

Breast feeding due to low intake. Gut motility decreases, more reabsorption. tx: feed more Breast milk jaundice decreases activity of 2,3 UGT. Conjugation decreases. Tx by switching to formula.

Question 50

How to treat physiologic jaundice

Answer 50

UV light or exchange transfusion.