GI

Question 1

Bilious vomiting means that obstruction is occurring?

Answer 1

beyond the ampulla of vater

Question 2

In an infant with bilious vomiting, what test should be done first?

Answer 2

X-ray

Question 3

An infant presents with two days of “green vomit” per mom. Birth history reveals polyhydramnios requiring induction of labor. An x-ray shows a double-bubble sign without evidence of air distally. What is the problem? How is this corrected? What is this associated with?

Answer 3

• Duodenal atresia
• Surgical correction
• Down syndrome

Question 4

What is the best way to evaluate a child with bilious vomiting and concern for malrotation?

Answer 4

Upper GI series

Question 5

Infants with malrotation are at a high risk for?

Answer 5

Volvulus

Question 6

What if an infant with bilious vomiting had an x-ray that showed a double bubble sign and air bubbles distally?

Answer 6

Intestinal atresia

Question 7

What causes intestinal atresia?

Answer 7

vascular accidents in utero from maternal cocaine use

Question 8

A patient with pyloric stenosis will present with what typical presentation?

Answer 8

A first born male with non-bilious, projectile vomiting in the first month of life. An olive-shaped mass and visible peristaltic waves will be seen on exam.

Question 9

What laboratory abnormality is present in children with pyloric stenosis?

Answer 9

hypokalemic, hypochloremic metabolic alkalosis

Question 10

What would an ultrasound of pyloric stenosis show?

Answer 10

A hypertrophied pylorus that resembles a donut

Question 11

What is the most common type of tracheoesophageal fistula?

Answer 11

Blind proximal esophagus; distal esophagus has connection to from trachea to stomach.

Question 12

What classic X-ray finding is seen in tracheoesophageal fistula?

Answer 12

NG tube coiling in the chest

Question 13

What is the cutoff for passage of meconium?

Answer 13

Should happen by 48 hours

Question 14

What can be used to treat a meconium ileus?

Answer 14

gastrograffin enema

Question 15

What would be seen in a patient with Hirschsprung’s disease?

Answer 15

dilated proximal colon and normal looking distal colon, which is actually the abnormal portion.

Question 16

What is the treatment for Hirschsprung’s?

Answer 16

Resect the portion of the bowel that is missing ganglion cells.

Question 17

What is the most common cause of constipation in children?

Answer 17

voluntary holding

Question 18

What are two maternal medications that would cause constipation in a newborn?

Answer 18

Magnesium and opioid use

Question 19

What metabolic abnormalities cause constipation?

Answer 19

Hypercalcemia, hypermagnesemia, hypoglycemia, hypokalemia

Question 20

A 6-year-old with anal fissure should be evaluated for?

Answer 20

IBD

Question 21

What children are at the highest risk for intussusception?

Answer 21

3 months to 3 years.

Question 22

A mom brings her 8-month old child in for abdominal pain that causes him to intermittently roll in a ball. Today he developed bloody diarrhea and so she brought him for evaluation. She describes the stool as looking like crushed cranberries. What is your concern? What should be done?

Answer 22

Intussusception

Air contrast barium enema both confirms and treats

Question 23

Meckel’s diverticulum is due to?

Answer 23

vitelline duce remnant

Question 24

How does Meckel’s Diverticulum cause bloody vomiting?

Answer 24

increased acid secretion leading to ulcers

Question 25

What is the rule of 2’s associated with Meckel’s?

Answer 25

• present by 2 years of age
• 2x more likely in males
• 2 inches long
• 2 feet from ileocecal valve
• 2% of the population

Question 26

What tests is diagnostic for Meckel’s?

Answer 26

technicium-99 radionucleotide scan

Question 27

When are the two peaks in age associated with crohn’s presentation?

Answer 27

10-20 years old and 50-80 years old

Question 28

Bloody diarrhea and FTT in a 6 month old should make you consider? Whats the fix?

Answer 28

Milk protein allergy

Switch to hydrolyzed formula

Question 29

What does an apt test on a neonate with vomiting tell you?

Answer 29

If it is their blood or swallowed maternal blood if the blood is resistant to denaturation, it’s fetal in origin.

Question 30

There are only two non-physiologic causes of elevated conjugated bilirubin in a newborn, what would they be?

Answer 30

1. Dubin johnson (black liver)
2. Rotor (painless jaundice)
   * Both have elevated urine coproporphyrin

Question 31

For the following tests, tell me what an elevated indirect bilirubin and positive test would mean?

1. positive coombs test
2. elevated reticulocyte count

Answer 31

1. Rh disease or ABO incompatibility

2. hemolysis-think spherocytosis, G6PD, pyruvate kinase deficiency

Question 32

What type of bilirubin can cause kernicterus? What is the result of Kernicterus?

Answer 32

Elevated indirect bilirubin (lipid soluble, crosses BBB)

irreversible deposition in basal ganglia and pons

Question 33

How can breast milk cause hyperbilirubinemia?

Answer 33

Slow moving bowels in a newborn cause too much bilirubin to be resorbed vs. breast milk inhibition of glucouronyl transferase (presents later).

Question 34

What is the biggest problem in an infant with congenital diaphragmatic hernia?

Answer 34

Hypoplastic lung

Question 35

How do you differentiate between gastroschisis and omphalocele?

Answer 35

Gastroschisis: right of midline, no membrane, associated with GI stenosis or atresia

Omphalocele: midline, covered with membrane, associated with Beckwith-Widemann syndrome.

Question 36

Direct hyperbilirubinemia that worsens after 2 weeks of age would e concerning for? How could you test?

Answer 36

biliary atresia. Ultrasound with show no intrahepatic ducts vs. HIDA scan after pre-med phenobarbital showing lack of bile reaching duodenum.

Question 37

What does the phenobarbital prior to a HIDA scan for biliary atresia do?

Answer 37

increases sensitivity of the test.