GI

Question 1

MCC Bowel obstruction younger than 2

Answer 1

Intussusception

Question 2

Intussusception - age range

Answer 2

3m to 3y

Question 3

Intussusception - location

Answer 3

usually proximal to the ileocecal valve

Question 4

Intussusception - risk factors

Answer 4

Conditions with lead points

• Meckel’s
• Intestinal lymphoma (>6y age)
• Henoch-Schonlein purpura,
• parasites
• polyps
• adeno- or rotavirus infection
• Celiac dz
• CF

Question 5

Abrupt-onset, colicky abd pain, in other-wise healthy child. Flexed knees and vomiting. Triad: Abd pain, vomiting, and bloody mucus in the stools (currant jelly stool).
PE: palpable “sausage-shaped” RUQ mass, tenterness, +guaiac. Absence of bowel in RLQ.

Answer 5

Intussusception

Question 6

U/S: target-sign

Answer 6

Intussusception

Question 7

Tx: Intussusception

Answer 7

Correct any electrolyte abnormality
Check CBC for leukocytosis
Consider NG for decompression
Air-contrast barium enema (diagnostic in >95%, curative in >80%>
Surgical reduction and resection if unstable, peritoneal signs, or failed enema

Question 8

Pyloric Stenosis - Risk Factors

Answer 8

Firstborn males

A/W TE fistulas, maternal h/o PS, erythromycin ingestion

Question 9

Non-bilious vomiting beginning around 3 wks of age and progressing to projectile emesis

Answer 9

PS

Question 10

Palpable olive-shaped, mobile, nontender epigastric mass. Visible gastric peristaltic waves

Answer 10

PS

Question 11

Barium studies: “string sign”

Answer 11

PS (narrow pyloric channel). May also be described as a pyloric beak

Question 12

Metabolic derangement in PS

Answer 12

hypochloremic, hypokalemic metabolic alkalosis (persistent loss of HCl).

Question 13

Tx: PS

Answer 13

Correct dehydration/acid-base abnormalities

Surgical: pyloromyotomy

Question 14

Meckel’s etiology

Answer 14

failure of the omphalomesenteric (vitelline) duct to obliterate.

Question 15

Type of tissue in Meckel’s

Answer 15

heterotopic gastric tissue

Question 16

MC congenital abnormality of the small intestine

Answer 16

Meckel’s

Question 17

Rule of 2s

Answer 17

Meckel's
MC in children under 2
2x MC in males
2 types of tissue (pancreatic and gastric)
2 in long
Found w/in 2ft of ileocecal valve
2% of the population

Question 18

Sudden, intermittent, painless rectal bleeding

Answer 18

Meckel’s

Question 19

Meckel’s complications

Answer 19

obstruction, diverticulitis (may mimic appendicitis), volvulus, and intussusception

Question 20

Dx: Meckel’s

Answer 20

Meckel scintigraphy scan (tc-99 pertechnetate) - detect ectopic gastric tissue
Plain films - useful for detecting obstruction and perforation

Question 21

Tx: Meckel’s

Answer 21

Surgical excision (diverticulum with adjacent ileal segment - if actively bleeding.
Ulcers frequently develop in adjacent ileum

Question 22

Hirschsprung’s Dz

Answer 22

Congenital lack of ganglion cells in the distal colon. Uncoordinated peristalsis and dec motility.
A/W - males, Waardenburg’s syndrome, MEN type 2

Question 23

Failure to pass meconium within 48h. Bilious vomiting, FTT

Answer 23

Hirschsprung’s (less severe may present later in life with chronic constipation

Question 24

Abdominal distention and explosive discharge of stool following rectal exam. Or lack of stool in rectum. Or abnormal sphincter tone

Answer 24

Hirschsprung’s

Question 25

Barium enema: narrowed distal colon with proximal dilation

Answer 25

Hirschsprung's (plain films reveal distended bowel loops with paucity of air in the rectum.

Question 26

Anorectal manometry: failure of the internal sphincter to relax after distention of the rectal lumen

Answer 26

Hirschsprung's

Question 27

Hirschsprung's dz - rectal bx

Answer 27

Required for definitive dx Absence of myenteric (Auerbach's) plexus and submucosal (Meissner's) plexus Hypertrophied nerve trunks enhanced with achetylcholinesterase stain.

Question 28

Tx: Hirschsprung's

Answer 28

2-stage surgical repair 1. diverting colostomy @ dx 2. definitive pull-through procedure connecting remaining colon to rectum

Question 29

1st month of life: bilious emesis, crampy abd pain, distention, and blood or mucus in the stool

Answer 29

Malrotation with volvulus

Question 30

Malrotation with volvulus

Answer 30

Congenital malrotation of the MIDGUT Cecum in the right hypochondrium Formation of Ladd's bands. Predispose to obstruction and constriction of blood flow.

Question 31

AXR: "bird-beak" appearance and air-fluid levels

Answer 31

Malrotation with volvulus (AXR may also appear normal

Question 32

Upper GI - abnormal location of LoT

Answer 32

Malrotation with volvulus | Study of choice - w/ stable pt

Question 33

Tx: Malrotation with volvulus

Answer 33

NG to decompress IV hydration Emergent surgical repair when volvulus is gastric Surgery or endoscopy with volvulus is intestinal

Question 34

MC GI emergency in neonates

Answer 34

``` Necrotizing enterocolitis (NEC) A portion of the bowel undergoes necrosis ```

Question 35

Premature infant: first few days of life: feeding intolerance, delayed gastric emptying, abd distention, bloody stools

Answer 35

NEC

Question 36

Complications of NEC

Answer 36

intestinal perf, peritonitis, abd erythema, shock

Question 37

AXR: pneumatosis intestinalis, dilated bowel loops, portal venous gas, abd free air

Answer 37

NEC intramural air bubbles, gas produced by bacteria in the bowel wall Serial AXR - q6h

Question 38

Labs in NEC

Answer 38

nonspecific: hyponatremia, metabolic acidosis, leukopenia or leukocytosis with L shift, thrombocytopenia, and coagulopathy (DIC with prolonged PT/aPTT and +D-dimer

Question 39

Tx: NEC

Answer 39

NPO, OG for gastric decompression, correct dehydration and lytes, TPN, IV abx Surgery: if perf or worsening AXR (usually an ileostomy with mucous fistula with later reanastomosis

Question 40

NEC - complications

Answer 40

stricture, short-bowel syndrome