Flashcards in GI Deck (45)
When is hyperbilirubinemia pathological?
First day of life
Above 19.5mg/dL in term child
When direct bili rises >2mg/dL at any time
Most serious complication of neonatal jaundice
Deposition of bili into basal ganglia.
Hypotonia, seizures, choreoathetosis, hearing loss
Ix for hyperbilirubinemia
ABO and Rh incompatibility, peripheral blood smear and retic count for hemolysis
Esophageal atresia-definition, presentation
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
Sphincter hypertrophy. Usu idiopathic
Not commonly found at birth; becomes more pronounced by first month of life or as late as 6/12
Presentation and findings-pyloric stenosis
Non-bilious projectile vomiting
Hypochloremic, hypokalemia metabolic acidosis. K+ loss worsens from aldosterone release in response to hypovolemia
Signs of pyloric stenosis
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
Membrane b/w nostrils and pharyngeal space that prevents breathing when feeding.
Associated with CHARGE syndrome
Turn blue when feeding, pink when crying
Coloboma of eye/CNS abnormalities
Retardation of growth and devel
GU defects e.g. hypogonadism
Ear anomalies and/or deafness
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
Rectum ends in blind pouch; conservation sphincter.
Unknown cause but assoc with Down's.
Part of VACTERL.
Don't pass meconium
Prototype finding of duodenal atresia
Lack or absence apoptosis, leading to improper canalization of duodenal lumen
Assoc w/ annular pancreas and Downs
CXR findings in duodenal atresia
Fluids, electrolytes. NGT to decompress bowel.
Vomiting, colicky abdo pain.
Mult air fluid levels.
Bird beak appearance on upper GI series at site rotation
Tx-sx or endoscopic untwisting
Currant jelly stool. Sausage-shaped mass, neuro sxs, abdo pain. Caused by polyp, hard stool, or lymphoma.
May be viral.
Assoc with rotavirus vaccine, HSP
Fever, abdo pain, poss bloody diarrhea
Vomiting, crampy abdo pain, watery diarrhea
Tx necrotizing enterocolitis
Abx, IV fluids, NGT. If medical management not successful, sx to remove affected bowel
Presentation necrotizing enterocolitis
Severely premature baby w/ low birth weight, vomiting, abdo distention, fever.
Frank or occult blood can be seen in stool.
"Pneumotosis intestinalis"-air within bowel wall
Bowel undergoes necrosis, bacteria invade intestinal wall.
Bile stained vomit
Vomiting at end paroxysmal coughing
Vomiting + Abdo distention
Intestinal obstruction, incl strangulated inguinal hernia
Vomiting + Blood in stool
Vomiting + FTT
Other chronic GI conditions