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Year 5 Paediatrics COPY > GI > Flashcards

Flashcards in GI Deck (45)
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1

When is hyperbilirubinemia pathological?

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

2

Most serious complication of neonatal jaundice

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

3

Ix for hyperbilirubinemia

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

4

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

5

Pathophys-pyloric stenosis

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

6

Presentation and findings-pyloric stenosis

Non-bilious projectile vomiting
Hypochloremic, hypokalemia metabolic acidosis. K+ loss worsens from aldosterone release in response to hypovolemia

7

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

8

Choanal atresia

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

9

CHARGE syndrome

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

10

Hirschsprungs

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

11

Imperforate anus

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

12

Prototype finding of duodenal atresia

Bilious vomiting

13

Duodenal atresia

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

14

CXR findings in duodenal atresia

Double bubble

15

Treatment-duodenal atresia

Fluids, electrolytes. NGT to decompress bowel.
Sx-duodenostomy

16

Volvulus

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

17

Intussusception

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

18

Signs-inflamm diarrhea

Fever, abdo pain, poss bloody diarrhea

19

Signs-noninflamm diarrhea

Vomiting, crampy abdo pain, watery diarrhea

20

Tx necrotizing enterocolitis

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

21

Presentation necrotizing enterocolitis

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

22

AXR-necrotizing enterocolitis

"Pneumotosis intestinalis"-air within bowel wall

23

MOA-necrotizing enterocolitis

Bowel undergoes necrosis, bacteria invade intestinal wall.

24

Bile stained vomit

Intestinal obstruction

25

Projectile vomiting

Pyloric stenosis

26

Vomiting at end paroxysmal coughing

Pertussis

27

Vomiting + Abdo distention

Intestinal obstruction, incl strangulated inguinal hernia

28

Vomiting + Blood in stool

Intussusception
Gastroenteritis-salmonella, campylobacter

29

Vomiting + FTT

GERD
Celiac
Other chronic GI conditions

30

Appendicitis

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).