Miscellaneous Topics

Question 1

What is Intussusception?

Answer 1

An acquired invagination of the proximal bowel into the distal bowel

Question 2

What is the most frequent cause of bowel obstruction and infants and toddlers?

Answer 2

Intussusception

Question 3

The Intussusception telescopes into the distal bowel by:

Answer 3

Peristaltic activity

Question 4

In Intussusception, the mesentery of the proximal bowel is compressed, resulting in:

Answer 4

Venous obstruction + Bowel wall edema -> Arterial insufficiency -> Necrosis

Question 5

What are the types of Intussusception?

Answer 5

1) Primary (idiopathic)
2) Secondary

Question 6

Is there a lead point in primary Intussusception?

Answer 6

No

Question 7

What is the cause of primary Intussusception?

Answer 7

Hypertrophy Peyer patches within the bowel wall

Question 8

Primary Intussusception occurs frequently after recent:

Answer 8

1) URTI
2) Gastroenteritis

Question 9

Which viruses could lead to a primary Intussusception?

Answer 9

1)Adenovirus
2) Rotavirus

Question 10

Is there a lead point in secondary Intussusception?

Answer 10

Yes

Question 11

Secondary Intussusception increases in proportion with:

Answer 11

Age

Question 13

What is the most common cause of secondary Intussusception?

Answer 13

Meckel’s Diverticulum

Question 14

Most patients who develop Intussusception are:

Answer 14

Well-nourished, healthy infant boys
(4-9 months old)

Question 15

The classic presentation of Intussusception is an infant or a young child with:

Answer 15

1) Intermittent crampy abdominal pain
2) “Currant Jelly” stools
3) Palpable mass

Question 16

Why do we see “Currant Jelly” stools in Intussusception?

Answer 16

Due to bowel ischemia and mucosal sloughing

Question 17

What imaging should you order if you suspect intussusception?

Answer 17

1) X-Ray
2) Ultrasound

Question 18

What do you see on Ultrasound for intussusception in the transverse plane?

Answer 18

Target or ‘donut’ lesion

Question 19

What do you see on Ultrasound for intussusception in the longitudinal plane?

Answer 19

Pseudokidney sign

Question 20

What is the Initial management for intussusception?

Answer 20

1) Immediate decompression (NG Tube)
2) NPO
3) IV fluid resuscitation and maintenance IVF
4) Correct electrolyte disturbances

Question 21

What is the non-operative management for intussusception?

Answer 21

Hydrostatic/Pneumatic Reduction (Under fluoroscopy or ultrasound guidance)

Question 22

What are the contraindications for Hydrostatic/Pneumatic Reduction in Intussusception?

Answer 22

1) Perforation/Peritonitis
2) Persistent hypotension/tachycardia
3) Sepsis

Question 23

What are the indications for operative management for intussusception?

Answer 23

1) Nonoperative reduction is unsuccessful or incomplete
2) Signs of peritonitis/ pneumoperitoneum
3) Presence of a lead point (secondary intussusception)

Question 24

What are the risk factors for Hypertrophic Pyloric Stenosis (HPS)?

Answer 24

1) Family history
2) Male gender
3) Younger maternal age
4) Being a first-born infant
5) Maternal feeding patterns

Question 25

What are some genetic factors that may play a role in HPS?

Answer 25

1) Race 2) Sex (Increased frequency in males) 3) First-born infants with a positive family history

Question 26

What are some environmental factors that may play a role in HPS?

Answer 26

1) Method of feeding (breast vs formula) 2) Seasonal variability 3) Exposure to erythromycin 4) Transpyloric feeding in premature infants

Question 27

What are some other factors that may play a role in HPS?

Answer 27

1) Excessive substance P 2) Decreased neurotrophins 3) Deficient nitric oxide synthase 4) Gastrin hypersecretion

Question 28

The main etiology for HPS is:

Answer 28

Unknown

Question 29

What is the main symptom that HPS presents with?

Answer 29

Nonbilious, progressive projectile vomiting (of recent feedings)

Question 30

When does HPS present?

Answer 30

In a full-term neonate (about 2-8 weeks old)

Question 31

How does HPS present on clinical exam?

Answer 31

1) If: a) Early: Appears well b) Late: Signs of dehydration 2) Visible gastric peristaltic waves 3) Palpable pylorus "olive sign"

Question 32

What electrolyte abnormality do you look for in HPS?

Answer 32

Hypochloremic hypokalemic metabolic alkalosis

Question 33

What imaging do you do for HPS?

Answer 33

Ultrasound

Question 34

How do you diagnose HPS on Ultrasound?

Answer 34

1) Muscle thickness of ≥4 mm 2) Pyloric length of ≥16 mm

Question 35

If the US findings for HPS are vague, then we should do:

Answer 35

Upper gastrointestinal series

Question 36

What are the pre-op supportive measures for HPS?

Answer 36

1) NPO +/- gastric decompression 2) IV fluid resuscitation 3) Correction of electrolytes

Question 37

What are the surgical options for HPS?

Answer 37

1) Laparotomy 2) Laparoscopic Pyloromyotomy

Question 38

Is HPS a surgical emergency?

Answer 38

No, but it's urgent

Question 39

What are the complications of surgery for HPS?

Answer 39

1) Mucosal perforation 2) Postoperative emesis 3) Prolonged postoperative emesis

Question 41

What are the two main congenital abdominal wall defect seen in infants?

Answer 41

1) Gastroschisis 2) Omphalocele

Question 42

Which congenital abdominal wall defect is covered by a peritoneal sac: Gastroschisis or Omphalocele?

Answer 42

Omphalocele

Question 43

Which congenital abdominal wall defect is NOT covered by a peritoneal sac: Gastroschisis or Omphalocele?

Answer 43

Gastroschisis

Question 44

Where is the defect location in an Omphalocele?

Answer 44

Midline through the umbilical ring

Question 45

Where is the defect location in Gastroschisis?

Answer 45

Usually to the right of the umbilicus

Question 46

Which congenital abdominal wall defect contains herniation of ONLY the bowel?

Answer 46

Gastroschisis

Question 47

Which congenital abdominal wall defect contains herniation of bowel AND organs?

Answer 47

Omphalocele

Question 48

How can we detect Gastroschisis in utero?

Answer 48

Via Ultrasound at 20 weeks gestation

Question 49

To check for Gastroschisis in utero, we need to perform an ultrasound at __ weeks gestation.

Answer 49

20

Question 50

What do you see on ultrasound in Gastroschisis?

Answer 50

1) Bowel loops floating freely in amniotic fluid 2) IUGR

Question 51

Abnormal maternal __ is universally elevated in Gastroschisis

Answer 51

Alpha-Fetoprotein