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MTB 4 (GI) Flashcards

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1
Q

What is choanal atresia?

A

Membrane b/t nostrils and pharyngeal space

Prevents breathing during feeding

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2
Q

How does choanal atresia present?

A

Child turns

  • Blue when feeding
  • Pink when crying
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3
Q

How do we dx choanal atresia?

A

CT

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4
Q

Tx for choanal atresia?

A

Surgical intervention

  • perforate membrane
  • reconnect pharynx to nostrils
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5
Q

What is Hirschsprung dz?

A

Lack of innervation in distal bowel by Auerbach plexus

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6
Q

What dz is ass’d with Hirschsprung dz?

A

Down syndrome

MEN type II

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7
Q

What is the presentation of Hirschsprung dz?

A

Failure to pass meconium in first 48 hours
Or
At all.
Bilious vomiting, FTT

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8
Q

When do normal infants pass meconium?

A

90% within first 24 hours

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9
Q

How do we Dx Hirschsprung dz?

A

Barium enema reveals narrowed distal colon w/proximal dilation

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10
Q

What do we seen on plain xrays in Hirschsprung dz?

A

Distended bowel loops with lack of air in rectum

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11
Q

What is seen on anorectal manometry in Hirschsprung dz?

A

High pressure in anal sphincter

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12
Q

Definitive Dx is made with what for Hirschsprung dz?

A

Full thickness Bx

- lack of ganglionic cells in submucosa

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13
Q

Tx for Hirschsprung dz?

A

3-stage surgery

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14
Q

What is imperforate anus?

A

Opening of anus is missing

Rectum ends as blind pouch

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15
Q

What dz is ass’d with imperforate anus?

A

Down syndrome

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16
Q

Presentation of imperforate anus?

A

Failure to pass meconium
PE: no anus
Tx: surgery

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17
Q

What is CHARGE syndrome

A 
Coloboma of eye, CNS abnormalities
Heart defects
Atresia of choanae
Retardation of growth/development
Genital/urinary defect - hypogonadism
Ear anomalies/deafness
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18
Q

What is VACTERL syndrome?

A 
Vertebral anomalies
Anal atresia
Cardiovascular anomalies
Tracheoesophageal fistula
Esophageal fistula
Renal abnormalities
Limb anomalies
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19
Q

What is seen in a quad screen (2nd trimester) for Down syndrome?

A

Increased Inhibin-A, b-HCG

Decreased MSAFP, Estriol

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20
Q

Bilious vomiting on first day of life

A

Duodenal atresia

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21
Q

What is the cause of Duodenal atresia

A

Lack/absence of apoptosis -> improper canalization of lumen of duodenum

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22
Q

Presentation of Duodenal atresia?

A

In utero: polyhydramnios

Bilious emesis w/in hours after first feeding - first 12 hours of life

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23
Q

CXR finding of Duodenal atresia

A

Double bubble sign - air bubbles in stomach and duodenum proximal to atresia

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24
Q

Tx of Duodenal atresia

Study These Flashcards
A
  1. IVF
  2. Electrolyte replacement - K+
  3. NGT bowel decompression
  4. Surgical duodenostomy
25
Volvulus
Bowel obstruction - loop of bowel twisted on itself
26
MC location of Volvulus
Midgut | Ileus
27
Presentation of Volvulus
Vomiting Colicky abdominal pain distension Passage of blood or mucus in stool
28
What is seen on upper GI series of Volvulus
Multiple air fluid levels Bird beak appearance Abnormal location of ligament of Treitz
29
Tx for Volvulus
Emergent surgical/endoscopic untwisting
30
Best initial therapy for Volvulus
Endoscopic decompression
31
Complication with Volvulus
Life-threatening sepsis from bowel necrosis w perforation
32
Sausage shaped mass on palpation
Intussusception
33
Presentation of Intussusception
``` Currant jelly stool Neuro signs Abdominal pain MC in first 2 years of life RLQ sausage shaped mass palpated ```
34
Intussusception pathophysiology
Telescoping of bowel into another segment of bowel
35
Causes of Intussusception
``` Polyp Hard stool Intestinal Lymphoma Viral Infxn - Gastroenteritis Meckels Hematoma Henoch Schloein ```
36
What vaccination is contraindicated in Intussusception
Rotavirus
37
MC location of Intussusception
Ileocecal Junction at RLQ
38
Pt draws up legs twd abdomen, follwed by emesis initially non-bilious progresses to bilious?
Intussusception
39
Best initial test for Intussusception
US shows doughnut sign or target sign
40
Most accurate test for Intussusception
Barium enema
41
When is barium enema CI in children?
Signs of Peritonitis shock perforation
42
Tx for Intussusception
1. IVF 2. Electrolytes - K, Ca, MG 3. NGT decompression 4. Barium enema = curative 5. Surgery - If barium enema ineffective
43
Management if target sign seen
Air enema
44
Where does Meckel's Diverticulum occur?
Small intestinal tract
45
Meckel's Diverticulum Rule
``` Rule of 2's 2% of population affected 2 feet from ileocecal valve 2 types of ectopic tissue: gastric and pancreatic 2X as common in Males 2 Years of age or younger 2% symptomatic 2 inches long ```
46
Presentation of Meckel's Diverticulum
Sudden Painless rectal bleeding
47
Most accurate test Meckel's Diverticulum
Technetium 99 scintigraphy scan
48
Tx for Meckel's Diverticulum
Surgical removal of diverticulum
49
Diarrhea w fever, abdominal pain, bloody diarrhea
Inflammatory diarrhea
50
Diarrhea with vomiting, crampy abdominal pain, watery diarrhea
Noninflammatory
51
Tx for diarrhea
Mild = Oral fluids Severe = IVF Can be isotonic crystalloid
52
Necrotizing Enterocolitis presentation
``` Premies w low birth weight Vomiting and abdominal distension Fever Feeding intolerance Bloody stools ```
53
Dx for Necrotizing Enterocolitis
Abdominal Xray shows pneumatosis intestinalis = air w/in bowel wall CT shows air in portal vein, dilated bowel loops Frank or occult blood in stool
54
What does CT show for Necrotizing Enterocolitis that has perforated
Pneumoperioteum
55
Tx for Necrotizing Enterocolitis
1. NPO - Bowel rest - discontinue feeding 2. IVF Stat 3. NGT bowel decompression 4. Surgery to remove affected bowel
56
What are indications for surgery in Necrotizing Enterocolitis
Perforation | Radiographic worsening on serial images
57
Complications ass'd with Necrotizing Enterocolitis
Intestinal strictures | Short bowel syndrome
58
Presentation of cyclical vomiting
Recurrent, self-limiting N/V Absence of any cause High incidence w parents w/ migraines
59
Complications with cyclical vomiting
Anemia | Dehydration

Peds (6 decks)

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