Pediatric GI Flashcards
(30 cards)
bilious emesis
BAD
DDx that we know of:
- newborn - duodenal atresia
- child - volvulus and malrotation
double bubble: air in proximal duodenum and stomach
duodenal atresia
what is duodenal atresia?
failure of lumen to re-canalize during 8-10th week of gestatio
tx duodenal atresia
place NG tube to decompress
surgery = definitive tx
esophageal fistula
- no air in gut
- NG tube gets stuck
clinical manifestations of esophageal fistula
- polyhydramnios
- excessive salivation, drooling
- choking, coughing, cyanosis after first feeding
- regurgitation
- aspiration
- respiratory distress
when does a baby w/ jaundice need a work-up?
>2 weeks
sx and labs of biliary atresia
Hx: pale/clay stools, dark urine, FTT
PE: jaudice starting at 2-3 weeks, icterus, firm/large liver, splenomegaly around 8 weeks
Labs: conj bili elevated, normal unconj bili
death if not tx
what is biliary atresia?
failure of fetus to develop an adequate pathway for bile to drain from liver to intestine
cause of 1/2 of all liver transplants
tx for biliary atresia
Kasai procedure: hepatoportoenterostomy - connect bowel lumen to porta hepatis containing bile duct remants
best if done in first 2 months of life
what is meckel’s diverticulum?
omphalomesenteric duct connecting midgut to yolk sac should involute by 8th week gestation. if failure –> DIVERTICULUM of heterotopic gastric mucosa
rule of 2s
Meckel’s diverticulum
- occurs in 2% pop
- only 2% of these cause a clinical problem
- location: 2 feet proximal to ileocecal valve, 2 inches long
- symptoms occur at 2 yrs
sx of meckel’s diverticulum
painless blood in stool of ~2 yr old
what is volvulus?
failure of midgut to appropriately reenter fetal abdomen
intestine becomes suspended by a stalk containing SMA –> midgut ischemia and infarction
pathophys of volvulus
midgut is predisposed to clockwise twisting of duodenum to transverse colon
65% present in 1st month of life, but may present at any age
sx and tx of volvulus
sx: abdominal distention, bilious vomiting suggests obstruction
volvulus –> bloody stools –> perforation –> peritonitis
older pts: intermittent cramping, abd pain, vomiting/diarrhea, constipation - more subtle
tx: surgical emergency! - Ladd’s procedure
dark red currant jelly stool
intussusception
typical image of volvulus
- site of obstruction: 2nd portion of duodenum
- “birds-bead” and cork screw
- duodenojejunal junction should be on left of the spine to be normal
tx intussussception
telescoping of small bowel in large bowel. can be fixed via enema – force pushes small bowel into position. usually does not reccur
what age are solid foods introduced?
4-6 mo
but continue breast milk or formula until 1 yo
typical age for intussusception
3
causes of failure to thrive
Not enough in: undernutrition, mechanical
Too much out: diarrhea, vomit, high metabolic needs
inadequate absorption: GI anomalies, metabolic disorders
gastroesophageal reflux
this is NORMAL - common problem in first 18 mo
no tx, just laundry. reassure parents.
cause: LES is a little untoned
pyloric stenosis - sx
nonbilious vomiting starting at 2-4 weeks. emesis increases, becomes projectile. FTT.
Hypokalemic metabolic alkalosis
occasionally: palpable olive, visual peristalsis
