Pediatric Upper GI CIS - Tieman/Brandau Flashcards Preview

Year2 GI Exam II > Pediatric Upper GI CIS - Tieman/Brandau > Flashcards

Flashcards in Pediatric Upper GI CIS - Tieman/Brandau Deck (30):
1

Case child is triplet - C section birth
-mother - hypothyroid and diabetic
-intubation and surfactant for resp distress

APGAR - 6
-extubated 4 hours
-day 4 - oral feeding begins - starts coughing and choking**

NG tube unsuccessful

also maybe has - umbilical catheter
-also could be septic

chest x-ray - air

DDx - tracheoesophagus fistula

2

multiple deliveries

need team for each baby

3

antibiotic for sepsis in newborn

amoxicillin
gentamycin

4

CXR for RDS

ground glass

5

GER

gastroesophageal reflux
-normal process

50% infants 0-3 months
2/3 4-6 months

no tx necessary - infants will grow out by 2 years old

6

GERD

in small percentage infants

failure to thrive

esophageal spasms

diagnosis - difficult to make
-pH probe into esophagus

7

most common TEF

esophagus ends in blind pouch
-distal esophagus connected to trachea

85%

do CXR - should see air in abdomen

8

types of TEF

H type - normal esophagus with fistula to trachea

9

CXR for TEF

air in abdominal organs - if most common type**

no air - so no communication to lung and distal fistula of esophagus

10

polyhydramnios

obstruction in GI tract
-occurs in TEF

11

barium swallow

not good for TEF diagnosis
-barium bad for lungs

12

VACTERL

vertebral
anorectal
cardiac
trachea
esophagus
renal
limb

associated congenital abnormalities

13

before surgery for TEF fistula

look for other anomalies
-VACTERL associations

cardiac and renal are important**

14

Case 12yo F to ED abdominal pain, sharp severe, constant, no radiation, bilious nonbloody emesis
-no fever, diarrhea, bloody stools, or back pain

hypoactive bowel sounds
-slight guarding
-LLQ and RLQ tenderness

pregnancy test negative

peristaltic rushes

DDx - acute abdomen - requiring surgical consultation
-appendicitis, obstruction, etc.

peristaltic rushes - obstruction

Xray - air in abdomen

barium swallow - double bubble - duodenum on right side of abdomen

and volvulus - around superior mesenteric artery

malrotation with midgut volvulus

15

peristaltic rushes

bowels are moving against something
-mechanical obstruction

16

duodenum

normally on right to left

17

development of GI

two folds - duodenum and colon

duodenum posterior
colon anterior

18

malrotation with midgut volvulus

duodenum stays on right

colon stays LUQ

peritoneal bands - lads bands - obstruct duodenum

is emergency - need to do surgery

also take out appendix - bc cecum will be on left and appendicitis will be overlooked

19

Case 11 day old infant, projectile vomiting, after every feeding and still hungry, vomit bright yellow

-vaginal delivery, no fever, no coughs
-weight loss

DDx - pyloric stenosis

low chloride
high bicarb

hyperchloremic metabolic alkalosis

ultrasound - no pyloric stenosis**

not pyloric stenosis - bc bilious vomiting** beyond ampulla of vater

CXR - double bubble

barium swallow - duodenal atresia

surgery - concern for trisomy 21

20

hypochloremic metabolic alkalosis

loss of H ions - vomiting**
renal H loss
shift of H to intracellular space
alkalotic agents
contraction alkalosis

21

pathology hyperchloremic metabolic alkalosis

increased plasma bicarb - due to hydrogen loss

decrease in net renal bicarb excretion (rise in reabsorption)

22

increased reabsorptio of bicarb

1 decreased circulating volume
2 chloride depletion and hypochloremia
3 hypokalemia

23

pyloric stenosis

male predominate

multifactorial genetic complnent

cause unknown

erythromycin exposure possible

diagnosis - palpation of pyloric olive or ultrasound (highly sensitive and specific)**

24

olive of pylorus

diagnosis of pyloric stenosis

skilled palpation

right after vomiting

25

duodenal atresia

failure of recanalization

26

trisomy 21

associated with duodenal atresia

jejunal/ileal - no associations

27

omphalocele

covered with peritoneum


**with other congenital anomalies - endocardial cushion defects

28

gastrochisis

not covered with peritoneum

failure to right of umbilicus

**not with other congenital anomalies

29

tx omphalocele

can't just shove guts back in - too much pressure bc small abdominal cavity

put bag around it - and gradually put it back in around 2-3 weeks

30

visceral peritonitis

with gastrochisis bc no amnion covering