Pediatrics: GI Conditions

Question 1

A patient presnts with:

FTT
Esophagitis
Refusal of feeding
Dystonic Neck Posturing

What are you concerned for?

Answer 1

GERD

Question 2

How should GERD be treated?

Answer 2

lifestyle modification, upright feeding

Question 3

When should medications like omeprazole or ranitidine be considered for GERD?

Answer 3

refractory cases

Question 4

A patient presents with the following:

Olive-like mass in RUQ

Post-Prandial Projectile Emesis

Dehydration, FTT

Hx of Macrolide ABX during 1st week of life.

What are you concerned for?

Answer 4

Hypertrophic Pyloric Stenosis

Question 5

What test should be 1st line for pyloric stenosis?

Answer 5

US

Question 6

If US is inconclusive for pyloric stenosis, what can be ordered?

Answer 6

Barium Contrast Study

Question 7

On Barium Contrast Study, you notice a (+) String Sign. What condition is this indicative of?

Answer 7

hypertrophic pyloric stenosis

Question 8

What is the tx of choice for pyloric stenosis?

Answer 8

surgery

Question 9

A patient presents with the following:

Bilious Emesis w/in 48 hours of birth

Failure to pass meconium

Abdominal Distension

What is this concerning for?

Answer 9

congenital intestinal atresia

Question 10

The following conditions increase the risk for what?

CF
Down Syndrome
Maternal TOBB use

Answer 10

congenital intestinal atresia

Question 11

What would you expect to see on X-Ray with duodenal congenital intestinal atresia?

Answer 11

Double Bubble Sign on X-Ray

Question 12

What would you expect to see on X-Ray with jejunoileal/colonic congenital intestinal atresia?

Answer 12

dilated loops

air fluid levels

Question 13

What test is used for confirmation of congenital intestinal atresia?

Answer 13

GI Contrast Study and Contrast Enema

Question 14

What is the progression of treatment for congenital intestinal atresia

Answer 14

broad spectrum abx

withhold feeding, IV hydration

Surgery

Question 15

A patient presents with:

Bilious/Yellow Vomit
Abdominal Pain
Hemodynamic Instability

Abd. Distension
Abd. Tenderness

What is this concerning for?

Answer 15

Midgut Malrotation

Question 16

Why should you order an X-Ray for midgut malrotation?

Answer 16

r/o perforation

Question 17

What is the test of choice to dx midgut malrotation, and what should you expect to find?

Answer 17

Upper GI Contrast Study:

Corkscrew Appearance

Question 18

What surgical intervention is used in midgut malrotation to prevent ischemia and recurrence?

Answer 18

LADD procedure

Question 19

A patient presents with the following:

Abdominal Pain
Abdominal Mass
Currant Jelly Stool 
Sausage shaped mass
Sudden onset abd. pain

Answer 19

Intussusception

Question 20

You suspect a patient has intussusception. What is the test of choice, and what should you expect to see?

Answer 20

Abdominal US: Target Sign/Coiled Spring Sign

Question 21

What treatment for intussusception is also diagnostic?

Answer 21

Hydrostatic/Pneumatic Enema

Question 22

What is the most common pediatric surgical emergency?

Answer 22

Appendicitis

Question 23

A patient presents with:

Anorexia

Migrating pain from periumbilical to RLQ

Fever

Vomiting

Answer 23

Appendicitis

Question 24

What physical exam tests should you expect to be positive with appendicitis?

Answer 24

Guarding
Rebound Tenderness
Obturator Sign
Iliopsoas Sign

Question 25

What diagnostic imaging can be useful in appendicitis?

Answer 25

US | Low dose CT

Question 26

What is the most common etiology of diarrhea?

Answer 26

viral (Norovirus, Rotavirus, Adenovirus)

Question 27

Would the following indicate increased or decreased severity of diarrhea? ``` Fever Pain Blood in stool Recent Abx Dehydration Leukocytosis ```

Answer 27

Serious.. Red Flags

Question 28

Is a stool culture needed for routine diarrhea?

Answer 28

no

Question 29

What tests can be ordered for diarrhea with red flags?

Answer 29

``` CBC CMP Celiac Testing Urine Cx Stool Tests ```

Question 30

Should you prescribe abx for bloody diarrhea in well-appearing children? Why or why not?

Answer 30

no, risk of HUS

Question 31

What is the recommended tx for diarrhea?

Answer 31

hydration

Question 32

Are antimotility agents recommended for tx of diarrhea?

Answer 32

no

Question 33

A patient presents with the following: Anemia FTT IgA Abs to TTG

Answer 33

Celiac

Question 34

Celiac Disease Allergic Enteropathy Malapsorption Functional Diarrhea These are all causes of...

Answer 34

chronic diarrhea

Question 35

UC or Chron? Transmural Inflammation Skip Lesions Cobblestone Appearance Mouth to Anus

Answer 35

Chron

Question 36

UC or Chron? Rectum to Colon Mucosal layer Diffuse/continuous erythema, friability, ulcer

Answer 36

UC

Question 37

The following medications can be used for what condition? Aminosalicylates Immunomodulating/Biologic Agents Steroids

Answer 37

IBD

Question 38

Patients presenting with the following should be concerning for... Diarrhea Abd. Pain Tenesmus

Answer 38

IBD

Question 39

Which condition has the following characteristics: 2% of the population 2:1 m:f ratio 2% have complications 2ft. from ileocecal valve

Answer 39

Meckel's Diverticulum

Question 40

A patient presents with painless rectal bleeding. What is this concerning for and what test confirms?

Answer 40

Meckel's Diverticulum Technetium-99 Scan

Question 41

What is the treatment of choice for Meckel's Diverticulum?

Answer 41

Surgery

Question 42

What condition can mimic Meckel's Diverticulum?

Answer 42

Appendicitis

Question 43

The following are causes of... ``` Anal stenosis Hypothyroidism Hypercalcemia Celiac Dz CF Fibrosis Hirschprung ```

Answer 43

Organic Constipation

Question 44

The following are characteristics of... Failure to pass meconium FTT Abd. Distension Lumbosacral/Neuro involvement Occult blood in stool

Answer 44

Organic Constipation

Question 45

What is the preferred tx for constipation?

Answer 45

fluids, gradual increase of fiber intake Decrease dairy Juice (apple, pear)

Question 46

What imaging should be ordered to r/o impaction in constipation?

Answer 46

X-Ray

Question 47

This condition is characterized by: Failure to pass meconium Bilious Vomiting Abd. Distension (+) Squirt Sign

Answer 47

Hirschsprung Disease

Question 48

This condition is an absence of ganglion cells that occurs < 6 weeks of age...

Answer 48

Hirschsprung Disease

Question 49

What is the test gold standard for Hirschsprung disease? What is often used instead?

Answer 49

Rectal Biopsy Contrast enema

Question 50

What is the definitive Tx for Hirschsprung disease?

Answer 50

surgical resection of affected area

Question 51

What is the definition of acute diarrhea?

Answer 51

3+ loose stools/day x 5 days or less