Peds GI

Question 1

Esophageal atresia: general and presentation

Answer 1

• males
• blind esophageal pouch with or without fistulous connection between the proximal or distal esophagus and trachea (usually distal*)
• associated with polyhydramnios (excess amniotic fluid
• choke and cough with oral feeding. copious secretions**, respiratory distress

Question 2

Esophageal atresia: imaging

Answer 2

Transesophageal fistula = gas in the bowel

Esophageal atresia without fistula = No gas in bowel

Question 3

Esophageal atresia: tx

Answer 3

1. NG tube in the pouch
2. Elevate head to prevent reflux
3. IV glucose and fluids
4. Surgery

Question 4

Esophageal foreign body

Answer 4

• most kids are asymptomatic

- symptoms include: dysphagia, odynophagia, drooling, regurgitation, chest or abdominal pain

Question 5

What is the most common ingested foreign body?

Answer 5

coin

Question 6

Describe the difference in how a coin will look on Xray between FB in esophagus or trachea?

Answer 6

Esophagus- heads and tails facing anterior and posterior

Trachea - heads and tails facing left and right

Question 7

Button battery ingestion

Answer 7

• may perforate in 2 hours

- must be removed surgically if not removed in 24-48 hours

Question 8

When does GER become GERD?

Answer 8

when there are secondary complications or symptoms (ex. FTT, refusal, GI bleeding, upper or lower airway symptoms)

Question 9

GERD: tx

Answer 9

• reflux will often resolve spontaneously (85%) by 12 months
• Thicken food with oat cereal
• Trial milk and soy free diet for 2 weeks
• Ranitidine***** (1st line)

Question 10

Eosinophilic esophagitis: general

Answer 10

• Males> females
  complications: 1. food impaction
  2. esophageal stricture
• *No response to GERD treatment**

Question 11

Eosinophilic esophagitis: diagnosis

Answer 11

Endoscopy (esophagogastroduodenoscopy)

• mucosa thickening, fissures, strictures
• **pinpoint white exudates (composed of eosinophils)*

Question 12

EOE: tx

Answer 12

• eliminate food allergens

- swallowed fluticasone (don’t rinse, and avoid eating for 30 min)

Question 13

Pica

Answer 13

• eating feces, clay, dirt, hairballs, ice, pain, sand for at least 1 month
• associated with zinc and iron deficiency*

Question 14

Pica labs

Answer 14

CBC, zinc level, lead level (if eating paint chips)

Question 15

Rumination

Answer 15

repeated regurgitation and re-chewing food (for at least 1 month)

• More common 3 -12 months
• associated with depression and eating disorders

Question 16

Which disease is associated with lactase deficiency, fat malabsorption, and protein malabsorption?

Answer 16

cystic fibrosis

Question 17

Phenylketouria (PKU)

Answer 17

most common inborn error or amino acid metabolism
-Autosomal recessive
-Caucasians
-intellectual disability (MCC finding overall)
-Musty or mousy odor to body and urine**
Tx: avoid aspartame, phenylalanine (<6mg/dL a day). Eliminated high-protein foods

Question 18

Celiac disease

Answer 18

-Gluten = wheat, rye, barley
-S/S: pain, bloating, constipation, dermatitis herpetiformis, poor weight gain**
delayed puberty or short stature*
-Unexplained Fe deficiency anemia*

Question 19

What blood test is elevated with gastroschisis and omphalocele?

Answer 19

AFP is elevated

Question 20

Omphalocele

Answer 20

• membrane covered herniation of abdominal contents into the base of the umbilical cord
• seen with US in 1st trimester

Question 21

Gastroschisis

Answer 21

-Uncovered intestine through abdominal wall defect to the RIGHT of the umbilical cord

Question 22

Diaphragmatic Hernia

Answer 22

• Left sided (where the esophagus is)
• Dx: prenatal ultrasound, bowel loops seen in chest cavity with mediastinal shift
• associated with polyhydramnios [excess amniotic fluid]
• scaphoid abodomen (sunken belly)

Question 23

Diaphragmatic hernia: complications

Answer 23

1. Pulmonary HTN***
2. Severe GERD
3. Risk for hearing loss, poor growth

Question 24

Inguinal hernias

Answer 24

Indirect: Lateral to the epigastric vessels

• MC than direct
• Mostly right sided

Direct: Medial to the epigastric vessels
-RARE in children

Question 25

Hesselbachs Triangle

Answer 25

1. inguinal ligament 2. Inferior epigastric vessels 3. Lateral border of rectus abdominis

Question 26

Femoral hernia

Answer 26

-Females -Often become incarcerated or strangulated Location: medial to femoral vein and lateral to lacunar ligament

Question 27

Umbilical hernias

Answer 27

-MC in african american infants

Question 28

Pyloric stenosis: General

Answer 28

- muscular hypertrophy of the pylorus - 1st born children - Caucasian - Hungry and nurse avidly - projectile post prandial vomiting***** - Olive mass in right upper quadrant*****

Question 29

Pyloric Stenosis: Dx and TX

Answer 29

1. Pyloric ultrasound 2. Barium Upper GI --> string sign (or apple core)**** Tx: surgery

Question 30

Duodenal atresia: general

Answer 30

- Trisomy 21* - Double-bubble sign on Xray*** (stomach and duodenum dilated) - Bilious vomiting hours after birth**

Question 31

Short Bowel Syndrome

Answer 31

- reduced intestinal absorptive surface (diarrhea, dehydration, electrolyte/nutrient deficiency, excessive gas, foul ambling stool) - Usually after surgical resection of bowel

Question 32

Intussusception

Answer 32

- telescoping of the bowel into another segment - MCC bowel obstruction in first 2 years of life - Idiopathic* - Red currant jelly** - Right sided sausage-shaped mass**

Question 33

Intussusception: Dx

Answer 33

- Xray: "target sign" 2 concentric circles - Barium and air enema - therapeutic and diagnostic - US is most specific and sensitive modality**

Question 34

Hirschprung Disease

Answer 34

- congenital megacolon - Trisomy 21 (Down syndrome) - Lack of neurons (aganglionic bowel) - Usual presentation: failure to pass meconium**, with vomiting and abdominal distention - foul ribbon stools in older kids - MC long-term complication is fecal incontinence

Question 35

Meckel's Diverticulum

Answer 35

``` MC congenital abnormality of the GI tract Rule of TWOs: -2% of population -Males 2:1 -within 2 feet of ileocecal valve -2 inches in length ``` -Contain cells from the stomach and pancreas***

Question 36

Meckel's Diverticulum: presentation

Answer 36

-Painless lower GI bleeding*

Question 37

Unconjugated hyperbilirubinemia

Answer 37

- transient in new borns | - Low glucuronate activity at birth

Question 38

Physiologic Jaundice of the newborn

Answer 38

-can cause Kernicterus -->brain injury from high unconjugated bilirubin Tx: bright lights (phototherapy) to make the unconjugated bilirubin more water-soluble

Question 39

Gilbert's Syndrome

Answer 39

- Mild autosomal dominant disorder - LFTs and liver biopsy normal - increase in unconjugated bilirubin after a 2 day fast (consistent with dx)

Question 40

Cystic Fibrosis

Answer 40

- Affects 4 areas: 1. Lung, 2, Pancreas (fat soluble vitamin deficiency**), 3. Intestine (intussception, carb intolerance), 4. Liver - Sweat chloride test**

Question 41

Pilonidal cysts

Answer 41

-Ingrown hair with infection at the natal cleft of the buttock

Question 42

Enterobiasis (Pinworms)

Answer 42

-intense anal itching | Tx: pyrantel pamoate --> repeat in 2 weeks

Question 43

Encopresis

Answer 43

Involuntary or intentional defecation - at least 3 months - at least 4 yrs old Tx: schedule toilet time after meals (gastrocolic reflex)

Question 44

Constipation

Answer 44

2 or more, for at least 2 months - <3 BMs per week - >1 episode of encopresis/week - impaction of rectum with stool - passage of stool so large it obstructs the toilet - pain with defecation Tx: prune, pear, peach "p"fruits - Miralax (polyethylene glycol) - Milk of magnesia