Peds GI Flashcards
(124 cards)
1
Q
necrotizing enterocolitis –> epidemiology?
A
- preterm
- term: congenital heart dz, immunosupp, umbilical venous catheter
2
Q
necrotizing enterocolitis –> cause?
A
combo of infxn & ischemia related to feeding
3
Q
necrotizing enterocolitis –> MC location?
A
ileum & RLQ colon
4
Q
necrotizing enterocolitis –> initial XR finding
A
loop of bowel:
- wall thicken
- fixed distention over serial exams
5
Q
necrotizing enterocolitis –> MC complication
A
bowel stricture
6
Q
hypertrophic pyloric stenosis –> epidemiology?
A
2-12wk M>F
7
Q
hypertrophic pyloric stenosis –> US findings? (3)
A
- thickened pylorus wall
- increased pyloric channel length
- gastric contents not pass thru
8
Q
pylorospasm –> US findings?
A
- normal pylorus
- gastric contents pass thru
9
Q
infant –> appendicitis –> common or rare?
A
rare
10
Q
volvulus –> clinical presentation?
A
neonatal bilious emesis
11
Q
malrotation –> MOA?
A
embryogenesis –> bowel fail to normally rotate
12
Q
malrotation –> potential complication? (2) why?
A
- abnormal mesenteric fixation –> volvulus
- Ladd bands –> distal bowel obstruct
13
Q
malrotation –> when present?
A
70% within 1mo
90% within 1yo
14
Q
UGI –> eval for malrotation –> specific components to evaluate? (3)
A
- C-sweep of duodenum
- duodeno-jejunal jx: L of midline & at level of duodenal bulb
- 2nd & 4th duodenum retroperitoneal & parallel
15
Q
midgut volvulus:
- MC XR appearance?
- uncommon XR appearance?
A
- MC XR appearance: mult dilated bowel loops
- uncommon XR appearance: duodenal obstruct –> double bubble sign
16
Q
midgut volvulus –> classic UGI finding?
A
corkscrew appearance
17
Q
malrotation –> cecum location?
A
- more midline than normal
- LLQ
18
Q
malrotation –> SMA & SMV location?
A
normal: right SMV, left SMA
malrotation: right SMA, left SMV
19
Q
malrotation –> tx?
A
Ladd procedure:
- reduce volvulus
- lyse mesenteric adhesions (Ladd bands)
- place small bowel on R, large bowel on L
20
Q
intussusception –> MC location?
A
ileocolic
21
Q
intussusception –> classic presentation?
A
- colicky abd pain
- currant jelly stool
- palpable RLQ abd mass
22
Q
intussusception –> idiopathic vs pathologic lead point –> epidemiology?
A
- newborn: pathologic lead pt
- 3mo-3.5yo: idiopathic
- > 3.5yo: pathologic lead pt
23
Q
neonate –> intussusception –> possible cause?
A
Meckel diverticulum
24
Q
> 3.5yo –> intussusception –> possible cause?
A
lymphoma
25
bloody stool --> US demonstrate bowel wall thickening --> ddx? (3)
- intussusception
- colitis
- intramural hematoma (d/t trauma, Henoch-Schonlein purpura)
26
intussusception --> tx?
air/contrast enema
27
intussusception --> tx enema reduction --> contraindication? (3)
- free air
- peritoneal signs
- septic shock
28
esophageal atresia & tracheoesophageal fistula --> MC assoc synd?
VACTERL
29
VACTERL --> synd?
- Vertebral segmentation anomaly
- Anal atresia
- Cardiac anomaly
- TracheoEsophageal fistula
- Renal anomaly
- Limb (radial ray) anomaly
30
tracheoesophageal fistula --> MC type?
82% --> type A: proximal esophageal atresia & distal TEF
31
proximal esophageal atresia & distal TEF --> classic CXR appearance?
- NG tube terminate mid-esophagus
| - air-filled bowel (from TEF)
32
TEF --> assoc condition?
tracheal anomaly:
- tracheomalacia
- bronchus suis
33
in utero --> polyhydramnios & lack of visualization of stomach --> ddx? (1)
esophageal atresia
34
gastric atresia --> diagnostic imaging finding?
single bubble
35
clinical presentation --> hypertrophic pyloric stenosis vs gastric atresia?
vomiting:
HPS: progressively worse
gastric atresia: not worse
36
neonatal bowel obstruct --> when present?
24-48 day old
37
XR --> proximal bowel obstruction --> next imaging modality of choice for evaluation? why?
UGI --> differentiate midgut volvulus (emergent surg) vs atresia (non-emergent)
38
XR --> distal bowel obstruction --> next imaging modality of choice for evaluation?
LGI
39
proximal bowel obstruction --> tx?
surg
40
distal bowel obstruction --> tx?
- surg
| - medical
41
duodenal anomaly --> other assoc anomaly? (5)
- Down
- VACTERL
- cardiac shunt lesion
- malrotation
- annular pancreas
42
duodenal atresia --> classic XR appearance?
- double bubble: dilation stomach + proximal duodenum
| - lack of distal bowel gas
43
double bubble + distal bowel gas --> ddx? (3)
- midgut volvulus
- annular pancreas
- duodenal stenosis/web
44
jejunal atresia --> MCC?
in utero vascular insult
45
jejunal atresia --> classic XR appearance?
triple bubble
46
distal bowel obstruction --> surgical causes? (2)
- distal atresia
| - Hirschsprung dz
47
distal bowel obstruction --> medical causes? (2)
- meconium ileus
| - fxal immaturity
48
what is microcolon?
abnormally small caliber (<1cm) colon --> d/t disuse
49
microcolon --> secondary to proximal vs distal bowel obstruction? why?
distal
proximal bowel --> secrete succus entericus --> prevent microcolon
50
microcolon --> MCC? (2)
- meconium ileus
| - ileal atresia
51
microcolon --> ddx? (4)
- meconium ileus
- ileal atresia
- total colonic Hirschsprung
- megacystic-microcolon-hypoperistalsis synd
52
meconium ileus --> assoc calcifications can be seen where? (2) why?
- peritoneal
- scrotal
perforation --> meconium peritonitis --> calcifications
53
meconium ileus --> classic XR appearance?
- distal obstruction (mult dilated bowel)
| - RLQ soap bubble lucencies
54
meconium ileus --> indicates what condition?
100% --> cystic fibrosis
55
meconium ileus --> LGI appearance? (2)
- microcolon
| - mult rounded filling defects (inspissated meconium)
56
meconium ileus --> tx?
water-soluble enema --> loosen inspissated meconium
57
fail to pass meconium --> MC condition?
small left colon (fxal immaturity of the colon, meconium plug synd)
58
small left colon --> MOA?
colonic ganglion cells --> temporary fxal immaturity --> distal colon abnormal motility
59
small left colon --> risk factors? (3)
- preterm
- maternal Mg for preclampsia
- maternal diabetes
60
small left colon --> microcolon or no microcolon?
no microcolon
61
small left colon --> XR finding?
distal bowel obstruct
62
small left colon --> LGI finding?
- small left colon
- discrete transition pt at splenic flexure
- filling defects in small left colon --> meconium plugs
63
small left colon w discrete transition pt at splenic flexure --> ddx? (2) how to differentiate? (2)
small left colon:
- rectum distend
- resolve w enema
Hirschsprung dz:
- rectum nondistend
- not resolve w enema
64
Hirschsprung dz --> anus is always involved --> T/F?
T
65
Hirschsprung dz --> continuous or scattered bowel involvemt?
continuous
66
Hirschsprung dz --> possible complication?
1/3 --> enterocolitis, similar to NEC --> toxic megacolon
67
Hirschsprung dz --> XR finding?
distal bowel obstruction
68
Hirschsprung dz --> LGI finding
- dilated proximal bowel
- narrow distal bowel
- tapered "cone-shaped" transition
69
Hirschsprung dz --> rectum:sigmoid ratio?
<1
70
what is megacystic microcolon intestinal hypoperistalsis synd?
congenital loss of bowel & bladder smooth muscle fx:
- absent intestinal peristalsis
- microcolon
- distended nonobstructed urinary bladder
71
childhood bowel obstruction --> ddx? (6)
AAIIMM:
- appendicitis
- adhesions
- internal/inguinal hernia
- intussusception
- Meckels
- malrotation
72
indirect inguinal hernia --> MOA?
patent processus vaginalis --> peritoneal comm to scrotum
73
imperforate anus --> role of imaging? preferred imaging modality?
clinical dx
eval level of obstruct: high/low relative to puborectalis sling (however, this is usu determined clinically)
infracoccygeal US
74
high anorectal malformation --> assoc anomalies? (3)
- GU-rectal fistula
- lumbosacral anomaly
- VACTERL
75
high anorectal malformation --> type of GU-rectal fistula --> M vs F?
- M: rectum to post urethra or bladder
| - F: rectum to vagina
76
low anorectal malformation --> assoc anomaly? (1)
perineal fistula
77
neonatal --> unconj hyperbili --> cause?
physiologic jaundice of newborn
78
neonatal --> conj hyperbili --> cause? (2)
- biliary atresia
| - neonatal hepatitis (ie Alagille synd, bile acid synthetic defect, metabolic dz, AAT1 def, infx)
79
neonatal --> conj hyperbili --> goal of imaging? preferred imaging modality?
Tc-99m-HIDA hepatobiliary scintigraphy --> differentiate biliary atresia vs neonatal hepatitis
80
neonatal --> conj hyperbili --> premedication for HIDA scan? why? when?
5 days of phenobarbital --> stimulate hepatocyte activity
81
biliary atresia --> natural progression if untx?
progressive cirrhosis --> early childhood death
82
biliary atresia --> HIDA findings? (3)
- normal hepatic tracer uptake
- normal hepatic clearance
- no excretion into small bowel
83
biliary atresia vs neonatal hepatitis --> US appearance?
cannot differentiate
sometimes absent GB --> suggest biliary atresia
84
biliary atresia --> tx?
Kasai portoenterostomy:
- excise entire extrahep biliary tree
- jejunal loop anastomose to liver
85
neonatal hepatitis --> HIDA findings?
- poor hepatic excretion
- delayed hepatic clearance (>12hr)
- variable bowel excretion
86
primary cancers w liver mets? (4)
- neuroblastoma
- Wilms tumor
- sarcoma
- Burkitt lymphoma
87
what is mesenchymal hamartoma?
developmental anomaly (not neoplasm) --> multicystic hamartomatous lesion --> malformed bile ducts, portal vein fragmts, extramed hematopoiesis --> benign
88
mesenchymal hamartoma --> when present?
neonate
89
what is gallbladder hydrops? predisposing condition? (2)
pathologically distended GB
- infx
- systemic inflamm (ie Kawasaki)
90
vascular neoplasm vs malformation?
neoplasm: new cell growth
malformation: disorganized vasc; no cell growth
91
high flow vascular malformation/neoplasm? (3)
- infantile hemangioma
- AVM
- AV fistula
92
low flow vascular malformation? (2)
- venous malformation
| - lymphatic malformation
93
adult --> hepatic hemangioma --> are actually venous malformation, T/F?
T
94
pediatric --> MC vascular hepatic tumor
infantile hemangioma & hemangioendothelioma
95
infantile hemangioma vs hemangioendothelioma?
hemangioma: benign
hemangioendothelioma: usu benign --> can mets
96
infantile hemangioma & hemangioendothelioma --> assoc synd? (1)
Kasabach-Merritt synd
97
Kasabach-Merritt synd --> synd? (3)
- vascular neoplasm
- hemolytic anemia
- consumptive coagulopathy
98
infantile hemangioma & hemangioendothelioma --> potential complication? (1)
25% --> congestive heart fail
99
infantile hemangioma & hemangioendothelioma --> MRI appearance (3)
- highly vascular
- T2 hyper
- enhance peripheral --> delayed fill-in
100
infantile hemangioma & hemangioendothelioma --> conventional angiography finding?
- enlrg celiac axis
| - aorta distal to celiac trunk --> narrow
101
infantile hemangioma & hemangioendothelioma --> tx?
- most spontaneously involute within 1st yr of life
- BB --> accel involution
- surg if CHF
102
3 MC childhood abd malig
1) neuroblastoma
2) Wilms tumor
3) hepatoblastoma
103
hepatoblastoma --> when present, younger/older/same as infantile hemangioma?
slightly older
104
hepatoblastoma --> assoc synd? (3)
- Beckwith-Wiedemann
- familial adenomatous polyposis synd
- fetal alcohol synd
105
Beckwith-Wiedemann --> screen for what? how often?
hepatoblastoma --> q6mo
106
hepatoblastoma --> what lab is elevated?
alpha-fetoprotein (AFP)
107
hepatoblastoma --> classic XR finding?
RUQ calcification
108
hepatoblastoma --> CT appearance?
- predominantly solid heterogeneous enhancing liver mass
| - like to invade portal & hepatic veins
109
pediatric --> cirrhosis --> causes? (5)
- AAT1 def
- glycogen storage dz
- tyrosinemia
- biliary atresia
- chronic viral hepatitis
110
HCC --> imaging appearance?
- heterogeneous hepatic mass
- early arterial enhance
- rapid washout
111
HCC --> AFP elevated or normal?
elevated
112
undifferentiated embryonal sarcoma (malig mesechymoma) --> epidemiology?
6-10yo
113
undifferentiated embryonal sarcoma (malig mesechymoma) --> AFP elevated or normal?
normal
114
liver mets --> primary? (2)
- neuroblastoma
| - Wilms tumor
115
Meckel diverticulum --> MOA?
omphalomesenteric duct --> incomplete regress
116
Meckel diverticulum --> pediatric --> potential complication? (2)
- GI bleed (if contain ectopic gastric mucosa)
| - lead pt --> intussusception
117
Meckel diverticulum --> adult --> potential complication? (2)
```
#1 SBO
#2 Meckel diverticulitis
```
118
what is omphalomesenteric duct?
duct --> connect intestine to umbilicus/yolk sac
119
omphalomesenteric duct --> incomplete regress --> complication? (2)
- #1 Meckel diverticulum
| - umbilico-ileal fistula
120
Meckel diverticulum --> rule of 2's?
- 2% population
- symptomatic before 2yo
- 2ft from ileocecal valve
121
rectal bleed --> suspect Meckel diverticulum --> imaging of choice?
Tc-99m pertechnetate scan
122
Tc-99m pertechnetate scan --> what tissue does it detect?
gastric mucosa
123
pediatric abd neoplasms w calcifications (3)
- neuroblastoma
- teratoma
- hepatoblastoma
124
pancreatoblastoma --> age?
1-8yo
