peds gi disorders 1 test 2

Question 1

(Hypertrophic) Pyloric stenosis causes

Answer 1

Incomplete maturation of nerve fibers to pylorus

Mechanical trauma from stomach contents resulting in pyloric muscle hypertrophy

Develops after birth
Associated with some genetic syndromes: Apert, Zellweger, trisomy 18

Question 2

t/f Females with pyloric stenosis have a 4x greater chance of having a child with the disease

Answer 2

true (this was one of the first questions I asked my wife. I aint got time for that)

Question 3

t/f Exposure to macrolide antibiotics (for treatment/ prophylaxis of pertussis) may increase risk.

Answer 3

true!

Question 4

presentation of pyloric stenosis

Answer 4

Non-bilious emesis that becomes progressively forceful

Vomiting, intermittent to start

Anxious to feed after emesis
Projectile vomiting as disease progresses

Question 5

age range for pyloric stenosis

Answer 5

Range: Birth- 3 months

Question 6

complication of pyloric stenosis

Answer 6

Dehydration, depending on time to diagnosis

Question 7

exam findings for pyloric stenosis

Answer 7

Anxious, hungry appearing

Dehydrated, malnourished – in advanced disease

Palpable pylorus (described as an “olive”)

Firm, mobile mass, olive shaped and located above and to the right of the umbilicus

Visible gastric peristalsis

Jaundice is commonly present

Question 8

first line imaging for pyloric stenosis

Answer 8

US (Merica!) 95% sensitivity

Question 9

if you don’t do an US and you do a barium upper GI exam what are you looking for

Answer 9

string sign- elongated pyloric channel

shoulder sign- bulge of the pyloric muscle in to the antrum

Question 10

what lab finding will you see with pyloric stenosis

Answer 10

Met B will demonstrate a hypochloremic metabolic alkalosis

due to loss of hydrogen ions and chloride from emesis

Question 11

how do you manage pyloric stenosis

Answer 11

Rehydration/ correction of electrolytes (may present with alkalosis secondary to vomiting)

Surgical consultation

Question 12

what is celiac disease

Answer 12

autoimmune disease

Gluten protein sensitivity

Wheat, barley, rye, less commonly oats

Question 13

what does celiac disease cause

Answer 13

Chronic inflammation of the small intestine

Question 14

what antibody is present in celiac disease

Answer 14

Anti-TG2 antibodies present

Question 15

what is the classic presentation of celiac disease

Answer 15

after the introduction of gluten containing foods:

Chronic diarrhea,
abdominal distention, irritability,
anorexia,
vomiting and poor weight gain

stops with a gluten free diet,

starts with re-introduction of gluten

Question 16

what is the common (it is atypical) presentation of celiac disease

Answer 16

minor GI issues

low height and weight increase

anemia from iron deficiency (not responsive to iron sups) (teeners)

arthritis, bone issues

Question 17

celiac disease PE findings

Answer 17

Bloating of the abdomen

Dental enamel hypoplasia – rare but highly specific when present

Muscle wasting

Question 18

lab findings for celiac disease

Answer 18

IgA anti-TG2

D-AGA

steatorrhea

Hypoproteinemia

Anemia (low MCV-iron def)

Question 19

(there is so much about celiac disease wtf!) what do you see on bowel biopsy

Answer 19

Villous atrophy with hyperplasia of the crypts
Abnormal surface epithelium

(marsh grading system)

Question 20

what does the marsh grading system look at

Answer 20

Intraepithelial lymphocytes

Crypt hyperplasia

Villi

Question 21

what is intussusception

Answer 21

segment of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction.

Question 22

age for intussusception

Answer 22

children aged 3 months to 6 years of age

Question 23

where does intussusception occure

Answer 23

Usually at ileocecal junction

Question 24

hallmark of intussusception

Answer 24

the jelly stool (dont eat it! not smuckers)

Sausage-shaped mass

knees to chest

Question 25

what is the common presentation of intussusception

Answer 25

paroxysms of abdominal pain with screaming and drawing up of the knees Vomiting and diarrhea occur soon after Bloody bowel movements with mucus appear within next 12 hours Lethargic between paroxysms and may be febrile

Question 26

Intussusception US findings x ray findings

Answer 26

coil spring lack of colonic gas

Question 27

intussusception tx

Answer 27

Hydrostatic/ pneumatic reduction (barium or h2o) surgical

Question 28

presents between age 2-8 bright red blood on the stool or protrusion from the rectum (red thing coming out of the butt hole)

Answer 28

Juvenile polyps tx - endoscopic resection

Question 29

containis all bowel layers Most common congenital GI abnormality

Answer 29

Meckel’s diverticulum

Question 30

what are the rules of twos for Meckel’s diverticulum

Answer 30

2:1 Male/ Female ratio, usually within 2 feet of terminal ileum, up to 2 inches in length

Question 31

Meckel’s diverticulum findings

Answer 31

stool is brick colored or currant jelly colored obstruction if persistent an be the lead point for intussusception

Question 32

imaging for Meckel’s diverticulum

Answer 32

Nuclear imaging – Meckel radionuclide scan tx - surgical removal

Question 33

Most common indication for acute abdomen surgery in children Incidence of perforation is high in childhood, particularly in children <2 y.o.

Answer 33

Appendicitis

Question 34

signs of Appendicitis

Answer 34

Anorexia Vomiting Pain – usually periumbilical to RLQ Diarrhea

Question 35

when does perf typically happen

Answer 35

36 hrs after symptom onset

Question 36

imaging used for appendicitis

Answer 36

US CT

Question 37

appendicitis UA findings cbc findings

Answer 37

few white or red blood cells Elevated white count CRP can be elevated

Question 38

t/f preme's have a lower chance of hernia formation

Answer 38

false | males also have a higher risk

Question 39

age with highest risk of Incarceration (jail time baby criminal!)

Answer 39

under 1yo

Question 40

when to refer a hernia

Answer 40

History of mass/ reducible mass: Elective referral Reducible mass w/ secondary symptoms: Urgent referral Non-reducible mass: Emergent referral

Question 41

what is constipation (this is getting deep)

Answer 41

“Any definition of constipation is relative and depends on stool consistency, stool frequency, and difficulty in passing the stool.”

Question 42

what is normal for stools newborn: breast feed: formula feed: toddler: preschool:

Answer 42

Newborn: usually 4 soft or liquid stools Breastfed: 3 soft/day Formula fed: 2 -3 stools/day Toddler: 1-2 formed stools/day Preschool: 1-2 formed stools/day

Question 43

common times for constipation to occur infancy: toddler: school age:

Answer 43

Infancy: at transition to solid foods Toddler: at transition to toilet training School-age: at entry to school

Question 44

ddx for constipation

Answer 44

Cystic Fibrosis – meconium plug Hirschprung – failure to pass stool, or passage of only small amount Hypothyroidism

Question 45

tx for constipation infants

Answer 45

Add osmotically active carbohydrates to the formula, titrating to desired effect (soft, easy to pass stool) fiber glycerin suppositories for impaction

Question 46

t/f Toilet training may trigger constipation

Answer 46

true very true

Question 47

tx for toddler constipation

Answer 47

decrease milk increase fiber miralax mineral oil laxatives / softners

Question 48

cause of constipation for school age

Answer 48

stool with holding tx is same as toddler

Question 49

Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 has been reached”

Answer 49

encopresis (ooops i crapped my pants!)

Question 50

signs of encopresis

Answer 50

large stools that clog toilet dirty underpants history of uti

Question 51

rectal exam findings in encopresis x ray findings

Answer 51

hard stool in vault lots of poop

Question 52

encopresis tx

Answer 52

mineral oil or lax bowel training

Question 53

gi issues that have butt hole bleeding

Answer 53

intussuscepton juvenile polyps meckel's diverticulum