week 6 peds abdominal

Question 1

4 week gestation

Answer 1

pancreas, gallbladder, and liver begin to form

intestine already exists as single tube

Question 2

infant GI tract

Answer 2

elasticity, musculature, and control mechanisms develop until 2-3 years old

Question 3

liver

Answer 3

creates blood cells by week 6
glycogen by week 9
bile by week 12

Question 4

pancreas

Answer 4

islets by week 12 -> insulin production

Question 5

spleen

Answer 5

active in blood formation until 1st year of life then moves to destruction of blood cells

Question 6

kidney

Answer 6

produces urine by week 12

Question 7

infant hx

Answer 7

gestation age
birth weight
passage of 1st meconium stool within 24 hours
jaundice 
vomiting 
diarrhea
colic
failure to gain wt 
steatorrhea 
enlarged abdomen

Question 8

Children hx

Answer 8

constipation
dietary habits
abdominal pain
psychosocial stressors

Question 9

intussusception patho

Answer 9

prolapse, or telescoping, of one segment of intestine into another -> intestinal obstruction
- common between 3-12mo

Question 10

intussusception subjective

Answer 10

acute intermittent abd. pain 
abd. distention 
vomiting
- can be dramatic onset 
legs and knees flexed up to abd. 
stools nml in beginning, then may be mixed with blood and mucus with a red currant jelly appearance.

Question 11

intussusception objective

Answer 11

sausage shaped mass may be palpated in the R or LUQ
lower quadrants feel empty
abdominal distention and guarding

Question 12

pyloric stenosis patho

Answer 12

hypertrophy of the circular muscle of the pylorus leading to obstruction of the pyloric sphincter

Question 13

pyloric stenosis subjective

Answer 13

s/s develop after several weeks
- regurgitation -> projectile vomiting
feeding eagerly
failure to gain weight

Question 14

pyloric stenosis objective

Answer 14

epigastric distention
possible visible wave of peristalsis in epigastric
small, rounded olive-shaped mass sometimes palpable in RUQ

Question 15

Meconium ileus patho

Answer 15

distal intestinal obstruction caused by thick inspissated impacted meconium in the lower intestine of newborn

Question 16

meconium ileus subjective

Answer 16

failure to pass meconium in the first 24 hours after birth
vomiting
abdominal distention

Question 17

meconium ileus objective

Answer 17

abdominal distention
complicated -> shock s/s:
- tachycardia, hypotension

Question 18

biliary atresia patho

Answer 18

congenital obstruction or absence of some or all of the bile duct system

• > bile flow obstruction
• postnatal or embryonic onset

Question 19

biliary atresia subjective

Answer 19

s/s of neonatal cholestasis develop in the first several weeks
- jaundice, light clay-colored stools, dark urine
possible failure to gain wt

Question 20

biliary atresia objective

Answer 20

jaundice in the first 2 months
hepatomegaly- may be firm to palpation
splenomegaly may occur
embryonic type: pt may have heart murmurs as well

Question 21

meckel diverticulum patho

Answer 21

outpouching of the ileum that varies in size from a small appendiceal process to a segment of bowel several inches long
often in proximity of the ileocecal valve
- incomplete obliteration of the vitelline duct resulting in a blind-ending pouch

Question 22

meckel diverticulum subjective

Answer 22

most asymptomatic
can have rectal bleeding
possible abdominal pain

Question 23

meckel diverticulum objective

Answer 23

painless rectal bleeding
some present with intestinal obstruction
- abd. tenderness, guarding, rebound tenderness

Question 24

necrotizing enterocolitis patho

Answer 24

inflammatory disease of the GI mucosa associated with prematurity and gut immaturity

Question 25

necrotizing enterocolitis subjective

Answer 25

``` may be subtle inability to tolerate feedings (oral or nasogastric) abd. distention vomiting blood stools ```

Question 26

necrotizing enterocolitis objective

Answer 26

``` temperature instability subtle signs of distress lethargy abdominal distension apnea respiratory distress Xray: air in the bowel wall (pneumatosis intestinalis) ```

Question 27

neuroblastoma patho

Answer 27

solid malignancy of embryonal origin in the peripheral sympathetic nervous system - commonly arising form the adrenal medulla, may occur anywhere along the craniospinal axis though

Question 28

neuroblastoma subjective

Answer 28

``` asymptomatic abdominal mass in a young child s/s could be - malaise - loss of appetite - weight loss - protrusion of one or both eyes ```

Question 29

neuroblastoma objective

Answer 29

firm, fixed, nontender, irregular, and nodular abdominal mass that crosses the midline metastases to periorbital region -> proptosis and infraorbital eccymoses horner syndrome, ataxia, opsomyoclonus "dancing eyes and dancing feet"

Question 30

wilms tumor (nephroblastoma) patho

Answer 30

most common intraabdominal tumor of childhood usually appears at 2-3 y/o small percent genetic: chromosome 11

Question 31

wilms tumor subjective

Answer 31

painless enlargement of the abdomen or an abdominal mass | some may have abdominal pain, vomiting, hematuria

Question 32

wilms tumor objective

Answer 32

may be felt on abdominal examination - firm, nontender mass deep within the flank, only slightly moveable, not crossing the midline, sometimes bilateral HTN may be present

Question 33

hirschsprung disease patho

Answer 33

primary absence of parasympathetic ganglion cells in a segment of the colon - > interrupts intestinal motility, absence of peristalsis - > accumulation of stool proximal to the defect

Question 34

hirschsprung disease subjective

Answer 34

s/s begin with failure to pass meconium in the first 24-48 hours - failure to thrive, constipation, abd. distention, episodes of bilious vomiting and diarrhea - small ribbon stools

Question 35

hirschsprung disease objective

Answer 35

severe constipation abdominal distention stool palpated in the LLQ

Question 36

hemolytic uremic syndrome (HUS) patho

Answer 36

triad of microangiopathic hemolytic anemia, thrombocytopenia, and uremia - most commonly caused by shiga-like toxin produced by E. coli

Question 37

hemolytic uremic syndrome subjective

Answer 37

preceding URI or gastroenteritis with fever, abd. pain, and vomiting diarrhea becomes bloody may lead to acute abd. or perforation some w/ sudden onset pallor, weakness, lethargy, and dec. urine output

Question 38

hemolytic uremic syndrome objective

Answer 38

``` dehydration edema petechiae hepatosplenomegaly severe GI disease: abd. distention, guarding, rebound tenderness ```

Question 39

umbilical hernia

Answer 39

common | 60% of black babies born with this

Question 40

pinworms

Answer 40

caused by nemotoad parasite