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GI 12 Peds Disorders

Pediatric GI Disorders

QuestionAnswer
A 40yo black woman is found to have non-caseating granulomas of the lung and hypercalcemia. What is the diagnosis? Sarcoidosis
A 25yo man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions o his tibias. What is the diagnosis? Crohn's dz
When is rifampin prophy indicated in the case of bacterial meningigits? Close contacts of ppl infected with Neisseria meningitis or H flu meningitis
What is the MC type of TE fistula? Blind upper esophageal pouch with lower esophagus attached to the trachea
What is the classic presenting scenario for necrotizing enterocollitis (NEC)? Preemie or low-birth weight infant started on tube feeds with abd distention
What are the key characteristics of the H&P of a pt with pyloric stenosis? Few weeks old infant with olive-shaped epigastric mass and non-bilious projectile vomiting
How do you diagnose a TE fistula? CXR following NG tube insertion (tube will curl up in blind pouch or end up in lung, etc)
What lab findings would you see in pyloric stenosis? Metabolic alkalosis with hypokalemia and hypochloremia (vomiting)
What imaging study, besides US, can be used to dx pyloric stenosis? What would you expect to see? Barium swallow shows thin pyloric channel "string sign"
Tx for pyloric stenosis? Pyloromyotomy
What labs would you expect to see with NEC? Metabolic acidosis 2/2 lactic acidosis from gut death. Decreased Na.
AXR showing bowel distention, air in bowel wall, portal v gas, and free air under diaphragm in a preemie. Dx? NEC
What would a Hirschsprung's diseased bowel bx show? Absence of ganglia
Radiograph findings in Hirschsprung's? Megacolon on barium enema, dilated bowel on AXR
Abd sausage mass and currant jelly stools. Dx? Intussusception (telescoping of bowel)
Name 4 risk factors for intussusception. 1. Meckel's diverticulum, 2. Henoch Schonlein purpura, 3. adenovirus infxn (inflames Peyer's patches), 4. CF
What intervention is both diagnostic and therapeutic in intussusception? Barium enema. In more severe cases, surgical reduction may be required.
Nature of pain in intussusception? Episodic sudden abd pain lasting <1min
In adults, what does intussusception suggest? Cancer :( (think of the bowel getting snagged on the tumor). Usually only tx is surgery in adults.
What is Meckel's diverticulum a remnant of? VItelline duct. It exists as an outpuoching of ileum near the ileocecal valve. May contain ectopic tissue.
Painless rectal bleeding + intussusception in a kid <2? Probably Meckel's diverituclum
MCC bowel obstruction in first 2 years of life? Intussusception
Name 2 common causes of physiologic neonatal jaundice. Physiologic undersecretion and breast-feeding failure
Name 3 causes of hemolysis-related causes of neonatal jaundice. maternal-fetal ABO incompatibility, hereditary RBC abnormality, G6PD deficiency
Name 2 causes of excess bilirubin production (in the absence of hemolysis) that can cause neonatal jaundice. Hemorrhage and maternal-fetal transfusion
Name 3 hepatic abnormalities that can cause neonatal jaundice. Gilbert's syndrome, Crigler-Najjar syndrome, biliary atresia.
What allows bilirubin to cross the BBB and cause kernicterus? Normally bilirubin is bound to albumin, but it can cross if: serum [bili] is high, serum [albumin] is low (preemies), or if competitive binders displace bili from albumin (sulfasoxole, ceftriaxone, aspirin)
What is enterohepatic circulation of bilirubin? Why can it be a problem in neonates? In adults, conj bili is red by gut bacteria to urobilin and excreted. Neonates have sterile digestive tracts, so β-glucuronidase deconj the conj bili, which gets reabsorbed by the intestines and recycled back into the circulation-> hyperbili.
What causes physiologic decreased clearance of bilirubin in a neonate? Deficiency of UDP glucoronyl transferase which takes bili bound to albumin and makes it water soluble inside the hepatocytes. This has to happen in order to be able to get bili out of the body (stool and urine).
What is kernicterus (be specific)? Deposition of bilirubin in basal ganglia and hippocampus which may cause permanent damage (seizures, apnea)
3 week old infant presents with new-onset jaundice and pale stools. D bili is >20% of T bili which is 12mg/dL. Dx? Why is early tx important? Dx is biliary atresia. Tx is surgical repair which must be done before 2mos of age to prevent biliary cirrhosis.
What abx is contraindicated in neonates with hyperbilirubinemia and why? Ceftriaxone b/c it displaces bili from albumin and increases the likelihood of kernicterus
Give the age, T bili level, cause and tx of physiologic jaundice of the newborn. Btwn 3-5d, T bili <10, caused by incr RBC turnover/change in bili metabolism, self-resolves in 2 weeks
Give the age, T bili level, cause and tx of exaggerated physiologic jaundice/breast feeding jaundice of the newborn. 1st week of life, T bili <15, caused by dehydration, tx is increasing freq/length of feedings
Give the age, T bili level, cause and tx of breast milk jaundice of the newborn. Age <1 week, T bili >5.5, caused by substances in milk, self-resolves or fixed by switching to formula
What characteristics might help you ID newborn jaundice as pathological? Happening in first 24h, incr in T bili either >0.5mg/dL/hr or 5mg/dL/day, T bili >13mg/dL in term infant, or jaundice appearing 2-3 weeks after birth
What is failure to thrive in children? Wt less than 3rd percentile for age or failure to gain weight appropriate for age. Always look for s/s of abuse or neglect.
A 2yo boy presents with painless rectal bleeding. What diagnosis do you suspect, and what study would you order to confirm the dx? Meckel's diverticulum. Meckel's scan
Created by: sarah3148