Pediatric Gastroenterology Quiz
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Questions and Answers

In a pediatric patient, which of the following is considered a critical factor when evaluating emesis?

  • The color of the emesis.
  • The frequency of emesis.
  • The volume of emesis.
  • Whether the emesis is bilious or non-bilious. (correct)

    • Which prenatal condition is commonly associated with esophageal atresia?

  • Placenta previa
  • Polyhydramnios (correct)
  • Oligohydramnios
  • Fetal ascites

    • Which of the following conditions is explicitly mentioned as a surgical emergency in the pediatric population?

  • Pyloric stenosis
  • The text does not specify any condition is a surgical emergency. (correct)
  • Meckel’s diverticulum
  • Esophageal atresia

    • A blind esophageal pouch, sometimes with a fistula to the airway, is characteristic of which condition?

    <p>Esophageal atresia</p> Signup and view all the answers

    Which of the following is NOT listed as a topic of discussion regarding pediatric GI complaints?

    <p>Appendicitis</p> Signup and view all the answers

    According to the information provided, which of the following may be associated with a fistula?

    <p>Esophageal Atresia</p> Signup and view all the answers

    The document states it utilizes documents under Section 107 of the Copyright Act. What is this commonly known as?

    <p>Fair Use</p> Signup and view all the answers

    What should be understood when dealing with abdominal pain in the pediatric population?

    <p>The different potential causes in children compared to adults</p> Signup and view all the answers

    A newborn presents with excessive drooling, choking with feeding attempts, and respiratory distress. Which condition is MOST likely?

    <p>Type C Esophageal Atresia</p> Signup and view all the answers

    What is a common finding on an abdominal X-ray for a patient with esophageal atresia and a distal tracheoesophageal fistula?

    <p>Abdominal distension with gas</p> Signup and view all the answers

    Which of the following is the MOST common type of esophageal atresia?

    <p>Type C (EA with distal TEF)</p> Signup and view all the answers

    A newborn is suspected to have esophageal atresia. What is the initial diagnostic step to confirm this condition?

    <p>Attempting to pass an NG or OG tube</p> Signup and view all the answers

    Which of the following is NOT typically associated with VACTERL?

    <p>Pulmonary Hypoplasia</p> Signup and view all the answers

    A patient has a congenital diaphragmatic hernia (CDH) through the foramen of Morgagni. Where is this defect located?

    <p>Anteriorly and on the right side</p> Signup and view all the answers

    A fetus has polyhydramnios and failure to visualize the stomach on prenatal ultrasound. Which condition(s) should be suspected?

    <p>Esophageal Atresia and/ or Congenital Diaphragmatic Hernia</p> Signup and view all the answers

    Which defect is covered by peritoneum and amniotic membrane, with the umbilical cord inserting into its sac?

    <p>Omphalocele</p> Signup and view all the answers

    Which condition is associated with the pancreas encircling the second part of the duodenum?

    <p>Annular pancreas</p> Signup and view all the answers

    What is the imaging sign commonly associated with duodenal atresia?

    <p>Double bubble</p> Signup and view all the answers

    What congenital abnormality is most commonly associated with duodenal atresia?

    <p>Trisomy 21</p> Signup and view all the answers

    What can be used to determine atresias in the lower GI tract?

    <p>Barium enema</p> Signup and view all the answers

    Which type of obstruction accounts for one-third of all neonatal intestinal obstructions?

    <p>Intestinal atresias or stenosis</p> Signup and view all the answers

    What is the most common cause of malrotation in neonates?

    <p>Nonrotation</p> Signup and view all the answers

    What imaging technique is considered the gold standard for diagnosing malrotation?

    <p>Upper gastrointestinal (UGI) series</p> Signup and view all the answers

    Which symptom is most commonly associated with midgut volvulus in neonates?

    <p>Bilious vomiting</p> Signup and view all the answers

    What is indicated as a surgical emergency in cases of intestinal obstruction?

    <p>Midgut volvulus</p> Signup and view all the answers

    Which imaging finding is diagnostic of volvulus?

    <p>Corkscrew appearance</p> Signup and view all the answers

    Which surgical procedure is performed to correct malrotation?

    <p>Ladd Procedure</p> Signup and view all the answers

    In cases of malrotation without volvulus, where is the duodenojejunal junction likely to be displaced?

    <p>To the right</p> Signup and view all the answers

    Why should an upper gastrointestinal (UGI) series not be performed on a patient in shock?

    <p>It is contraindicated due to risk of perforation.</p> Signup and view all the answers

    What is a giant omphalocele characterized by?

    <p>Defect larger than 4 cm containing liver</p> Signup and view all the answers

    What is the most common congenital abnormality associated with giant omphalocele?

    <p>Cardiac anomaly</p> Signup and view all the answers

    In what percentage of giant omphalocele cases is prematurity observed?

    <p>10-50%</p> Signup and view all the answers

    What is a key feature of gastroschisis?

    <p>Defect located at the junction of the umbilicus and skin</p> Signup and view all the answers

    What is the primary treatment approach for intestinal obstruction in newborns?

    <p>Fluid resuscitation and correction of metabolic alkalosis</p> Signup and view all the answers

    What is the cardinal symptom of intestinal obstruction in newborns?

    <p>Bilious emesis</p> Signup and view all the answers

    Which statement regarding treatment for giant omphalocele is incorrect?

    <p>Only surgical intervention is necessary</p> Signup and view all the answers

    Which of the following defects is NOT commonly associated with gastroschisis?

    <p>Cardiac anomalies</p> Signup and view all the answers

    Study Notes

    Pediatric Surgery Overview

    • Marian Safaoui, MD, is an Associate Professor of Surgery at Western University.
    • The lecture material is for educational purposes within the course only and cannot be shared outside of it.

    Objectives

    • Understand abdominal pain in the pediatric population.
    • Understand the importance of bilious vs. nonbilious emesis.
    • Know what conditions are surgical emergencies.
    • Know the "buzzwords" for common pediatric GI complaints.

    Topics

    • Esophageal atresia
    • Pyloric stenosis
    • Gastroschisis
    • Omphalocele
    • Biliary atresia
    • Annular pancreas
    • Meckel's diverticulum
    • Congenital diaphragmatic hernia
    • Malrotation
    • Volvulus
    • Intestinal atresia
    • Intussusception
    • Hirschsprung disease
    • Necrotizing enterocolitis

    Esophageal Atresia

    • Blind esophageal pouch with or without a fistula between the esophagus and airway.
    • Polyhydramnios is often seen in pregnancy.
    • Incidence is 1 in 3000.
    • Associated with VACTERL (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Renal, Limb) anomalies.

    Clinical Presentation of Esophageal Atresia

    • Excessive drooling and secretions within the first hours of life.
    • Choking during feeding attempts.
    • Cyanosis and respiratory distress.
    • Abdominal distention with crying (in Type C).

    Diagnosis of Esophageal Atresia

    • Failure to pass NG/OG tube into the stomach.
    • Imaging (plain film of the abdomen) shows gasless abdomen if no fistula, gas in abdomen if a fistula is present

    Diagnosis of Stomach Issues using Imaging

    • Can be diagnosed prenatally through MRI and Ultrasound, which show polyhydramnios (excess amniotic fluid) and failure to visualize the stomach.

    Treatment for Esophageal Atresia

    • Must rule out VACTERL anomalies; cardiac anomalies in up to 40% of patients.
    • Surgical treatment: Primary esophagoesophagostomy.
    • Echo is required to assess the side of the aortic arch.

    Congenital Diaphragmatic Hernia (CDH)

    • 1:2000-4000 live births.
    • 8% of all major congenital anomalies.
    • High mortality rate (up to 60%).
    • Associated with pulmonary hypoplasia and pulmonary hypertension.
    • Failure of the pleuroperitoneal membrane to fuse.

    Types of CDH

    • Bochdalek hernia: More common (90%), posterior defect.
    • Morgagni hernia: Less common (10%), anterior defect.

    Paraesophageal Hiatal Hernia

    • Types I-IV describe different degrees of herniation of the stomach through the esophageal hiatus.
    • Diagnostic imaging uses X-rays (showing a large hiatus) and upper gastrointestinal (UGI) studies.

    Gastroschisis

    • Defect in the anterior abdominal wall.
    • Intestines protrude outside the body without any covering.
    • Commonly located to the right of the umbilical cord.
    • 10% rate of intestinal atresia.
    • Fetal well-being is a major determinant for timing delivery.

    Vomiting

    • Most childhood vomiting is due to acute viral gastroenteritis.
    • Bilious emesis indicates obstruction, possible malrotation and midgut volvulus.

    Pyloric Stenosis

    • Postnatal hypertrophy of the pylorus muscle.
    • Incidence is 1-8 per 1000 births (5:1 male predominance).
    • 13% have a positive family history.
    • Infants are typically 2-12 weeks old, 3-6 weeks age most common.
    • Projectile postprandial nonbilious emesis.
    • Palpable "olive".

    Intestinal Obstruction in Newborns

    • Cardinal symptom is bilious emesis.
    • Proximal obstruction: high-grade vomiting shortly after birth, minimal abdominal distention.
    • Distal obstruction: delayed emesis with abdominal distention, absence of stooling.

    Malrotation

    • Malrotation with volvulus accounts for 10% of neonatal intestinal obstructions.
    • Presentation in the first 3 weeks of life, bilious emesis, abdominal pain.
    • Midgut volvulus is a surgical emergency.

    Duodenal Obstruction

    • Extrinsic causes: congenital peritoneal bands, annular pancreas, duodenal duplication.
    • Intrinsic causes: stenosis, mucosal diaphragm, duodenal atresias.

    Annular Pancreas

    • Due to incomplete rotation of the pancreatic bud, resulting in the pancreas encircling the second part of the duodenum.
    • Associated with Trisomy 21.

    Atresias

    • Intestinal atresias/stenosis accounts for 1/3 of all neonatal intestinal obstructions
    • Can occur anywhere in the GI tract (esophageal, pylorus, duodenal, jejunoileal, colonic, imperforate anus)

    Duodenal Atresia

    • Bilious emesis without abdominal distention.
    • Occurs in the first 24 hours of life
    • Frequently associated with Trisomy 21.
    • Imaging shows "double bubble" on abdominal plain films
    • Surgical treatment: duodenoduodenostomy.

    Jejunoileal Atresia

    • Bilious emesis and abdominal distention
    • Presents within the first 2 to 3 days of life.
    • Dilated bowel loops on abdominal plain film.
    • Lack of colonic gas
    • Contrast enema: microcolon with reflux into the intestines.
    • Surgical Treatment: end-to-end anastomosis

    Meckel's Diverticulum

    • Most prevalent congenital anomaly of the GI tract.
    • The omphalomesenteric duct fails to close, resulting in the diverticulum.
    • "Rule of 2s": 2% of population, 2 years old, 2 types of tissue, 2 feet from the ileocecal valve, 2 inches in length.
    • Symptoms include bleeding, intestinal obstruction, diverticulitis.

    Intussusception

    • Most frequent cause of intestinal obstruction in the first 2 years of life, 3x more frequent in males than females
    • Often associated with viral illness
    • Ileum telescopes into colon, causing obstruction, bleeding, pain
    • "Currant jelly stools"

    Necrotizing Enterocolitis (NEC)

    • Most common and potentially lethal GI disorder in premature infants.
    • Risk factors include prematurity, initiation of enteral feeding during stress.
    • Involves the terminal ileum and colon
    • Characterized by bowel inflammation, thickening, and necrosis.
    • Symptoms may include abdominal distention, bloody stools, fever, edema.

    Hirschsprung Disease

    • Absence of ganglion cells in the bowel, causes megacolon.
    • Most commonly affects the rectum.
    • More frequent in boys.
    • Often associated with Down syndrome.
    • Symptoms include delayed meconium, bilious emesis, and abdominal distention

    Low Intestinal Obstruction

    • Delayed or absent stooling with mild abdominal distension
    • Contrast enema is diagnostic and therapeutic, commonly for meconium plugs.

    Meconium Ileus

    • Thick, viscous meconium obstructs the ileum.
    • Associated with cystic fibrosis
    • Imaging shows dilated bowel loops, absence of air fluid levels.
    • Treatment: Water-soluble contrast enema; exploratory laparotomy if contrast doesn't reflux.

    Short Gut

    • Removal of over 50% of the small bowel length.
    • Common causes include neonatal intestinal resection, NEC, intestinal atresias, gastroschisis, volvulus.

    Additional Notes

    • Imaging: Various imaging techniques like X-rays, ultrasounds, and upper gastrointestinal (UGI) studies are used to diagnose different conditions.
    • Treatment: Treatments often involve fluid resuscitation, antibiotics, and surgery. Surgical techniques like anastomosis (joining the ends of two parts of the gut together) and colostomies are used.
    • Clinical presentation: This can vary greatly depending on the specific condition. Various symptoms like vomiting, distension, bleeding are associated with intestinal obstructions and other complications.

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    Pediatric Surgery Lecture Notes PDF

    Description

    Test your knowledge on critical pediatric gastroenterology topics, including emesis evaluation, esophageal atresia, and associated prenatal conditions. This quiz highlights surgical emergencies and essential understanding when dealing with pediatric abdominal pain. Perfect for medical students and healthcare professionals specializing in pediatrics.

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