Podcast
Questions and Answers
What is the primary defect in Criglar-Najjar syndrome type I?
What is the primary defect in Criglar-Najjar syndrome type I?
What is a characteristic feature of biliary atresia?
What is a characteristic feature of biliary atresia?
Which symptom is associated with untreated Criglar-Najjar syndrome type I?
Which symptom is associated with untreated Criglar-Najjar syndrome type I?
What condition results from a complete deficiency in uridine 5'diphosphoglucuronosyltransferase?
What condition results from a complete deficiency in uridine 5'diphosphoglucuronosyltransferase?
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What can result from untreated biliary atresia in infants?
What can result from untreated biliary atresia in infants?
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What is the primary cause of duodenal atresia?
What is the primary cause of duodenal atresia?
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Which clinical feature is associated with duodenal atresia in a newborn?
Which clinical feature is associated with duodenal atresia in a newborn?
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What imaging sign is characteristic of duodenal atresia?
What imaging sign is characteristic of duodenal atresia?
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In cases of pyloric stenosis, which syndrome might also be suspected based on presentation?
In cases of pyloric stenosis, which syndrome might also be suspected based on presentation?
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What condition can develop as a consequence of malrotation?
What condition can develop as a consequence of malrotation?
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Which imaging study is typically the first step when a patient presents with bilious emesis?
Which imaging study is typically the first step when a patient presents with bilious emesis?
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Which of the following is NOT a clinical presentation of duodenal atresia?
Which of the following is NOT a clinical presentation of duodenal atresia?
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What is the main treatment strategy for duodenal atresia?
What is the main treatment strategy for duodenal atresia?
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What characterizes bilious emesis?
What characterizes bilious emesis?
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Which of the following is NOT a common cause of non-bilious emesis?
Which of the following is NOT a common cause of non-bilious emesis?
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What is a potential cause of persistent non-bilious vomiting?
What is a potential cause of persistent non-bilious vomiting?
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In children, which condition is least likely related to new onset biliary emesis?
In children, which condition is least likely related to new onset biliary emesis?
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What might indicate the onset of viral gastroenteritis in a child?
What might indicate the onset of viral gastroenteritis in a child?
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What condition can cause increased intracranial pressure leading to vomiting?
What condition can cause increased intracranial pressure leading to vomiting?
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Which of the following is a common cause of bilious emesis in children?
Which of the following is a common cause of bilious emesis in children?
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Which statement about gastroparesis is accurate?
Which statement about gastroparesis is accurate?
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What is intussusception?
What is intussusception?
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Which type of intussusception is more common in children?
Which type of intussusception is more common in children?
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Which symptom is characteristic of intussusception in a child?
Which symptom is characteristic of intussusception in a child?
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What kind of mass is typically felt on a physical exam of a child with intussusception?
What kind of mass is typically felt on a physical exam of a child with intussusception?
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What diagnostic tool is typically used to identify intussusception?
What diagnostic tool is typically used to identify intussusception?
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What is the relationship between intussusception and Rotavirus vaccination?
What is the relationship between intussusception and Rotavirus vaccination?
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What type of diarrhea is associated with intussusception in children?
What type of diarrhea is associated with intussusception in children?
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At what age is intussusception most commonly observed in children?
At what age is intussusception most commonly observed in children?
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What is the main reason for assessing all newborns' total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) before discharge?
What is the main reason for assessing all newborns' total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) before discharge?
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Which treatment option converts bilirubin into a water-soluble compound?
Which treatment option converts bilirubin into a water-soluble compound?
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What are the potential complications of exchange transfusion?
What are the potential complications of exchange transfusion?
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Which of the following is a risk factor for hyperbilirubinemia in newborns?
Which of the following is a risk factor for hyperbilirubinemia in newborns?
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When should exchange transfusion be initiated in a jaundiced infant?
When should exchange transfusion be initiated in a jaundiced infant?
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In the context of assessing newborns, which factor is NOT a recognized risk for hyperbilirubinemia?
In the context of assessing newborns, which factor is NOT a recognized risk for hyperbilirubinemia?
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What is the most likely condition if an infant presents with absence of UDP-glucuronyl transferase and high levels of unconjugated bilirubin?
What is the most likely condition if an infant presents with absence of UDP-glucuronyl transferase and high levels of unconjugated bilirubin?
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What is the best practice regarding the cessation of phototherapy?
What is the best practice regarding the cessation of phototherapy?
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What is the most likely diagnosis for a patient with a direct bilirubin level of 5.0 mg/dL and a total bilirubin level of 5.5 mg/dL?
What is the most likely diagnosis for a patient with a direct bilirubin level of 5.0 mg/dL and a total bilirubin level of 5.5 mg/dL?
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Which characteristic is associated with the diagnosis of biliary atresia?
Which characteristic is associated with the diagnosis of biliary atresia?
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What is the mechanism of bilirubin handling in patients with biliary atresia?
What is the mechanism of bilirubin handling in patients with biliary atresia?
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Which statement is false regarding biliary atresia?
Which statement is false regarding biliary atresia?
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Which of the following options is NOT a treatment commonly associated with biliary atresia?
Which of the following options is NOT a treatment commonly associated with biliary atresia?
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What condition is characterized by a deficiency in uridine 5’-diphosphoglucuronosyltransferase?
What condition is characterized by a deficiency in uridine 5’-diphosphoglucuronosyltransferase?
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What form of hyperbilirubinemia is expected in a patient with biliary atresia?
What form of hyperbilirubinemia is expected in a patient with biliary atresia?
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Which of the following is true about the inheritance pattern of biliary atresia?
Which of the following is true about the inheritance pattern of biliary atresia?
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Study Notes
Pediatric GI Overview
- Mariam Fahim, DO is an Associate Professor at Western University of Health Sciences and a Pediatrician at Inscriptions Children's Clinic (ICC).
- No conflicts of interest were disclosed regarding industry relationships or products during the presentation.
- Learning objectives include understanding the causes of vomiting/emesis in infants and children, the differences between Omphalocele and Gastroschisis, the clinical presentation of Pyloric stenosis, Duodenal Atresia, Volvulus, Malrotation, Intussusception, Gastroesophageal Reflux, Hyperbilirubinemia, Necrotizing Enterocolitis in neonates, and Imperforate Anus and Hirschsprung's Disease.
Vomiting in Infants
- Most pathological vomiting occurs early in life (hours to days).
- Causes of pathological vomiting are mainly anatomical and often require surgery.
- Always consider head trauma as a central cause of vomiting, especially in cases of suspected child abuse.
- Normal infant vomiting is characterized by small amounts, non-projectile, non-bilious, and formula-colored.
- Spitting up in infants is typically normal.
Bilious vs. Non-Bilious Emesis
- Bilious emesis is green due to the issue being distal to the Ampulla of Vater.
- Bilious emesis is never normal.
- Common causes of bilious emesis include duodenal atresia, jejunal atresia, Hirschsprung disease, malrotation/volvulus, annular pancreas, and imperforate anus.
- Non-bilious emesis is not green because the blockage is proximal to the Ampulla of Vater.
- Persistent non-bilious vomiting often relates to the stomach or esophagus.
- Common causes include pyloric stenosis, tracheoesophageal fistula, increased intracranial pressure (ICP), brain tumors, intracranial masses, and Chiari malformations.
Vomiting in Children
- New onset of biliary emesis is rare in children with atresia, Hirschsprung's disease, and malrotation/volvulus.
- Vomiting in clusters, sudden onset, and quick resolution is often a sign of viral gastroenteritis (versus prolonged and severe illness in bacterial gastroenteritis).
- Vomiting many hours after food intake suggests gastroparesis, often secondary to surgery with vagus nerve damage, opioid and anticholinergic usage, or a neuromuscular disorder such as cerebral palsy or muscular dystrophy.
- Vomiting can be a symptom of migraines, appendicitis, or pregnancy (adolescent females).
- Diabetic ketoacidosis (DKA) is also a common cause of vomiting in children.
Omphalocele vs. Gastroschisis
- Omphalocele: Abdominal viscera herniate through the abdominal wall at the umbilicus. Contents are covered by a hernia sac.
- Often associated with Trisomies (Trisomy 21, Trisomy 13), Beckwith-Wiedemann syndrome and other anomalies.
- Gastroschisis: Abdominal viscera herniate through the abdominal wall paraumbilically (usually to the right). Contents are NOT covered by a hernia sac.
- Rarely associated with additional anomalies and increasing in frequency, notably associated with young maternal age and use of certain medications.
Pyloric Stenosis
- Pyloric sphincter abnormality with hypertrophy.
- Exact cause is unknown, but neonatal hyperacidity may be involved.
- Clinical features include projectile, non-bilious vomiting (2-6 weeks after birth), and an "olive"-shaped mass palpated on the abdomen, potentially with visible peristalsis.
- Associated with Turner and Edwards syndromes.
- Risk factors include formula feeding, male predominance, erythromycin use, and nulliparity (first-born son), and also occurs 2-8 weeks post-iron poisoning.
- Diagnosis is made through abdominal ultrasound.
- Treatment is via pyloromyotomy (surgery).
Duodenal Atresia
- Failure of duodenum to recanalize in utero.
- Clinical features include intrauterine polyhydramnios, and postpartum bilious vomiting (if distal to the major duodenal papilla), and an X-ray showing a double bubble sign and gasless distal bowel.
- It is associated with Down Syndrome (approximately 30%).
- Treatment involves surgery with fluid removal from the stomach via nasogastric tube and IV fluid administration.
Malrotation and Volvulus
- Malrotation: Incorrect alignment of intestines due to failure to rotate during development, often leading to the ileocecal valve being in the wrong quadrant (RUQ rather than RLQ). Timing of presentation depends on severity of any blockage.
- Volvulus: Twisting of the intestine around its blood supply, often a consequence of malrotation, which causes ischemia. Clinical features usually include bilious emesis and abdominal distention.
- Abdominal X-rays are the first-step when bilious emesis is suspected but may be normal, though upper gastrointestinal (GI) series can offer insight into abrupt cutoff points. Contrast enema may display abnormal cecum positioning. Over half of malrotation cases appear in the first month of life, with 30% appearing in the first week.
Intussusception
- Bowel telescopes into another part of the bowel.
- Most common cause of bowel obstruction in children 6 months to 36 months of age.
- Clinical features include abrupt onset of abdominal pain, relieved by the knee-chest position, and the presence of currant jelly-like stool.
- Diagnosis involves an ultrasound with a target sign and is also possible via air-contrast barium enema to cure the condition.
Gastroesophageal Reflux
- Stomach acid backs up into the esophagus during or after eating.
- Symptoms frequently include burning/squeezing (heartburn), post-meal spitting up, and acidic taste in the mouth.
- Chronic dry coughing, especially at night, is common, often associated with asthma or obesity.
- The gold standard for diagnosis is an ambulatory 24-hour pH monitor.
- Treatment often includes antacids, histamine 2 (H2) receptor antagonists, or proton pump inhibitors (PPIs). These may be indicated if the infant or child has trouble gaining weight from GERD.
Necrotizing Enterocolitis (NEC)
- Bacterial invasion of the intestinal walls, leading to inflammation and potential destruction.
- It is a common life-threatening emergency in newborns, particularly in premature infants, and is often associated with formula feeding, low birth weight, and packed RBC transfusions.
- Clinical features include bloody diarrhea, abdominal distention.
- Feared complication is pneumatosis intestinalis (air between intestinal walls).
Imperforate Anus vs. Hirschsprung's Disease
- Both conditions cause neonatal constipation (difficulty passing meconium), vomiting, abdominal distension, and dilated loop of bowels on X-ray.
- Imperforate Anus: Absence of an anal opening.
- Hirschsprung's Disease: Absence of ganglion cells, leading to lack of bowel relaxation and peristalsis in rectum and distal sigmoid colon.
- Key differences are in the presence of anal anomalies and the clinical feature of explosive stool release in Hirschsprung's.
Hyperbilirubinemia
- Elevated bilirubin levels in the blood.
- May have a genetic component.
- High levels of unconjugated bilirubin are implicated in kernicterus.
- Possible causes of hyperbilirubinemia include prematurity, exclusive breastfeeding, jaundice within 24 hours of birth, hemolytic disease, East Asian race, cephalhematoma/bruising, phototherapy in a sibling, and high risk zone bilirubin or TcB before discharge.
- Treatment options include phototherapy and exchange transfusion.
Other Important Topics
- Board Questions & Answers: Provide specific board-style questions and answers for each topic.
- Normal Intestinal Rotation: Visualization of the stages of intestinal rotation in a fetus.
- Risk Factors for Hyperbilirubinemia: Factors associated with an increased risk.
- Pathology of Hyperbilirubinemia: Unconjugated and conjugated forms.
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Description
Explore the critical aspects of Pediatric Gastroenterology, focusing on conditions like vomiting in infants, Omphalocele, Gastroschisis, and more. This quiz will test your understanding of various gastrointestinal issues faced by infants and children. Enhance your knowledge on clinical presentations and underlying causes.
