Peds -- Gi

Front 1

What are some causes of pancreatitis in a child?

Back 1

1. Blunt abdominal trauma = most common cause
2. Meds (steroids, azathioprine, thiazides, sulfonamides).
3. HUS
4. Sepsis
5. CBD obstruction from GB stone.
6. Hereditary pancreatitis.

Front 2

1. Which is associated with other congenital abnormalities: Gastroschisis or Omphalocele?
2. What are the associated abnormalities?
3. Where does the umbilical cord insert on omphalocele and gastroschisis.

Back 2

1. Omphalocele is associated with other congenital abnormalities. However, the small bowel is exposed to amniotic fluid in gastroschisis resulting in matting of bowel loops and abnormal fxn of the small bowel loops.
2. Omphalocele is associated with cardiac abnormalities, renal abnormalities, and Beckwith-Wiedemann Syndrome.
3. The umbilical cord inserts on top of the omphalocele. However in gastroschisis, the umbilical cord inserts lateral to the herniating bowel loops.

Front 3

1. What is the etiology of pyloric stenosis?
2. What are the size measurements of pyloric stenosis?
3. What is the DDX?
4. What are the laboratory abnormalities in pyloric stenosis?

Back 3

1. Hypertrophy of the circular muscle fibers of the pylorus thought to be due to abnormal innervation.
2. >15mm in length and >3mm in thickness. Say you would give D5W through NGT to watch the narrowed pylorus.
3. Pylorospasm and prostaglandin therapy.
4. Metabolic alkalosis, hypochloremia, hypokalemia.

Front 4

1. What are the 3 different types of gallstones?
2. What is the etiology of gallstones in a child?

Back 4

1. Three varieties of stones exist:
- Cholesterol (2/2 supersaturated bile).
- Pigmented (precipitated calcium bilIrubinate)
- Mixed (most common type).
2. Diuretics (lasix), hemolysis (sickle cell disease, thalassemia, spherocytosis), IBD (abnormal enterohepatic circulation), cystic fibrosis, short gut syndrome.

Front 5

1. What are the imaging findings of hepatoblastoma?
2. Is AFP elevated with hepatoblastoma?
3. What is the typical age range for hepatoblastoma?
4. What is the characteristic pattern seen on angiography?
5. Can you differentiate HCC from hepatoblastoma on imaging?

Back 5

1. On US: heterogeneous, echogenic solid mass with poorly defined borders with possible vascular invasion. On NECT, low attenuation mass with areas of inhomogeneity related to hemorrhage or necrosis. Stippled or coarse calcification.
2. Tumor cells produce AFP like HCC, however, cirrhosis is not present in hepatoblastoma.
3. Patients present with an right upper quadrant mass and are under 5 years, usually less than 2 years of age. HCC usually occurs after 4 years of age.
4. Spoke wheel pattern is seen on angiography.
5. No. Tissue dx is needed.

Front 6

1. What are the findings in Hirschsprung Disease?
2. What is it associated with?

Back 6

1. Transition point can be gradual or abrupt. A normal rectum is always wider than the sigmoid. A rectum/sigmoid ratio > 1 excludes the diagnosis of HS. The critical view on the contrast enema is the early lateral view demonstrating the rectum is less distensible than the sigmoid and showing a transition zone.
2. 20% of patients may have Down syndrome, cardiac, GI and GU anomalies.
Male to female ratio is 4:1.
NOTE: total colonic Hirschsprung disease can present as a microcolon.

Front 7

1. What the 2 types of mesenteric adenitis?
2. What is the etiology of primary mesenteric adenitis?
3. What are the imaging findings?

Back 7

1. Primary vs. Secondary. Primary mesenteric adenitis is defined as right sided adenopathy in the absence of an acute inflammatory process.
Secondary mesenteric adenopathy si assoicaetd with appendicitis and inflammatory processes.
2. The primary form is more common in children and thought to be related to low grade bowel inflammation from infections (Yerisinia, Campylobacter, Salmonella, Shigella).
3. Three or more nodes (>0.5 cm in short axis) in the RLQ with absence of other local pathology.

Front 8

1. What is the most common cause of rectal bleeding in a child?
2. What are the 4 categories of polyps?
3. What is the nature of juvenile polyps?

Back 8

1. Juvenile polyp
2.
- Isolated juvenile polyps
- Inherited polyposis syndromes (Peutz-Jegher)
- Adenomatous polyposis syndromes
- Non-inherited polyposes.
3. Isolated juvenile polyps are inflammatory in nature and often appear either solitary or in clusters within the colon. They are prone to bleeding

Front 9

1. What is the triad for hemangioendothelioma?
2. What are the imaging findings of hemangioendothelioma?
3. What is the treatment?

Back 9

1.
- Right upper quadrant mass
- Cutaneous hemangiomas
- High output CHF
2.
- Enlarged celiac and hepatic arteries. The aorta will appear reduced in caliber distal to the take-off of the celiac artery.
- Peripheral enhancement on early phase imaging with delayed filling in.
- May be multiple (mimics hypervascular mets) or infiltrative
- May have calcifications
3. Regresses spontaneously. However if the patient is symptomatic (CHF and consumptive coagulopathy), they can be treated with steroids and interferon therapy or embolization.

Front 10

1. What is the etiology of duodenal atresia?
2. What are some associated abnormalities?
3. What is the ddx of double double sign?

Back 10

1. Failure of recanalization. Complete failure causes complete obstruction, while incomplete recanalization causes duodenal stenosis due to a web.
2. Congenital heart disease, TE fistula, imperforate anus, and down syndrome (seen in 1/3 of pts with duodenal atresia).
3. Duodenal atresia/stenosis, annular pancreas, malrotation/volvulus, preduodenal portal vein.

Front 11

What is the ddx of fatty liver?

Back 11

- Cystic fibrosis
- malnutrition
- hyperalimentation
- glycogen storage disease
- steroid therapy

Front 12

What are the causes of cirrhosis in a child?

Back 12

- Biliary atresia: obliteration of extrahepatic ducts
- Cholestasis secondary to total parenteral nutrition or cystic fibrosis
- Metalbolic abnormalities: Tyrosinemia, Galactosemia, Alpha-I-antitrypsin deficiency, hemochromotosis.
- Hepatitis

Front 13

Choledochal cyst

Back 13

CBD measuring greater than 10mm in a child strongly suggests a choledochal cyst.

Front 14

Functional ileus

Back 14

Often consequence of systemic disease such as congenital heart disease or sepsis, infectious enterocolitis, or milk intolerance.
Can look like necrotizing enterocolitis.

Front 15

Complications of necrotizing enterocolitis

Back 15

- Short gut syndrome
- Stricture

Front 16

CYSTIC LIVER MASS

Back 16

- Mesenchymal hamartoma
- Hemangioendothelioma (has more solid components; look for enlarged celiac trunk with decrease in caliber of the aorta distal to the take off of the celiac)
- Embryonal sarcoma (presents as low attenuation centrally with enhancing periphery)
- Necrotizing metastases
- Abscess (umbilical venous catheter infection)

Front 17

Causes of gallstones in children

Back 17

- Chrionic infection
- Hemolytic anemia
- TPN
- Ilieal resection

Front 18

Solid pancreatic mass

Back 18

- SPEN (solid and papillary epithelial neoplasm): more common in girls.
- Lymphoma
- Pancreatoblastoma

Front 19

Presacral mass

Back 19

- Sacrococcygeal teratoma
- Anterior meningocele
- Rectal duplication cyst
- Lymphangioma
- Ovarian cyst
- Hydrometrocolpos
- Rhabdomyosarcoma