Neonatal jaundice > 72 hrs
sepsis, breast milk jaundice, breast feeding jaundice, Gilberts. Remember, breast feeding jaundice:
suboptimal supply of breast milk, requires hydration and supplementation. Breast Milk jaundice is
when the baby's liver is not developed enough to handle breaking down the supply of breast milk
from mom.
Asian baby age 1 month with jaundice and direct hyperbile
Biliary atresia - dx of intra and extrahepatic bile ducts leading to obstructive jaundice, cirrhosis, and
death. Typically diagnosed before 2months ago. Tx: surgery w/ Kasai procedure.
Baby with conjugated hyperbili
*Will require admission and work up*. DDx: biliary atresia, SEPSIS, cholelithiasis, cystic fibrosis,
Wilson's, etc ...
What are the most concerning (and unique) causes of abdominal pain in the following age groups: 0-
3mo, 3mo-2yr, school aged kids
0-3mo: Necrotizing Enterocolitis, Hirschprung's/Toxic Megacolon, Volvulus, Pyloric Stenosis; 3mo-2yr:
Intussusception, Meckel's Diverticulum, Foreign Bodies; School age: similar to adults including
pregnancy (consider if >8)
Dx and Tx of Necrotizing Enterocolitis
Inflammation & necrosis of the bowel wall from translocaiton of gut bacteria; prematurity(greatest
risk factor); SSx: bilious emesis, bloody stools, abdominal wall erythema; Dx: XR with pneumatosis
intestinalis (pathognomonic), portal vein air (poor prognosis); Rx: IVF, broad spectrum antibiotics, NG
tube (bowel rest), surgery consult, admit
Dx and Tx of Hirschsprung Disease
Lack of ganglion cells in the rectosigmoid colon; SSx: Delayed passage of meconium (>48 hr) →
obstruction & bilious emesis (late finding); Complications: enterocolitis/toxic megacolon; Dx: rectal
biopsy (gold standard), contrast enema (transition zone); Rx: surgery, admit
Dx and Tx of Midgut Volvulus
1st mo of life; Congenital malrotation → volvulus → midgut ischemia; SSx: bilious vomiting (always
emergent), abd pain/distention, ± rectal bleeding/hematochezia (gut ischemia); XR "double bubble"
can also be seen in duodenal atresia; Dx (definitive): upper GI series "corkscrew", US; Rx: NGT, surgery
consult. Associated conditions: congenital diaphragmatic hernia, congenital heart disease,
omphalocele
, Dx and Tx of Intussusception
6mo-3yr; telescoping of bowel (ileoceal most common); Tumor, Meckel's, post-viral, HSP; SSx: colicky
abd pain w/ LETHARGY + abd mass (sausage-shape in RUQ; RLQ usually empty) + "currant jelly" stools;
AXR: obstruction, Dance's sign (pathognomonic); Dx (preferred): US "target sign"; Rx: OR (sick),
air/contrast enema (not sick), abx
Dx and Tx of Meckel Diverticulum
Most common congential GI malformation. Incomplete closure of vitelline duct → heterotopic gastric
mucosa; SSx: painless rectal bleeding 2/2 ulceration → obstruction (2/2
intussusception/volvulus/hernia; Rule of 2s: 2% of population, 2% symptomatic, 2ft proximal to
terminal ileum, 2x more often in males, 2yo most common; Dx: Meckel scan; Rx: surgical consult
Where do ingested foreign bodies usually get stuck?
Cricopharyngeus C6 (60-80%), GE junction T11 (10-20%), Aortic Arch T4 (5-20%); Coin most common
object swallowed. CXR (AP): coin appears flat if in esophagus
What are indications for emergent endosocopy for ingested foreign body?
High-grade obstruction, object in esophagus >24hr, object >6cm, sharp objects, multiple objects
swallowed, button battery in esophagus, button battery in stomach >48hr or if symptomatic (earlier)
Dx and Tx of Pyloric Stenosis
Age 2-8 wks. Hypertrophied pylorus. Most common congenital GI disorder. Risk factors: first-born
males, macrolide abx exposure. SSx: nonbilious projectile vomiting, "hungry vomiter"; Labs: hypoCl,
hypoK, metabolic alkalosis (2/2 vomiting), dehydration. Exam: palpable "olive-shaped" mass. Dx: US
(target sign), upper GI series "string sign". Rx: IVF, surgery
What is the most likely location of traumatic C-spine injury in young children?
Age < 8yrs more susceptible to upper cervical spine injuries (C1-3).
What are normal variants in pediatric c-spine imaging?
Pseudosubluxation (C2 on C3), growth plates can look like fractures, anterior wedging
What is SCIWORA?
"Spinal cord injury without radiographic abnormalities." May present with missed old injury leading to
significant subsequent injury after relatively minor trauma. XR/CT without abnormalities, MRI will
show problem area. Most commonly seen in children and the elderly.
Review common causes of anemia in young children
Physiologic nadir (Hgb 9 at 6wks), B12/folate deficiency (high MCV, hypersegmented polys, seen in
vegans), Iron deficiency (1-2yr, low MCV, associated with pica, breath holding, high milk intake (more
than 28-32 ounces per day), Sickle Cell dz (hemolysis, high retic count), Lead Poisoning (basophilic
stippling, abd pain, AMS)
How do you determine ETT size, depth, and blade size in young children?
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