All right, here's some pediatric GI that I don't really talk
about too much, but are starting to show up on the boards.
They're all going to end in some sort of surgical repair.
They're all going to present at birth which means they make for
great differential diagnosis and or bow tie questions and or
matrix or grid questions, so on and so forth.
So knowing them is important. The first one I talk about is
tracheo esophageal fistula with esophageal atresia.
Whoa Doctor Z, that's a mouthful.
It is. But what do I teach you?
You need to know terminology. You need to know your medical
terminology because we don't come out speaking in medical
terms. We learn it as if it's a second
language or third language or so on.
So tracheo esophageal. So tracheo esophagus, fistula.
There's a connection between the trachea and the esophagus.
Well, that's not supposed to be there with esophageal atresia,
which means there's a premature closure of the esophagus, which
means when this child is fed, when this child is getting their
first feed and that milk, that formula, whatever they're eating
or consuming, fills up the atresia.
It's going to spill right over into the trachea.
It becomes one of ascraf, It's airway, airway, airway.
They're going to have this sensation of fluid, kind of like
drinking any type of a fluid or beverage and then going down the
quote, UN quote wrong pipe. They're going to have this
sensation of choking. When they have that sensation of
choking, they're going to cough. And in a newborn, in an infant,
they're not going to just turn pale, they're going to turn
cyanotic. So you've got choking, coughing
and cyanosis, the three CS of tracheoosophageal fistula with
esophageal atresia. So signs and symptoms of course.
What are we going to do about it?
Well, surgical repair. And why are we freaking out
about it? It is airway, airway, airway.
The next one is gastroscosis. This is a term that you don't
see very often on the boards, but makes for a great
differential diagnosis. With tracheosophageal fistula,
it is a GI congenital malformation.
So with gastroschisis, I will spell that for you.
GASTROSCHISIS gastroschisis. In this situation we actually
have the intestines protruding through the abdomen.
You can visualize the intestines through the abdomen.
It has not sealed. And now what are we going to do
next? Well, first and foremost, if
I've got the abdomen exposing my intestines, what am I freaking
out about? Which one to ask?
Graph, Am I freaking out about sepsis?
Because in that moment we have to immediately wrap that exposed
bowel with a saline soaked gauze because we cannot risk
infection, sepsis. They're not going to survive
this. Again, what is the treatment
here? It is going to be surgical
repair. The last one is a duodenal
atresia, a duodenal atresia. So again, this means that the
duodenum has not fully developed.
It's not going to only be the fact that we're going to feed
them and have this bilious emesis because it did pass the
stomach and they made it to the duodenum, but it's not going to
go anywhere beyond that. So now this child's duodum is
going to fill up, fill up, fill up.
It's going to back up into the stomach, stomach, stomach.
And now we've got this bilious emesis.
Think of all the GI malformations, all the GI,
especially Pediatrics that have bilious or non bilious vomiting.
You think that makes for a great case study or a bow tie or a
matrix grid? It does, absolutely.
And in this situation we could get a freebie question out of
this. The freebie question is how are
we going to see this or diagnosis?
So we get an AXR which is short for abdominal X-ray, you need to
know your abbreviations because now with case studies or nurses
notes or H and PS history and physicals, they're starting to
use abbreviations. So AXR similar to CXR abdominal
X-ray versus chest X-ray. But in this situation, because
we are dealing with the duodenal atresia, we're going to do an
abdominal X-ray. What we're going to get is a,
quote, UN quote, double bubble. And basically what this is, is
there's air bubbles in the duodenum and also in the
stomach. So you get this double bubble.
And if you were to look it up online, it's pretty interesting
to see that bubble in the duodenum and in the abdomen, I
mean in the stomach. And now we've diagnosed this
duodenal atresia. Well, if they're going to have
Bilius emesis within hours of their first feed, we're worried
about aspiration. This becomes airway.
So ask Graf a freebie question with a diagnosis and maybe even
another freebie question with how to treat it.
Because again, with the treatment, like the
aforementioned congenital malformations, it is surgical
repair. So know these three along with
knowing Hirschsprung, knowing pyloric stenosis,
intisusception, there's so many different things that can show
up with pediatric GI and any type of congenital malformation
or any type of development that can happen.
So make sure you know these because again I cannot emphasize
this enough. You're talking bow tie,
traditional select, all that apply, freebie questions, matrix
grid questions, case studies, so many different ways that I can
ask any type of pediatric GI. So good luck and hope you enjoy.