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All right, here's some pediatric
GI that I don't really talk 

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about too much, but are starting
to show up on the boards. 

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They're all going to end in some
sort of surgical repair. 

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They're all going to present at 
birth which means they make for 

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great differential diagnosis and
or bow tie questions and or 

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matrix or grid questions, so on 
and so forth. 

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So knowing them is important. 
The first one I talk about is 

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tracheo esophageal fistula with 
esophageal atresia. 

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Whoa Doctor Z, that's a 
mouthful. 

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It is. 
But what do I teach you? 

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You need to know terminology. 
You need to know your medical 

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terminology because we don't 
come out speaking in medical 

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terms. 
We learn it as if it's a second 

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language or third language or so
on. 

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So tracheo esophageal. 
So tracheo esophagus, fistula. 

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There's a connection between the
trachea and the esophagus. 

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Well, that's not supposed to be 
there with esophageal atresia, 

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which means there's a premature 
closure of the esophagus, which 

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means when this child is fed, 
when this child is getting their

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first feed and that milk, that 
formula, whatever they're eating

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or consuming, fills up the 
atresia. 

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It's going to spill right over 
into the trachea. 

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It becomes one of ascraf, It's 
airway, airway, airway. 

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They're going to have this 
sensation of fluid, kind of like

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drinking any type of a fluid or 
beverage and then going down the

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quote, UN quote wrong pipe. 
They're going to have this 

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sensation of choking. 
When they have that sensation of

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choking, they're going to cough.
And in a newborn, in an infant, 

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they're not going to just turn 
pale, they're going to turn 

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cyanotic. 
So you've got choking, coughing 

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and cyanosis, the three CS of 
tracheoosophageal fistula with 

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esophageal atresia. 
So signs and symptoms of course.

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What are we going to do about 
it? 

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Well, surgical repair. 
And why are we freaking out 

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about it? 
It is airway, airway, airway. 

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The next one is gastroscosis. 
This is a term that you don't 

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see very often on the boards, 
but makes for a great 

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differential diagnosis. 
With tracheosophageal fistula, 

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it is a GI congenital 
malformation. 

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So with gastroschisis, I will 
spell that for you. 

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GASTROSCHISIS gastroschisis. 
In this situation we actually 

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have the intestines protruding 
through the abdomen. 

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You can visualize the intestines
through the abdomen. 

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It has not sealed. 
And now what are we going to do 

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next? 
Well, first and foremost, if 

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I've got the abdomen exposing my
intestines, what am I freaking 

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out about? 
Which one to ask? 

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Graph, Am I freaking out about 
sepsis? 

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Because in that moment we have 
to immediately wrap that exposed

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bowel with a saline soaked gauze
because we cannot risk 

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infection, sepsis. 
They're not going to survive 

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this. 
Again, what is the treatment 

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here? 
It is going to be surgical 

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repair. 
The last one is a duodenal 

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atresia, a duodenal atresia. 
So again, this means that the 

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duodenum has not fully 
developed. 

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It's not going to only be the 
fact that we're going to feed 

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them and have this bilious 
emesis because it did pass the 

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stomach and they made it to the 
duodenum, but it's not going to 

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go anywhere beyond that. 
So now this child's duodum is 

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going to fill up, fill up, fill 
up. 

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It's going to back up into the 
stomach, stomach, stomach. 

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And now we've got this bilious 
emesis. 

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Think of all the GI 
malformations, all the GI, 

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especially Pediatrics that have 
bilious or non bilious vomiting.

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You think that makes for a great
case study or a bow tie or a 

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matrix grid? 
It does, absolutely. 

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And in this situation we could 
get a freebie question out of 

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this. 
The freebie question is how are 

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we going to see this or 
diagnosis? 

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So we get an AXR which is short 
for abdominal X-ray, you need to

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know your abbreviations because 
now with case studies or nurses 

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notes or H and PS history and 
physicals, they're starting to 

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use abbreviations. 
So AXR similar to CXR abdominal 

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X-ray versus chest X-ray. 
But in this situation, because 

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we are dealing with the duodenal
atresia, we're going to do an 

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abdominal X-ray. 
What we're going to get is a, 

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quote, UN quote, double bubble. 
And basically what this is, is 

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there's air bubbles in the 
duodenum and also in the 

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stomach. 
So you get this double bubble. 

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And if you were to look it up 
online, it's pretty interesting 

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to see that bubble in the 
duodenum and in the abdomen, I 

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mean in the stomach. 
And now we've diagnosed this 

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duodenal atresia. 
Well, if they're going to have 

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Bilius emesis within hours of 
their first feed, we're worried 

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about aspiration. 
This becomes airway. 

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So ask Graf a freebie question 
with a diagnosis and maybe even 

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another freebie question with 
how to treat it. 

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Because again, with the 
treatment, like the 

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aforementioned congenital 
malformations, it is surgical 

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repair. 
So know these three along with 

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knowing Hirschsprung, knowing 
pyloric stenosis, 

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intisusception, there's so many 
different things that can show 

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up with pediatric GI and any 
type of congenital malformation 

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or any type of development that 
can happen. 

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So make sure you know these 
because again I cannot emphasize

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this enough. 
You're talking bow tie, 

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traditional select, all that 
apply, freebie questions, matrix

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grid questions, case studies, so
many different ways that I can 

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ask any type of pediatric GI. 
So good luck and hope you enjoy.