Pediatrics
Pediatric GI
Pediatrics

Pediatric GI

Pyloric stenosis, intussusception, Hirschsprung, NEC, malrotation.

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◆Pyloric stenosis

  • •First-born males, 3–6 weeks of age
  • •Projectile non-bilious vomiting + olive-shaped epigastric mass
  • •Hypochloremic hypokalemic metabolic alkalosis
  • •US: pyloric muscle >4 mm thick
  • •Fluid + electrolyte correction FIRST, then Ramstedt pyloromyotomy

◆Intussusception

  • •Toddler (6 mo–2 yr) + intermittent severe crampy pain + currant jelly stools + sausage mass
  • •US: target/donut sign
  • •Air or contrast enema = diagnostic AND therapeutic
  • •Surgery if enema fails or perforation

◆Hirschsprung

  • •Failure of neural crest migration → absent ganglion cells
  • •Delayed meconium >48 h + abdominal distention + forceful stool on rectal exam
  • •Risk: Down syndrome
  • •Diagnose: rectal suction biopsy
  • •Surgical pull-through

◆NEC

  • •Premature (esp. <32 wk) + feeding intolerance + bloody stools + distention
  • •KUB: pneumatosis intestinalis (air in bowel wall)
  • •NPO + NG decompression + IVF + broad-spectrum abx
  • •Surgery for perforation or refractory

◆Malrotation with midgut volvulus

  • •Bilious emesis in neonate = SURGICAL EMERGENCY
  • •Upper GI series: corkscrew + right-sided ligament of Treitz
  • •Bowel ischemia within hours
  • •Emergent Ladd procedure

◆Duodenal atresia

  • •Double bubble sign on KUB
  • •Association with Down syndrome

◆Umbilical hernia (toddler)

  • •Soft + reducible + <5 yr + <1.5 cm → observe (most close by 3–5 yr)
  • •Repair if persistent >5 yr, incarceration, or ≥1.5 cm

◆Infantile hemangioma

  • •Most resolve spontaneously → observe
  • •If large, ulcerated, vision-threatening → propranolol
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