Examkin

Question

Difficulty: MediumPediatric Gastrointestinal Disorders

Match each classic pediatric gastrointestinal clinical presentation to its most appropriate definitive management or next best therapeutic step.

  • An 8-month-old child presents with paroxysms of intense crying, drawing the lower extremities toward the abdomen, accompanied by stools containing mucus and blood.Air or contrast enema reduction
  • A 5-week-old boy is evaluated for worsening, forceful postprandial vomiting of non-bilious stomach contents; exam shows a firm epigastric nodule.Intravenous fluid resuscitation followed by pyloromyotomy
  • A 4-day-old newborn abruptly develops green-stained emesis. A contrast study demonstrates the duodenojejunal junction failing to cross the midline.Emergent Ladd procedure
  • A 48-hour-old term neonate exhibits marked abdominal distension and delayed meconium passage, followed by a sudden rush of flatus and stool upon digital rectal stimulation.Resection of the aganglionic bowel segment
  • A 2.5-year-old toddler is evaluated for a large volume of painless, bright red blood per rectum. A technetium-99m scan shows an area of ectopic uptake in the right lower quadrant.Surgical excision of the omphalomesenteric duct remnant

Answer

The correct matches pair each classic pediatric GI presentation with its definitive therapeutic intervention: Intussusception is treated with air/contrast enema; Pyloric stenosis requires IV fluids followed by pyloromyotomy; Malrotation/volvulus necessitates an emergent Ladd procedure; Hirschsprung disease is treated with resection of the aganglionic segment; and a symptomatic Meckel diverticulum requires surgical excision.
Each vignette represents the most classic epidemiological and clinical presentation for a specific pediatric gastrointestinal disorder. The correct matches reflect standard-of-care guidelines: non-operative reduction for stable intussusception, metabolic resuscitation prior to surgery for pyloric stenosis, emergent Ladd procedure for volvulus, aganglionic segment resection for Hirschsprung disease, and excision of the omphalomesenteric remnant for a symptomatic Meckel diverticulum.

Step-by-Step Solution

1
Analyze the 8-month-old infant's presentation.
Identify intussusception based on episodic crying, drawing legs up, and bloody/mucus stools.
Recognizing this classic triad directs the clinician to air or contrast enema for immediate reduction.
2
Evaluate the 5-week-old boy's symptoms.
Diagnose hypertrophic pyloric stenosis from the projectile non-bilious vomiting and palpable epigastric mass.
Understanding that this condition causes severe electrolyte derangements dictates that IV fluid resuscitation must precede pyloromyotomy.
3
Assess the 4-day-old neonate with bilious emesis.
Identify malrotation with midgut volvulus confirmed by the abnormal duodenal position on the upper GI series.
This is a surgical emergency necessitating a Ladd procedure to prevent ischemic necrosis of the bowel.
4
Review the 48-hour-old neonate's clinical picture.
Diagnose Hirschsprung disease based on delayed meconium passage and the explosive release of stool on rectal exam.
The underlying pathology is aganglionosis, which must be surgically resected.
5
Examine the 2.5-year-old toddler's presentation.
Identify a bleeding Meckel diverticulum due to painless hematochezia and positive technetium-99m scan.
Symptomatic diverticula containing ectopic gastric mucosa require surgical excision.

Key Concept

Targeted Management of Pediatric Gastrointestinal Emergencies
Rate this question

Topics

Pediatric Gastrointestinal Disorders

More questions from this topic