CPEN Gastrointestinal Emergencies 3 — Questions and Answers
Question 1: A neonate presents with failure to pass meconium in the first 48 hours of life, abdominal distension, and bilious vomiting. Rectal exam results in explosive release of gas and stool. Which diagnosis is most likely?
- Meconium ileus
- Hirschsprung disease (Correct answer)
- Intussusception
- Necrotizing enterocolitis
Correct answer: Hirschsprung disease
Hirschsprung disease classically presents with failure to pass meconium, abdominal distension, and explosive decompression upon rectal examination due to the absence of ganglion cells in the rectosigmoid.
Question 2: A premature neonate at 28 weeks gestation in the NICU develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. What is the most critical immediate intervention?
- Begin total parenteral nutrition and continue enteral feeds
- Make the infant NPO and start broad-spectrum antibiotics (Correct answer)
- Administer corticosteroids to reduce intestinal inflammation
- Perform immediate surgical resection
Correct answer: Make the infant NPO and start broad-spectrum antibiotics
Necrotizing enterocolitis requires immediate bowel rest (NPO), nasogastric decompression, and broad-spectrum antibiotics as initial management.
Question 3: A 14-year-old presents with rectal bleeding, urgency, and mucus in the stool for 6 weeks. Colonoscopy reveals continuous mucosal inflammation from the rectum. Which condition is most consistent with these findings?
- Crohn disease
- Ulcerative colitis (Correct answer)
- Infectious colitis
- Ischemic colitis
Correct answer: Ulcerative colitis
Continuous mucosal inflammation starting at the rectum and extending proximally is the hallmark of ulcerative colitis, distinguishing it from the skip lesions of Crohn disease.
Question 4: A child with known hemophilia A presents with acute abdominal pain and is found to have a retroperitoneal hematoma on imaging. What is the most appropriate initial treatment?
- Emergency laparotomy
- Administer factor VIII concentrate (Correct answer)
- Administer fresh frozen plasma alone
- Start heparin therapy
Correct answer: Administer factor VIII concentrate
In a child with hemophilia A, the priority is to restore factor VIII activity to stop the bleeding before any surgical consideration.
Question 5: A 6-year-old ingests a button battery. X-ray confirms it is lodged in the esophagus. What is the most appropriate next step?
- Observation with repeat X-ray in 24 hours
- Immediate endoscopic removal (Correct answer)
- Administer cathartics to facilitate passage
- Perform a barium swallow to confirm location
Correct answer: Immediate endoscopic removal
Button batteries lodged in the esophagus require immediate endoscopic removal due to the risk of liquefactive necrosis, perforation, and aortoesophageal fistula within hours.
Question 6: Which assessment finding best differentiates peritonitis from a non-surgical cause of abdominal pain in a pediatric patient?
- Abdominal guarding and rebound tenderness (Correct answer)
- Nausea and vomiting
- Fever above 38°C
- Diffuse abdominal tenderness
Correct answer: Abdominal guarding and rebound tenderness
Involuntary guarding and rebound tenderness indicate peritoneal irritation and are the most specific signs pointing to a surgical intra-abdominal emergency.
Question 7: A 4-year-old who swallowed a coin has it confirmed by X-ray to be in the stomach. The child is asymptomatic. What is the recommended management?
- Immediate endoscopic retrieval
- Observation and follow serial X-rays, as most coins pass spontaneously (Correct answer)
- Administer magnesium citrate to speed passage
- Surgical removal due to risk of bowel obstruction
Correct answer: Observation and follow serial X-rays, as most coins pass spontaneously
Coins in the stomach of asymptomatic children will pass spontaneously in most cases and require only observation with follow-up imaging if not passed within 4 weeks.
CPEN Gastrointestinal Emergencies 3
A neonate presents with failure to pass meconium in the first 48 hours of life, abdominal distension, and bilious vomiting.
Rectal exam results in explosive release of gas and stool.
Which diagnosis is most likely?