Amniotic Fluid
	Oligohydroamnios	Polyhydroamnios
?	Baby can’t pee	Baby cant swallow
DDx	Weak abd muscles (tx w/ serial foley) Renal agenesis	Wardeng-hoffman Intestinal atresia

Congenital Umbilical Hernia
Path	Incomplete closure of abdominal muscles
Clx	·       Soft, nontender bulge at umbilicus ·       Protrudes with increased abdominal pressure ·       Typically reducible ·       Non tender ·       Dx CLINICALLY (no need for dxic tests)
Tx	·       Observe (spontaneous closure) ·       Elective surgery around age 5 ·       Do US if it’s ACQUIRED umbilical hernia.

	Coanal Atresia
	CHARGE syndrome is a set of congenital defects which are seen in conjunctions. C: coloboma of the eye, central nervous system anomalies H: heart defects A: atresia of the choanae R: retardation of growth and/or development G: genital and/or urinary defects (hypogonadism) E: ear anomalies and/or deafness
S/S	·       Baby turns blue while feeding & pink while crying
Dx	Clx → CT
Tx	Surgery

	Hirshsprung dz
?	·       Associated w/ Down ·       Failure of neurons to migrate ·       ø aurbach / myenteric
S/S	Can presents in 2 ways: ·       FTPM (on DRE → diarrhea) ·       Toddler w/ overflow incontinence
Dx	·       1˚ X-Ray ·       2˚ Barium ·       3˚  Manometry (⤴️ Pressure) ·       BEST: Bx
Tx	3-stage Surgery

	Doudenal Atresia
?	Associated w/ Down, Annular pancreas
S/S	First 12 hours: Billous Vomiting
Dx	X-ray: double-bouble
Tx	NGT Surgery

Biliary atresia
Path	·       Idiopathic ·       Progressive obliteration of extrahepatic bile ducts
Clx	·       Asymptomatic at birth ·       Age 1-8 weeks: Jaundice Acholic stools &/or dark urine Hepatomegaly
Dx	·       Conjugated hyperbilirubinemia ·       Liver biopsy: bile duct plugs & proliferation, portal tract edema, fibrosis ·       Intraoperative cholangiogram (gold standard): biliary obstruction
Tx	·       Hepatoportoenterostomy (Kasai procedure) ·       Liver transplant

	Intususseption
?	Associated with previously used Rotavirus vaccine and HSP.
S/S	colicky abdominal pain, bilious vomiting, and currant jelly stool. On PEx: right quadrant sausage-shaped mass
Dx	US Contrast enema “Target sign”
Tx	1˚: IVF + Electrolytes 2˚ NGT Barium Enema (both dx & Tx) ·       contraindicated if the child has signs of peritonitis, shock, or perforation.

Intussusception
RF	·       Recent viral illness or rotavirus vaccination ·       Pathological lead point Congenital malformation of the intestines (eg, Meckel diverticulum) Henoch-Schönlein purpura Celiac disease
Clx	·       Sudden, intermittent abdominal pain ·       “Currant jelly” stools ·       Sausage-shaped abdominal mass
Dx	·       “Target sign” on ultrasound
Tx	·       Air or saline enema ·       Surgery

VACTERL syndrome

·       V: vertebral anomalies ·       A: anal atresia ·       C: cardiovascular anomalies ·       T: tracheoesophageal fistula ·       E: esophageal atresia ·       R: renal anomalies ·       L: limb anomalies

Diarrhea (Gastroenteritis)
?	Can be Infectious / non-infectious
S/S	Diarrhea → Dehydration
Dx	Look for an organism
Tx	Fluid Resuscitation Antidiarrheals such as loperamide are always the wrong answer.

Necrotizing enterocolitis (NEC)
RF	Prematurity (but not only to premature!) Very low birth weight (<1.5 kg [3.3 1b]) Enteral feeding (formula > breast milk) Pt w/ CHD -> ⤵️ BF to intestines
Clx	Feeding intolerance / Lethargy Unstable VS (⤵️ T°) Bilious emesis, bloody stools, abdominal distention
X-Ray	Pneumatosis intestinalis Portal venous gas Pneumoperitoneum
Tx	Bowel rest; parenteral nutrition Broad-spectrum IV Abx ± Surgery

	Wilms	Neuroblastoma
?	·       Semi-hypertrophy of 1 kidney ·       (Wilms tumor, aniridia, GU malformations, and mental retardation is referred to as WAGR syndrome. The a deletion on chromosome 11) ·       metanephros	adrenal medulla tumor (neural crest)
S/S	Abdominal mass (does not cross midline) Anirdia (no iris) Constipation N/V	Abdominal mass Hypsarrythmia (dancing eyes) and opsoclonus (dancing feet) are hallmarks.
Dx	·       1˚: US ·       Best˚: Contrast CT	·       ⤴️ URINE VMA and metanephrines ·       Bx: small round blue/purple cells ·       N-myc gene amplification ·       131I-MIBG body scan to detect metastasis ·       MRI
Tx	Total nephrectomy + chemo + radiation	Surgical resection

Neuroblastoma
Path	·       Neural crest origin ·       Involves adrenal medulla, sympathetic chain
Clx	·       Median age <2 ·       Abdominal mass ·       Periorbital ecchymoses (orbital metastases) ·       Spinal cord compression from epidural invasion (“dumbbell tumor”) ·       Opsoclonus-myoclonus syndrome
Dx	·       Elevated catecholamine metabolites ·       Small, round blue cells on histology ·       N-myc gene amplification

Meckel diverticulum
#	Rule of 2s: ·       2% prevalence ·       Age 2 ·       2:1 male/female ratio ·       Location within 2 feet of ileocecal valve
Clx	·       May be asx, incidental finding ·       Painless lower gastrointestinal bleeding ·       ± Anemia
Comp	·       Intussusception ·       Volvulus ·       Intestinal obstruction
Dx	·       Technetium-99m pertechnetate scan

Evaluation of neonatal hydration
Signs	Decreased wet diapers Absence of tears Sunken fontanelle Dry mucous membranes Decreased skin turgor Delayed capillary refill
Tx	<7% ·       Continue exclusive breastfeeding ·       Follow-up at age 10-14 days to check that infant has regained birth weight ≥7% ·       Assess for oromotor dysfunction ·       Assess for lactation failure ·       Dally weights ·       Consider formula supplementation

Differential diagnosis of regurgitation & vomiting in infants
Dx	Clx	Tx
GERD	Physiologic ·       Asymptomatic ·       Happy spittter Pathologic ·       FTT ·       Significant irritability ·       Sandifer syndrome	·       Reassurance ·       Positioning therapy ·       Thickened feeds ·       Antacid therapy ·       If severe, esophageal pH probe monitoring & upper endoscopy
Milk protein allergy	·       Regurgitation/vomiting ·       Eczema ·       Bloody stools	·       Elimination of dairy & soy protein from diet
Pyloric stenosis	·       Projectile nonbilious vomiting ·       Olive-shaped abdominal mass ·       Dehydration, weight loss	·       Abdominal U/S ·       Pyloromyotomy

HUS
Path	Shiga toxin (infection w/ E.coli or Shigella)
Clx	·       Hx of bloody diarrhea ·       Fatigue, pallor ·       Bruising, petechiae ·       Oliguria, edema
Dx	·       Hemolytic anemia (schistocytes, ⤴️bilirubin) ·       ⤵️PLT ·       Acute kidney injury (t BUN, T creatinine)
Tx	·       Fluid & electrolyte management ·       Blood transfusions ·       If severe → Dialysis

PED constipation
RF	·       Initiation of solid food & cows milk ·       Toilet training ·       School entry
Clx	·       Painful/hard bowel movements ·       Stool withholding ·       Encopresis (feces in underwear >4ys)
Complications	·       Anal fissures ·       Hemorrhoids ·       Enuresis/urinary tract infections
Tx	·       ⤴️Dietary fiber & water intake ·       Limit cow’s milk intake to <24 oz ·       Laxatives ·       ± Suppositories, enema

Food protein—induced allergic proctocolitis
RF	Family history of allergies, eczema, or asthma
Clx	·       Young infant ·       Painless, bloody stools ·       ± Spit-up
Tx	·       Elimination of milk & soy from maternal diet in breastfed infants ·       Hydrolyzed formula in formula-fed infants
Prognosis	resolution by 1 year