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Gastrointestinal > 03.07 Obstruction in Neonates, Infants and Children > Flashcards

03.07 Obstruction in Neonates, Infants and Children Flashcards

1
Q

In the neonatal period, bile in the vomitus should be considered to be due to ____, until proven otherwise

A

IO

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2
Q

Hourly nasogastric aspirate of more than ___ in a neonate is an evidence of significant gastric retention

A

20cc

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3
Q

Etiologies of vomiting can be ___, ____, and ____

A

Mechanical
Reflex
Central

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4
Q

Characteristics of significant vomiting

A

Bile-stained
Bloody
Projectile
Persistent

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5
Q

Extreme danger in vomiting

A

Aspiration

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6
Q

To minimize aspiration, insert an ___ to decompress the stomach

A

OGT/NGT

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7
Q

Congenital defect of the abdominal wall in which the bowel and solid viscera are covered by peritoneum and amniotic membrane

A

Omphalocele

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8
Q

Congenital anomaly characterized by a defect in the anterior abdominal wall through which the intestinal contents freely protrude

A

Gastroschisis

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9
Q

Abnormal contour of the abdomen

A

Bulges

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10
Q

Passed within 24 hours

A

Meconium

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11
Q

Meconium is abnormal if:

A

None is passed
Delayed more than 24 hours
Brown, malodorous, whitish, mucoid, passed only by rectal washout

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12
Q

Smooth, firm mass that emerges through the external inguinal ring lateral to the pubic tubercle and enlarges with increased intraabdominal presure

A

Inguinal hernia

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13
Q

The first consideration we have to look for in an imperforate anus is if the patient has a ____

A

Fistula

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14
Q

Pouch of air in the rectum can be demonstrated through ___ within ____ after birth

A

Invertogram

18-24 hours

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15
Q

X-ray of the entire baby in one film

A

Babygram

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16
Q

If pre-sacral air is absent:

A

Obstruction

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17
Q

If pre-sacral air is present:

A

Normal
Ileus
Partial obstruction

18
Q

Important to children up to ____ since they do not have true pelvises yet

A

2 years of age

19
Q 
Polyhydramnios, no diabetes
Vomited after each feeding
Bilious vomitus
Vigorous cry, normal VS, well-hydrated
Upper abdomen is full
Microcolon in barium enema
A

Small bowel atresia

20
Q

Hallmark of duodenal obstruction

A

Bilious vomiting without abdominal distention

21
Q 
Difficulty with feedings
Nonbilious vomitus
Always hungry
Dehydrated
Pulsion like wave starting in the upper quadrant moving to the right
Vomited curdled milk
Fingernail-size firm mobile mass (olive tumor) could be palpated in the epigastrium
String sign
A

Pyloric stenosis

22
Q

In HPS, pyloric muscle wall thickness > ___

23
Q

In HPS, pyloric channel length > __

24
Q

HPS occurs from the ___

A

1st-2nd month of life

25
Q

HPS is repaired through ____

A

Myotomy (Fredet-Ramstedt pyolomyotomy)

26
Q 
Poor feeding since birth
Bilious vomiting of 12 hours duration
Passage of meconium
Irritable neonate with minimal abdominal distension
Double bubble sign
A

Malrotation

27
Q

Common causes of duodenal obstruction

Beak sign, sudden cutoff sign

A

Malrotation
Annular pancreas
Duodenal atresia

28
Q

There is a formation of ____ in malrotation

A

Peritoneal bands (Ladd’s bands)

29
Q

CC of malrotation

A

Unexplained bilious vomiting

30
Q 
Nonbilious vomiting
Extremely healthy
Better in between bouts of apparent pain
Cry and become pale
Runny nose in the previous week
Blood in the stool
After crying, upper quadrant fullness
Currant jelly/tomato juice
A

Ileo-ceocal intussusception

31
Q

Most common cause of intussuscpetion in infancy

A

Idiopathic

32
Q

Sudden onset, in a previously well child, of severe paroxysmal colicky pain that recurs at frequent intervals and is accompanied by straining efforts with legs and knees flexed and loud cries

A

Intussusception

33
Q

Progressive abdominal distension
Full term
Vomited several times
Passage of large stool after withdrawing the rectal thermometer

A

Hirschprung disease

34
Q

Pathology of neonatal Hirschprung disease

A

Congenital absence
Ganglion cells
Auerbach/meissner’s plexi

35
Q

Functional instestinal obstruction

Non-propulsive, fails to relax

A

Neonatal Hirschprung disease

36
Q

Classic triad of intussusception

A

Pain
Palpable sausage-shaped abdominal mass
Bloody or currant jelly stool

37
Q

A child with Hirschprung disease is seen to have abnormally increased contraction of the anal canal and no relaxation of the internal sphincter with rectal distention in what test

A

Anorectal manometry

38
Q

Rectal biopsy in Hirschprung disease

A

Absence of ganglion cells

Presence of hypertrophied nerve bundles

39
Q

Confimatory staining procedures for HD

A

Acetylcholinesterase staining

Calretinin staining

40
Q

Alternative to colonostomy

A

Colonic irrigation

41
Q

Colonic irrigation

A

Wam saline
Effluent clear
Daily
Up to right colon

42
Q

Treatment for HD

A

Colonic irrigation

Swenson pull-through procedure

Gastrointestinal (9 decks)

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