1.4 MTB Step 3 - The Newborn (GI & Hepatobiliary) Flashcards
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
MECONIUM PLUGS (Lower Colon) & MECONIUM ILEUS (Lower Ileum)
What is the Initial Presentation for both Meconium Plugs and Meconium Ileus?
Intestinal Obstruction
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
MECONIUM PLUGS (Lower Colon) & MECONIUM ILEUS (Lower Ileum)
What are (4) Conditions associated with Meconium Plugs (Lower Colon)?
- Small Left Colon in IODM
- Hirschsprung Disease
- Cystic Fibrosis
- Maternal Drug Abuse
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
MECONIUM PLUGS (Lower Colon) & MECONIUM ILEUS (Lower Ileum)
What is (1) Condition associated with Meconium Ileus (Lower Ileum)?
- Cystic Fibrosis
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
MECONIUM PLUGS (Lower Colon) & MECONIUM ILEUS (Lower Ileum)
What is the Best INITIAL Diagnostic Test for both Meconium Plugs (Lower Colon) and Meconium Ileus (Lower Ileum)?
Abdominal X-Ray
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
MECONIUM PLUGS (Lower Colon) & MECONIUM ILEUS (Lower Ileum)
What is the Best Treatment for both Meconium Plugs (Lower Colon) and Meconium Ileus (Lower Ileum)?
Gastrografin Enema
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
“A newborn is born by normal vaginal delivery without complication. There is no respiratory distress. Upon his first feed, he is noted to have prominent drooling; he gags and develops respiratory distress. CXR reveals an infiltrate in the lung.” Which Test will Confirm the Diagnosis?
Nasogastric Tube (NGT) Placement:
- This patient has a Tracheoesophageal Fistula (TEF).
- Classically, there is choking and gagging with the First Feeding and then respiratory distress develops due to Aspiration Pneumonia.
- The feeding tube will be coiled in the chest
- Don’t forget to look for other abnormalities associated with VACTERL Syndrome.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What are the V.A.C.T.E.R.R.L. Abnormalities?
- V ertebral Defects
- A nal Atresia
- C ardiac Abnormalities
- T racheoesophageal Fistula w/ E sophageal Atresia
- R adial Anomalies
- R enal Anomalies
- L imb Syndrome
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What is the Cause of Tracheoesophageal Fistula (TEF)?
Embryological Malformation:
- Division of the Cranial part of the Foregut into the Respiratory and Esophageal parts is Incomplete.
- Occurs at Week 4 of Development.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What are (3) Common Disorders Associated with Duodenal Atresia?
- Premature infant
- Down Syndrome
- Polyhydramnios
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What are the (2) Steps in the Treatment of an infant with Duodenal Atresia?
Nasogastric Decompression
and
Surgical Correction
**You MUST search for other VACTERRL Abnormalities with X-Ray of the Spine, Abdominal US, and Echocardiogram**
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What are the (4) Differential Diagnoses of “Double-Bubble” seen on X-Ray?
- Duodenal Atresia
- Annular Pancreas
- Malrotation
- Volvulus
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
UPPER GASTROINTESTINAL MALFORMATION
What is the Mechanism of Duodenal Atresia?
- During Duodenal development, the Lumen is COMPLETELY Occluded by Epithelium, then is Re-Formed.
- Duodenal Atresia = Failure to Re-Form a Lumen
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
ANNULAR PANCREAS
What is an Annular Pancreas?
- In this condition, the Pancreas surrounds the Second Part of the Duodenum in a ringlike formation and can cause obstruction.
- Annular Pancreas forms when the Ventral Bud does NOT rotate with the Duodenum during the 7th week of gestation. This causes encasing of the Duodenum
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
ANNULAR PANCREAS
What are (3) other Clinical Disorders / Findings Associated with Annular Pancreas?
- Polyhydramnios
- Low Birth Weight (LBW)
- Feeding Intolerance
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
ANNULAR PANCREAS
How do you Diagnose Annular Pancreas?
Abdominal X-Ray
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What are (3) common Presenting Manifestations of Necrotizing Enterocolitis (NEC)?
- Premature Infant
- Low APGAR Scores
- Bloody Stools, Apnea, and Lethargy when feeding is started.
**NEC is a true Medical/Surgical Emergency with 50% Mortality related to ischemia, inflammation of the bowel, and ultimately perforation.**
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What are (2) Signs of Ischemia in Necrotizing Enterocolitis (NEC)?
- Abdominal wall Erythema
- Abdominal Distension
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What is the Greatest Risk Factor for Necrotizing Enterocolitis (NEC)?
Premature Delivery
Another Risk Factor is Formula Feeding
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What is the Best INITIAL Diagnostic Test for Necrotizing Enterocolitis (NEC)?
Abdominal X-Ray
US may also be helpful
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What are (4) Steps included in the Best INITIAL Therapy for Necrotizing Enterocolitis (NEC)?
- Stop ALL Feeds
- Decompress the Gut
- Begin Broad Spectrum Antibiotics
- Evaluate for Surgical Resection
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
NECROTIZING ENTEROCOLITIS (NEC)
What is Pneumatosis Intestinalis?
The Pathognomonic sign of Necrotizing Enterocolitis (NEC) as seen on Abdominal X-Ray:
- Gas Cysts in the Bowel Wall instead of in the Bowel Lumen
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
“A 2-day-old baby boy born via NSVD with APGAR 9,9 has not yet passed meconium. The mother states that the baby has not yet had a bowel movement but has been passing urine frequently. The newborn is taking breast milk without complications.”
What is the NEXT STEP in the Management of this patient?
Rectal Exam
Physical Exam needs to be done on each patient before an imaging test is undertaken.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
HIRSCHSPRUNG DISEASE
What is the Cause of Hirschsprung Disease?
Aganglionic Colon: there are NO nerves in part of the colon.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
HIRSCHSPRUNG DISEASE
- What is the Best INITIAL Test for Hirschsprung Disease?
- What is the Best Initial IMAGING Test for Hirschsprung Disease?
- What is the Most ACCURATE Test for Hirschsprung Disease?
-
Best Initial: Rectal Exam
- After the rectal exam, the patient will pass a large volume of stool.
-
Best Imaging: Barium Enema
- Shows MEGACOLON Proximal to the Obstruction.
-
Most Accurate: Rectal Biopsy
- Shows NO Nerve Cells in the Rectum.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
HIRSCHSPRUNG DISEASE
What is the Treatment for Hirschsprung Disease?
Surgical Removal of the affected portion of the Rectum.
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
IMPERFORATE ANUS
What Clinical Finding may be the result of an Imperforate Anus?
Failure to Pass MECONIUM
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
IMPERFORATE ANUS
What is the Meaning of “Imperforate Anus”?
There is
NO Rectum
GASTROINTESTINAL AND HEPATOBILIARY DISORDERS
IMPERFORATE ANUS
What is the Best INITIAL and Most ACCURATE Test for Imperforate Anus?
Best Initial AND Most Accurate Test is the same:
PHYSICAL EXAM
Will show NO Rectal Opening
