17-1 -- Congenital Anomalies Flashcards
Many organs develop simultaneously, thus if there is a GI anomaly it should prompt?
Evaluation of other organs
Atresia
Incomplete development
– Anus most common
Esophageal Atresia involves the esophagus not fully developing. What will it create anatomically and cause?
- Creates a thin, noncanalized cord
= Mechanical obstruction
Fistulas between the esophagus and trachea are common because they both develop from the foregut. What other defects will those with TE fistulas present with?
Cardiac defects
Esophageal Stenosis
Lumen of the esophagus is decreased due to fibrous wall thickening
Possible symptoms of Esophageal Stenosis?
Partial or complete obstruction
How does a Diaphragmatic Hernia develop?
Incomplete formation of the diaphragm allows the abdominal viscera to herniate up into the thoracic cavity
Diaphragmatic Hernias usually develop on which side?
Left side
What main sign will be seen with Diaphragmatic Hernias?
Pulmonary Hypoplasia
Omphalocele and Gastroschisis both involve herniation which direction?
Ventrally
Omphalocele
Abdominal viscera and liver covered by amnion and peritoneum
Gastroschisis
ALL layers of abdominal wall herniate
- usually intestine
Abdominal viscera and liver fail to return to abdominal cavity – covered by amnion and peritoneum
Omphalocele
ALL layers of abdominal wall herniate ventrally
Gastroschisis
Gastroschisis is usually an ____ defect
Isolated
Most common GI ectopic tissue issue?
Gastric mucosa in upper 1/3 of esophagus
What can ectopic gastric mucosa cause in the upper esophagus?
Acid secretion
= GERD, dysphagia, Barrett’s Esophagus, Adenocarcinoma
What can ectopic pancreatic tissue cause?
Damage and inflammation
What can mimic invasive cancer?
Ectopic tissues
Meckel Diverticulum
Blind outpouching of GI tract that communicates with lumen and all 3 bowel wall layers
Most common site of Meckel Diverticulum?
Ileum
- Blind outpouching of GI tract that communicates with lumen
What causes a Meckel Diverticulum?
Failed involution of vitelline duct
Rule of 2’s is seen with?
Meckel Diverticulum = Symptoms at 2 years old, 2X more males, 2 feet above ileocecal junction 2 inches long 2% of population
Rule of 2’s
- Symptoms at 2 years old
- 2X more common in males
- Within 2 feet of ileocecal junction
- 2 inches long
- 2% of population
= Meckel Diverticulum
What is often seen with Meckel Diverticulum?
Ectopic gastric or pancreatic tissue
Symptoms of Meckel Diverticulum?
Peptic ulcers, bleeding, pain
Pyloric Stenosis
Narrowing/hyperplasia of pylorus
= Food cannot leave stomach easily
Risk factors for Pyloric Stenosis?
- Males, Monozygotic twins, Turner syndrome (45XO), Trisomy 18
- Exposure to erythromycin or azithromycin after birth
Symptoms of Pyloric stenosis usually present when?
3-6 weeks of life
Symptoms of Pyloric Stenosis?
- Regurgitation, projectile non-bilious vomiting
- Demanding re-feeding
- Firm, ovoid abdominal mass
- Abnormal left to right peristalsis before vomiting
Symptoms of Pyloric Stenosis?
- Regurgitation, projectile non-bilious vomiting
- Demanding re-feeding
- Firm, ovoid abdominal mass
- Abnormal left to right peristalsis before vomiting
Describe how Hirschsprung Disease arises
- NCC migration from cecum to rectum arrested prematurely
- Distal intestinal segment lacks Meissner Submucosal Plexus AND Auerbach Myenteric Plexus
= NO peristaltic contractions, (+) obstruction, Proximal dilation
Hirschsprung Disease arises due to?
NCC migration from cecum to rectum arrested prematurely
= Aganglionosis
With Hirschsprung Disease, what is always affected?
Rectum
With Hirschsprung Disease, what innervations is the affected segment missing?
- Meissner Submucosal Plexus
2. Auerbach Myenteric Plexus
Symptoms of Hirschsprung Disease?
NO peristaltic contractions
(+) for obstruction
= Proximal DILATION of bowel
What loss of function mutations are seen with Hirschsprung Disease sometimes?
Mutations in Receptor Tyrosine Kinase, RET
- EDN
Hirschsprung Disease has an association with?
Down Syndrome
How does Hirschsprung Disease affected males/females?
Males more commonly affected
Females aganglionic segment is longer
With Hirschsprung Disease, what is always affected?
Rectum