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pediatric surgery umf > digestive > Flashcards

digestive Flashcards

1
Q

what is duodenal atresia

A

a malformation of the duodenum ( due to failure of recanalisation) that prevents bolus from leaving the stomach. It is associated with down’s syndrome

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2
Q

What are the categories of duodenal atresia

A 
Type 1 (most common): A mucosal web or diaphragm obstructs the duodenal lumen, causing proximal dilatation
Type 2: The proximal and distal segments of the duodenum are connected by an atretic cord.
Type 3: The proximal and distal segments of the duodenum are completely separated.
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3
Q

Clinical signs and symptoms of duodenal atresia

A
  • Abundance of bilious vomiting occurs in the first 24-36 hours after delivery.
  • Abdominal distention
  • absence of bowel movements
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4
Q

Diagnosis of duodenal atresia

A

Prenatal ultrasound: Polyhydramnios

Xray: Double bubble ( absence of gas in remaining bowel)

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5
Q

Treatment of duodenal atresia

A

Parenteral nutrition
Gastric decompression
duodenoduodenostomy

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6
Q

What is colonic atresia

A

A type of intestinal atresia, which involves blocked or missing sections anywhere along the large intestine

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7
Q

What causes colonic atresia

A

Decrease in the blood flow to the large intestine:

Invagination, volvulus, intestinal hernia, laparoschisis

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8
Q

Anatomical classification of colonic atresia

A

Type 1- membranous atresia( bowel lumen connected with membrane)
Type 2 - The bowel is discontinuous, with portions connected by a fibrous cord
Type 3 - The bowel ends are completely separated, and the mesentery has a gap

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9
Q

Diagnosis of colonic atresia

A
  • Vomiting: late after delivery (around 24 hours)
  • Impressive abdominal distention
  • Meconium is not eliminated
  • Invertography, US: polyhydramnios, dilated bowel loops
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10
Q

Treatment of colonic atresia

A

Proximal dilated part resected and anastomosed with healthy portion of bowel

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11
Q

What is volvulus

A

Intestine and mesentery rotates around itself cutting off its blood supply

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12
Q

What are the symptoms of volvulus

A 
bilious vomiting
severe abdominal pain
abdominal distention
bloody stools
septic shock
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13
Q

What is the treatment for acute volvulus

A

Untwist the intestine, and attach it to the abdominal wall to prevent from twisting again.
resection of infarcted parts

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14
Q

What is Hirschsprung disease

A

There is an absence of parasympathetic ganglion cells in the rectum, and sometimes also in the colon. results in a constantly constricted section of bowel which causes a functional obstruction when the child is born

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15
Q

symptoms of Hirschsprung disease in newborn

A

Failure to pass meconium within 48 hours of birth
Abdominal distension
Vomiting – may include bile staining
Rectal examination- may be watery stool

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16
Q

symptoms of Hirschsprung’s Enterocolitis

A 
bloody diarrhea, 
abdominal distension, 
pain, 
fever, 
foul smelling stools 
 vomiting.
17
Q

Symptoms of Hirschsprung in older children

A 
Chronic constipation 
Failure to thrive
Abdominal distension
Early satiety
Flared thoracic cage
18
Q

Diagnosis of Hirschsprung(excluding history)

A

DRE- Empty ampulla
Abdominal palpation- depressible masses like butter
Abdominal Xray- dilated bowel loops
Barium Enema - funnel shape ( narrowing of rectum)
rectal biopsy-Absence of ganglion cells in the myenteric plexus, Presence of Ach positive nerve trunks

19
Q

Differential diagnosis of Hirschsprung in newborns

A
  • Acute enterocolitis-
  • Meconium plug syndrome-
  • Meconium ileus:
  • Syndrome of intestinal motility troubles
20
Q

Differential diagnosis of Hirschsprung in children

A
  • Chronic constipation (idiopathic megacolon)
  • tumour in the space between rectum and sacrum
  • Neuronal intestinal dysplasia:
  • anal stenosis(acquired/congenital) can cause an obstruction in evacuating feces
21
Q

Treatment of Hirschsprung

A

Colonic enema- 3-4/d, insert salt solution through tube
Colostomy- if enterocolitis
radical treatment- resection of affected area without ganglions,. 3 techniques, swenson ( most popular) Duhamel, stove

22
Q

Define anorectal malformation

A

Abnormal opening of anus and rectum

23
Q

What are the types of anorectal defects in males

A
  • Perineal fistula
  • Recto-urethral fistula (bulbar, prostate)
  • Recto-vesicular fistula (bladder neck)
  • Anal imperforation without fistulas
  • Rectal atresia
24
Q

What are the types of anorectal defects in females

A
  • Perineal fistula
  • Vestibular fistula
  • Anal imperforation without fistula
  • Rectal atresia
  • Cloaca
  • Complex malformations
25
Q

define rectoperineal fistula in male

A

Fistula does not open into the perineum but in the scrotum, base of penis , midline perineal raphe

26
Q

what is rectal urethral fistula in male

A

fistula located at bulbar or prostatic part of urethra

infant may pass meconium through urethra

27
Q

what is rectovestibular fistula

A

3rd opening in vestibule ( where there’s vaginal and urethral opening)

28
Q

What is cloacal malformation

A

Rectum, vagina and urethra fuse to create a single opening in the perineum

29
Q

What are the associated ano rectal malformations

A 
VACTERL
vertebral defect
anal atresia
cardiac
Tracheo-eophageal fistula
Renal abnormality
Limb abnormality
30
Q

diagnosis of anorectal malformation

A 
perineal inspection
>24 hours for meconium to pass, meconium comes from a different place 
VACTERL screening:
Spinal and sacral radiographs
MRI spine
Spinal ultrasound
ECHO
NG tube and abdominal xray
Renal US
Limb xray
31
Q

Treatment of anorectal malformation

A

First 24-48 h : i.v fluids, antibiotics, decompression ( pressure needed for poo to be pushed out and xray are not correct)
After months , colostomy
After 1-3 months posterior sagittal anorectoplasty(psarp) surgeon will create a new anus and then separate the bowel from the fistula and bring it down to join the newly created anus

32
Q

How to treat cloaca

A

Colostomy

vaginostomy

pediatric surgery umf (5 decks)

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