embryology- GI embryology-Tracheoesophageal anomalies -Congenital pyloric stenosis-Pancreas and spleen embryology Flashcards
A patient has a malformed gastrointestinal tract from pharynx to duodenum. What part of the embryo had impaired development?
Foregut
In a patient with a hiatal hernia, the herniated structure was originally derived from the ____ (foregut/midgut/hindgut).
Foregut (herniation of the proximal stomach through the diaphragm)
A developing embryo suffers a malfunction of the midgut. Which region of the gastrointestinal tract will be impacted?
Duodenum to the transverse colon
The part of the colon supplied by both the hepatic and splenic flexures is derived from the ____ (foregut/midgut/hindgut).
Midgut (the transverse colon is supplied by both the hepatic and splenic flexures)
A developing embryo suffers damage to the hindgut. As an adult, what structures of the GI tract will be affected?
The distal transverse colon to the rectum
A patient with ulcerative colitis always has involvement of this GI structure, which derives from the ____ (foregut/midgut/hindgut).
Hindgut (UC always affects the rectum and may affect more proximal regions)
An extrusion of abdominal contents not covered by the peritoneum is found on a newborn undergoing surgery. Name this diagnosis.
Gastroschisis (failure of the lateral body folds to fuse)
A baby with bladder exstrophy presents to the clinic. What type of folds failed to close properly during embryologic development?
Caudal folds
A baby presents with sternal defects. Failure of what type of folds to close properly caused this clinical scenario?
Rostral folds
An extrusion of abdominal contents into the umbilical cord is covered by the peritoneum on a newborn having surgery. Name this diagnosis.
Omphalocele (sealed by peritoneum)
In the sixth week, the midgut herniates through this structure, then returns to the abdominal cavity (week 10) and rotates around the SMA.
Umbilical ring
A newborn presents with severe abdominal distention. Around which artery is the baby’s midgut malrotated?
Superior mesenteric artery
A baby is born with trisomy 21 and diagnosed with duodenal atresia. How would you explain this GI tract malformation to the parents?
Failure of the duodenum to recanalize
An infant fails to pass meconium at birth. X-ray shows apple-peel atresia of the lower GI tract. What most likely happened in utero?
Vascular accident causing jejunal, ileal, and colonic atresia (characteristic apple-peel atresia on x-ray)
What is the most common subtype of tracheoesophageal fistula?
Esophageal atresia (a blind-pouch upper esophagus with the lower esophagus connected to the trachea)
What are some symptoms seen with the most common subtype of tracheoesophageal fistula?
Cyanosis, choking, and vomiting with feeding, air bubble on x-ray of the chest (or polyhydramnios, if still in utero)
A patient’s CXR shows an airway stricture. He is drooling excessively. How do you confirm your suspected diagnosis?
Attempt to pass a nasogastric tube (in a tracheoesophageal fistula, the tube will not reach the stomach)
A newborn chokes and vomits with the first feeding, and she reportedly had polyhydramnios in utero. Why might this baby become cyanotic?
The newborn may develop cyanosis from laryngospasm (to avoid reflux-related aspiration) (this is a tracheoesophageal fistula)
A baby with esophageal atresia has a chest x-ray revealing a gasless abdomen. What type of esophageal atresia is this?
Pure atresia
In a patient with congenital pyloric stenosis, hypertrophy of the pylorus leads to what problem?
Gastric outlet obstruction
An infant with projectile vomiting is found to have a palpable, epigastric, olive-sized mass is found on physical exam. Name this condition
Congenital pyloric stenosis
In a baby with suspected congenital pyloric stenosis, what type of vomit would rule out the disorder?
Bilious (bilious vomit originates distal to the pyloric sphincter)
The mother of a newborn says her previous child had developed projectile vomiting. When would this most likely occur in this newborn?
2 weeks of age
A 3-week-old baby has projectile nonbilious vomiting and a normal physical exam. What treatment will likely be indicated?
Surgical pyloromyotomy (with pyloric stenosis, the classic “olive mass” is often not palpable
