Failure to pass meconium

Question 1

Imperforated anus

Answer 1

Path: VACTERAL
Pt: no hole, maybe fistula
Dx - xray to see where the end of the intenstine is
TX - mild - fix now
severe - initiate colostomy, and reverse later

(need to check for all the below) 
Vetebral anomalies (US sacrum) 
Anus (xray) 
Cardiac (echo) 
TE fistula (catch Xray) 
Eosophageal atresia
Renal  (vioidal cystourethrogram) 
Limb (xray wrist)

Question 2

Meconium ileus (bowel obstruction)

Answer 2

Path: cystic fibrosis
- not enough water in lumen, causes meconium plug and bowel obstrction
Pt: failure to pass meconium (prenatal screen - everyone gets this for cystic) - patient with no prenatal acre
Dx: Xray (show transition point of gas filled plug)
Tx: water enema (daignose, leafve)

F/U - sweat chloride test
vit a,d,k,e
Pancreatic enzymes
pulmonary tarlet

Question 3

Hirrenhburgs

Answer 3

Down syndrome

Path: failure to migrate during embreogensis, failure of nerons to innovate some part of the distal colon
Pt: failure to pass meconium in first 48 horus
-bilious bomit, FTT.
-palpable colon
-explore diahorrea on rectal exam or lack of stool
-or get chronic constiapiton later in life w overflow incontinetnce
Dx - xray - good colon - dilated
Bad - normal (wont relax, no poo)

Dx - 1. contast enema - see transition point (with the good presentaiton)

2. chornic - anal rectal manometery - increased tone and failure to relax
3. best test - biosy see no plexus

Tx - resect bad bowel (2 stage - colectomy)

Question 4

Voluntary holding

Answer 4

pain, embarassemnt, cognitive impairment
PtL oilet training, school get nervouse - volunatry to invovlntayr
-overflow incontenc
Dx - clinical
Tx - bowel regmin - stool softenr, behaviour

Question 5

treatment of constipation

Answer 5

1. polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen as the first-line treatment
2. add a stimulant laxative if Movicol Paediatric Plain does not lead to disimpaction after 2 weeks
3. substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol Paediatric Plain is not tolerated