Failure to Pass Meconium Flashcards
first question to think about when trying to dx slow moving colon?
what age is pt?
FTPM
failure to pass meconium in 48 hours
- most kids pass by 24 hrs
FTPM dx
- any upper obstruction (think bilious emesis)
- imperforate anus
- meconium ileus
- hirschbrung’s
constipation ddx
voluntary holding
hirschbrung’s
medication problems
diet
imperforate anus patho
part of VACTERL
- no anal opening
may be stooling via fistula
imperforate anus dx
cross table xray
tx imperforate anus
mild: fix now surgery
severe: wait for baby to get bigger, place colostomy now, surg later
imperforate anus f/u
VACTERAL
- vertebral anomalies
- imperforate anus
- cardiac issue
- tracheoesophageal fistula
- renal
- limb
- U/S sacrum
- xray anus
- echocardiogram
- catheter with xray
- voiding cug
- xray wrist
** must be done prior to imperforate anus surg
meconium ileus aka
CF
meconium ileus sx
FTPM
- know CF from screen
- or pt w/o screen
meconium ileum dx
xray: transition gas filled plug
meconium ileus tx
water enema
f/u meconium ileus
sweat cholride test confirm
- give DEAK vitamins
- pancreatic enzymes
- pulmonary toliet test
hirschbrung’s patho
- failure of migration of inhibitory neurons for relaxation in auerbach and meisner plexus do not descend fully to innervate colon
- distal colon not innervated innervated
hirschbrung sx
FTPM within 48 hrs
palpable colon
explosive diarrhea on rectal exam
10% have chronic diarrhea, overflow incontinence