Failure to Pass Meconium Flashcards

1
Q

first question to think about when trying to dx slow moving colon?

A

what age is pt?

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2
Q

FTPM

A

failure to pass meconium in 48 hours

  • most kids pass by 24 hrs
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3
Q

FTPM dx

A
  • any upper obstruction (think bilious emesis)
  • imperforate anus
  • meconium ileus
  • hirschbrung’s
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4
Q

constipation ddx

A

voluntary holding
hirschbrung’s
medication problems
diet

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5
Q

imperforate anus patho

A

part of VACTERL
- no anal opening
may be stooling via fistula

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6
Q

imperforate anus dx

A

cross table xray

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7
Q

tx imperforate anus

A

mild: fix now surgery
severe: wait for baby to get bigger, place colostomy now, surg later

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8
Q

imperforate anus f/u

A

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

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9
Q

meconium ileus aka

A

CF

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10
Q

meconium ileus sx

A

FTPM

  • know CF from screen
  • or pt w/o screen
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11
Q

meconium ileum dx

A

xray: transition gas filled plug

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12
Q

meconium ileus tx

A

water enema

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13
Q

f/u meconium ileus

A

sweat cholride test confirm

  • give DEAK vitamins
  • pancreatic enzymes
  • pulmonary toliet test
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14
Q

hirschbrung’s patho

A
  • 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
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15
Q

hirschbrung sx

A

FTPM within 48 hrs
palpable colon
explosive diarrhea on rectal exam

10% have chronic diarrhea, overflow incontinence

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16
Q

hirshbrungs dx

A

xray: good colon = dilated, bad colon looks normal

90% will go for contrast enema look for transition pt

10% do anorectal mamometry which will show increased tone

best test: bx

17
Q

hirschbrungs tx

A

surgically resect bad colon (remove part that looks normal)

18
Q

voluntary holding why?

A

pain, embarrassment, cognitive impairment

19
Q

two main times holding shows up

A

toliet training
going to school

voluntary can turn into involuntary

see: overflow incontinence

20
Q

encopresis

A

overflow incontinence

severe constipation

21
Q

dx voluntary holding

A

clinical

22
Q

voluntary holding tx

A

bowel regimen
behavior

rare: disimpact (anesthesia for kid)