GI Flashcards
Most common type of tracheo esophageal fistula
Esophageal atresia with fistula between trachea and distal esophagus( Type 1a and 3 depending on classifn system)
Reason for enlarged gastric bubble in TEF
Fistula between trachea and distal esophagus leading to air entering stomach (not usually seen in types 1b and 1e)
Syndrome associated with TEF
VACTERL
Verterbal
Ano-rectal malformations
Cardiac abnormalities
Tracheo
Esophageal fistula
Renal, Radial aplasia
Limb
Investigation of choice for TEF
Flexible bronchoscopy looking
- presence of fistula to proximal segment
- presence of fistula to distal segment
Incision for TEF
4th of 5th intercostal space
Steps for TEF ligation and repair
Isolate azygos vein
Interrupted sutures
1. Posterior first
2. Then anterior
Check whether NGT is able to pass thru patent repair
- on POD5 inject dye to check for leak and whether feeds can be started
Place chest tube to drain saliva leak
Monitor in NICU
What does double bubble sign with absent distal colonic and rectal suggest
Duodenal atresia or annular pancreas
Part of pregnancy duodenal atresia usually occurs
1st trimester: Failure of recanalization
Windsock appearance suggests?
Duodenal webs/intraluminal duodenal diverticulum
syndrome associated with duodenal atresia
T21
Suspicion in newborn with NBNB projectile vomiting
Hypertrophic pyloric stenosis
First steps for newly diagnosed duodenal atresia
- Order TTE tro cardiac abnormalities
- Drip and suck the neonate
Direction umbilical vein catheter usually goes in
Superiorly
Why duodenal atresia usually p/w bilious vomiting
Usually distal to ampulla of vater
How duodeno-duodenostomy is usually performed for duodenal atresia
side to side anastomosis b/w D1 and D3, D2 often too atretic
Radiological invx to confirm small bowel atresia
Barium enema
Barium follow through would be too dilated
Most common types of duodenal atresia and the etiology
Type 1 and 3a, usually due to vascular accident/ischemia
Part of pregnancy where jejunal and ileal atresia tend to occur
2nd and 3rd trimester due to ischemia
Risk factor for short gut syndrome
DJ flexure to ileocecal valve <60cm
Options for jejunal and ileal atresia mx
- Stoma
- Bowel resection
How suction rectal biopsy is done
3 biopsys starting 3cm from rectum, 3cm apart
Mx of hirschsprung
Non surgical: rectal washout 2-3x a day
Surgical
1) Transverse colon colostomy as temporizing
2) Definitive is pull through eg Duhamel, Swensen
Invx for hirschsprungs disease
- Suction rectal biopsy to confirm diagnosis
- Barium enema to delineate anatomical segment
- XR to look for dilated bowel segments
What to check for intraop in Pull through
intraop frozen section to check for ganglion cells present at dentate line via pull through
Common cx of anorectal malformations in boys
Fistula to genito urinary system
- check intra op if present, needs to be ligated
Reason for double barrel stoma with division in ARM for boys
Reduce entry of fecal output into distal segment that may cause UTIs/ fecaluria
Mx of Ano rectal malformations
LAARP/PSARP
Laparoscopic/ Posterior sagittal AnoRecto Plasty
Side of umbilical cord that gastroschisis usually comes out of
Almost always on the right side of the umbilical cord
Syndromes predisposing to omphalocele/exomphalos
T13,18,21 edwards patau downs
Beckwith Wiedemann syndrome
Temporizing measure for closing large omphalocele
A silo sutured to the skin to help reduce heat and fluid loss
Common organs involved in omphalocele
Stomach, small intestine, liver and spleen
How to monitor for excessive intra abdominal pressure when replacing an omphalocele
- Intra vesical pressure management
- Looking for desaturation
Types of congenital diaphragmatic hernia
- 80% bochdalek foramen left posterolateral
- 10% right sided
- 5% morgagni foramen anterior
Cx of Congenital diaphragmatic hernia
- Pulmonary hypotension
- Pulmonary hypoplasia
3.
Acute medical Mx of CDH
Intubation and ventilatory support
1.High frequency oxygen ventilation
2. Nitric oxide to help with pulmonary vasodilation
3. extra corporeal membrane oxygenation for severe cases
Signs and Sx of Hypertrophic Pyloric stenosis
Sx
1. NBNB projectile vomiting
Signs
1. Olive shaped mass at the LUQ
Invx for Hypertrophic Pyloric Stenosis
Biochemical
1. RP for electrolytes hypokalemia hypochloremia, low bicarb, BE less than -2
2. ABG for metabolic acidosis
3. Urine for paradoxical aciduria
Imaging
1. Transabdominal US
US finding for Hypertrophic Pyloric Stenosis
Hypertrophied muscles around pylorus
Can include Dynamic study
Mx of hypertrophic pyloric stenosis
Pyloromyotomy( open vs lap vs transumbilical)
- Split pyloric muscles without entering the lumen
trial of feeds 4hrs after
Barium enema findings for Hirschsprungs disease
- Transition zone with funneling
- Reversal of rectosigmoid ratio
Sign of HAEC
Hirschsprung associated enterocolitis
Sawtooth appearance from mucosal edema
Age group where intussusception is common
6 months to 6 years
Most common cause of intussuception
Infection causing hypertrophy of Peyer Patches or lymphadenitis
First line management of intussusception
Air enema
What to consent for in open reduction of intussusception
Appendicectomy so RUQ pain won’t lead to diagnostic dilemma
Possible pathological lead points to expect in patients outside of 6m to 6y
- Meckel
- Polyps
- Hamartoma
- Masses eg lymphoma, GIST
- IgA Vasculitis/HSP
Number of air enema reductions before converting to open reduction
3-4 attempts with high pressures not >120mmHg
Mx of intuss with suspected pathological lead point
Open reduction with exploration
Mx of indirect inguinal hernia in neonate/infant
Surgical herniotomy due to high risk of cx( incarceration, obstruction, strangulation and perforation)
Age where hydrocele is
Radiological signs of Hirschsprungs
- Transition point
- Mosaic colonic pattern
