Intestinal Obstruction

Question 1

In which group of population do we commonly see duodenal atresia?

Answer 1

Triosomy 21

Question 2

What is the common clinical presentation of duodenal atresia?

Answer 2

Billous vomitting without abdominal distension

Question 3

What is the key radiological feature of duodenal atresia?

Answer 3

Double bubble sign

Question 4

If you see double bubble sign, and you find gas distally in the rectum, what would be your differential?

Answer 4

Stenosis instead of atresia

Question 5

What is the non-operative management of duodenal atresia?

Answer 5

NPO, NGT, IVF.

Question 6

What are the other abnormalities that are commonly seen with duodenal atresia?

Answer 6

Congenital heart defect - kidney - anorectal malformation.

Question 7

What is the surgery of choice for duodenal atresia?

Answer 7

Duodeno-duodenostomy

Diamond shaped anastomosis

Question 8

What are the alternatives for duodeno-duodenostomy?

Answer 8

Duodeno-jejunostomy
Side to side duodeno-duodenostomy
Tapering duosenoplasty

Question 9

Triple bubble in x-ray abdomen appearance indicate the presence of

Answer 9

Jejunoileal atresia

Question 10

What is the characteristic signs of jujenoileal atresia?

Answer 10

Passage of gray plugs of mucus in the rectum + villous vomitting + jaundice + abdominal distension

Question 11

Differentiate between bowel distention in duodenal atresia and in meconium ileus

Answer 11

Meconium ileus occur before even swalloing air.

Question 12

What is a risk factor for jejunoileal atresia?

Answer 12

Polyhydraminos

Question 13

What are the types of jejunoileal atresia?

Answer 13

1- stenosis 
2- type 1 
2- type 2
3- type 3a
4- type 3b 
5- type 4

Question 14

Describe the lesion in type 1 jejunoileal atresia?

Answer 14

Bowel is in continuity, but membrane is causing the obstruction

Question 15

Describe the lesion in type 2 jejunoileal atresia?

Answer 15

Intact mesentry + bowel connected by fibrous band

Question 16

Describe the lesion in type 3a jejunoileal atresia?

Answer 16

V shape mesentry

Question 17

What makes type 3b difficult to manage?

Answer 17

Because it’s supplied by one single artery

Question 18

What could be a complication of treating jejunoileal atresia?

Answer 18

Short bowel syndrome

Question 19

Where do we see the apple core appearance sign?

Answer 19

In type 3b jejunoileal atresia

Question 20

Describe the lesion in type 4 jejunoileal atresia?

Answer 20

Sausage like lesion

Question 21

How does meconium ileus usually present

Answer 21

• distension
• visible loops
• doughy abdomen
• maternal polyhydaminos

Question 22

When you diagnose meconium ileus in patient, your must test for:

Answer 22

Cystic fibrosis

Question 23

What is the pathophysiology of meconium ileus?

Answer 23

Dysfunction in exocrine-eccrine function.

Loss production of mucus and meconium clogs the bowel.

Question 24

In which disease do you expect to see soap bubble appearance?

Answer 24

In meconium ileus

Question 25

What are the radiological signs to see in meconium ileus?

Answer 25

- thickening - disparity in the diameter of bowel. [some dilated some are collapsed] - ground glass\soap bubble appearance

Question 26

Meconium ileus develops in;

Answer 26

Intrauterine.

Question 27

What is the role of contrast enema in meconium ileus?

Answer 27

Both diagnostic (can rule out atresia) and theraputic.

Question 28

What special precautions should be taken in meconium ileus?

Answer 28

- cover w\Ab to prevent translocated bacteria - hydrate patient - ensure that there’s an attending surgeon to operate in case of perforations

Question 29

How do they do the procedure of contrast enema in meconium ileus?

Answer 29

1- insert catheter from rectum then inject enema. 2- inject N-acetylcystine to dissolve meconium 3- place it for 1-3 days in irregate

Question 30

Treatment in Meconium Ileus in usually:

Answer 30

Non-operative Gastrografin (isotonic water-soluble contrast enema) & 1% N-acetylecysteine

Question 31

Define Meconium Plug Syndrome

Answer 31

Failure to pass meconium with first 24 hours, Maternal gestational diabetes:

Question 32

Treatment of Meconium Plug Syndrome:

Answer 32

Non-operative Contrast enema is diagnostic and therapeutic

Question 33

Non-bilious projectile vomiting and epigastric mass (olive sign):

Answer 33

Hypertrophic Pyloric Stenosis

Question 34

Hypertrophic Pyloric Stenosis sign in imaging

Answer 34

string sign” or “double railroad track sign”:

Question 35

hallmark metabolic derangement in Hypertrophic Pyloric Stenosis:

Answer 35

- Hypochloremic - Hypokalemic - Metabolic alkalosis

Question 36

Treatment of Hypertrophic Pyloric Stenosis:

Answer 36

Fredet–Ramstedt pyloromyotomy (without entering the lumen/mucosa)

Question 37

How does intussecption usually present?

Answer 37

Crampy, sever, intermittent abdominal pain last for 1-2min with 5-10min intervals:

Question 38

Describe stool in intussecption

Answer 38

Red current jelly stool

Question 39

Most common site of intussusception:

Answer 39

Ileocecal valve

Question 40

What is dance’s sign

Answer 40

RLQ mass on plain abdominal film, empty RLQ on palpation

Question 41

Treatment of intussusception:

Answer 41

Air or barium enema; 85% reduce with hydrostatic pressure

Question 42

Bilious vomiting in infant considered as a .......... until proven otherwise:

Answer 42

Malrotation ( volvulus )

Question 43

Procedure done for malrotation (name)

Answer 43

Ladd’s procedure