Neonatal Intestinal Obstruction Flashcards
What is the onset, association and clinical picture of CHPS (Congenital hypertrophic pyloric stenosis)?
Onset: 3-6 weeks
Associations:
-M>F
-Familial
-Erythromycin and azithromycin in the first 14 days
Clinical picture:
-Symptoms: Forceful, projectile, Non-bilious vomiting
-Signs: Olive sign
What are the investigations and treatment of CHPS?
Investigations:
1-US: Thickness>4mm, Length>14mm
2-Barium meal
3-Hypocalcemic, hypochloremic metabolic alkalosis
Treatment: Ramstad’s Pyloromyotomy
What are the onset, associations and clinical picture of Duodenal Atresia?
(It is most commonly in the 2nd part of the duodenum)
Onset: 1st day
Associations:
-Down syndrome
-Cardiac anomalies
-Annular pancreas
-Malrotation
Clinical picture:
-Billious vomiting
-Electrolytes imbalance
What are the investigations and treatment of Duodenal atresia?
Investigations:
-X-ray: Double bubble sign
-Barium meal
Treatment: Duodenoduodenostomy
What are the onset, associations and clinical picture of meconium ileus?
Onset: 2 days
Associations: Cystic fibrosis
Clinical picture: Thick sticky meconium then IO
What are the investigations and treatment of meconium ileus?
Investigations:
-x-ray: soup bubbles
-Barium enema: micro colon
-Sweat chloride test
Treatment:
-Non-Surgical: gastrografin and acetylcysteine in rule or enema
-Surgical: ileostomy
What are the onset, associations and clinical picture of Hirschsprung disease?
Onset: neonates or any age
Associations:
-M>F
-Down syndrome
Clinical picture:
-Delayed passage of meconium
-constipation
-gush of stool with PR
What are the investigations and treatment of Hirschsprung disease?
Investigations:
-X-Ray: IO
-Barium enema: Macro-colon
-Rectal biopsy: (diagnostic)
1-2cm above the dentate line
2-hypertrophied nerve terminals and no ganglions
-Anorectal manometry
Treatment:
Operation, resection of a-ganglionic segment and anastomosis
