Neonatal Intestinal Obstruction Flashcards
What is the definition of a neonate?
A child less than 4 weeks (28 days) old.
What is the definition of neonatal intestinal obstruction?
A blockage in the intestinal tract preventing the forward movement of contents, mostly congenital.
What maternal condition is commonly associated with neonatal intestinal obstruction?
Maternal polyhydramnios.
What are common symptoms of neonatal intestinal obstruction?
Feeding intolerance, bilious emesis, abdominal distension, failure to pass meconium.
What is the incidence of neonatal intestinal obstruction?
1 in 2,000 births.
What chromosomal abnormality is duodenal atresia commonly associated with?
Trisomy 21 (Down syndrome) in 30% of cases.
What does VACTERL syndrome stand for?
Vertebral, Anal, Cardiac, Tracheoesophageal, Renal, Limb anomalies.
What is the most common cause of jejunal and ileal atresia?
Vascular accidents during fetal development.
What are the three main mechanisms of neonatal intestinal obstruction?
Intraluminal, extramural, and intramural obstruction.
What is an example of an intraluminal cause of obstruction?
Meconium plug.
What is an example of an extramural cause of obstruction?
Ladd bands, Meckel’s diverticulum, hernias.
What is an example of an intramural cause of obstruction?
Atresia, Hirschsprung disease.
What is the characteristic radiologic sign of duodenal atresia?
Double bubble sign.
What condition presents with difficulty swallowing and gastric vomiting in neonates?
Foregut obstruction.
What condition presents with bilious vomiting and abdominal distension?
Jejunal or ileal obstruction.
What are the three surgical procedures used to treat Hirschsprung disease?
Swenson, Duhamel, and Soave procedures.
What is the most common cause of large bowel obstruction in neonates?
Hirschsprung disease (aganglionic megacolon).
What diagnostic tool is useful for detecting hypertrophic pyloric stenosis?
Ultrasonography.
What is the preferred non-surgical method for treating intussusception?
Air insufflation.
What is the purpose of placing a nasogastric tube in neonatal intestinal obstruction?
To decompress the intestine.
What contrast enema is used for both diagnosis and treatment of meconium ileus?
Gastrografin enema.
What is the primary treatment for duodenal atresia?
Surgical correction.
What is a hallmark feature of colonic obstruction in neonates?
Abdominal distension, feculent emesis, and failure to pass meconium.
What condition presents with failure to pass meconium within 48 hours of birth?
Hirschsprung disease.
What is the standard initial management for neonatal intestinal obstruction?
Admission, NG decompression, IV fluids, antibiotics, and respiratory/cardiac support.
What type of biopsy is used for diagnosing Hirschsprung disease?
Rectal suction biopsy or full-thickness biopsy.
What is the treatment for an imperforate anus?
Surgical incision and repair.
What is the significance of a ‘double bubble’ sign on X-ray?
Suggests duodenal atresia.
Which diagnostic imaging modality is most useful for malrotation with volvulus?
Upper GI series.
What is the first-line imaging study for neonatal bowel obstruction?
Plain abdominal X-ray.
Which condition involves the failure of neural crest cells to migrate to the colon?
Hirschsprung disease.
What is the most common cause of lower gastrointestinal obstruction in neonates?
Hirschsprung disease.
What condition is characterized by delayed passage of meconium and chronic constipation?
Hirschsprung disease.
What is the treatment of choice for jejunal atresia?
Surgical relief of the obstruction.
What is the prognosis for uncomplicated neonatal intestinal obstruction?
Generally good.
What is the best initial step in managing meconium ileus?
Gastrografin enema.
What can cause a closed-loop obstruction in neonates?
Volvulus or strangulated hernia.
What does a ‘soap bubble’ appearance on X-ray suggest?
Meconium ileus.
What percentage of neonates with intussusception respond to air insufflation?
0.83
What condition is characterized by ‘currant jelly’ stools?
Intussusception.
What is the most common location for neonatal small bowel atresia?
Jejunum and ileum.
What is a key sign of an esophageal atresia with tracheoesophageal fistula?
Excessive drooling and respiratory distress.
What syndrome is commonly associated with anal atresia?
VACTERL syndrome.
What causes a meconium plug syndrome?
Functional immaturity of the colon.
What surgical procedure is used for Hirschsprung disease before definitive pull-through?
Temporary colostomy.
What is the most common surgical emergency in neonates?
Intestinal obstruction.
What is the mortality risk of untreated neonatal intestinal obstruction?
High due to sepsis and shock.
Which surgical technique for Hirschsprung disease preserves normal bowel function best?
Swenson procedure.
What is the preferred surgical approach for duodenal atresia?
Duodenoduodenostomy.
Why are multiple enemas sometimes needed for meconium ileus?
To loosen thick meconium with detergent-like effects.
