PEDIATRIC Section 7: Luminal GI (Bowel Obstruction in an Older Child)) Flashcards
Think about this when you talk about Obstruction in an OLDER child
AA-II-MM
Most common cause of bowel obstruction in children >4y.o.
Appendicities
What kind of hernia is common in kids?
Indirect hernias
Describe indirect hernias
lateral to the inferior epigastric,
What is the most common complication of Indirect hernias?
Incarceration
The most common obstruction in 1 month-1 year
Age range in Intussusception
90% between 3 months and 3 years don’t have lead points)
What is the normal mechanism of Intussusception?
forward peristalsis resulting in invagination of proximal bowel (the intussusceptum) into lumen of the distal bowel (the intussuscipiens).
Intussusception size?
They have to be bigger than 2.5 cm to matter (in most cases- these are enterocolic), those that are less than 2.0 cm are usually small bowel-small bowel and may reduce spontaneously within minutes.
Diagnosis? Sign?
What is the other sign?
Intussusception
Target Sign
Other sign: Kidney sign
Contraindications of Reducing Intussusception
Contraindications:
Free Air (check plain film)
Peritonitis (based on exam)
Recurrence in reducing intussusception happens after?
72 hours
Pressure in Reducing intussusception should NOT exceed ___ mmHg?
ressure should NOT exceed 120 mmHg
what shoud be the next step step if they perforate and get tension pneumoperitoneum in Intussusception reduction?
Needle decompression
this is a congenital diverticulum in the distal ileum
Meckels Diverticulum
it is a persistent piece of the omphalomesenteric duct.
Meckels Diverticulum
Remember this rule when you talk about Meckels Diverticulum
Rule of 2s
2% of teh population
2 types of heterotopic mucosa (gastric and pancreatic)
2 feet from the IleoCecal valve
2 inches LONG
2 cm in DIAMETER
Symptims before the child is 2
If Meckels Diverticulum has gastric mucosa (the ones that bleed typically do), What should be seen?
it will take up Tc-Pertechnetate just like the stomach (hence the Meckel’s scan).
What are the complications of Meckels?
- Can get diverticulitis in the Meckels (mimic appendicitis)
- GI Bleed from Gastric Mucosa (causes 30% of symptomatic cases)
- Can be a lead point for intussusception (seen with inverted diverticulum)
- Can Cause Obstruction
Diagnosis?
Meckels Diverticulum
