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Surgery M4 part 2 > Pediatrics 3 > Flashcards

Pediatrics 3 Flashcards

1
Q

What are the types of neonatal obstruction?

A

DYNAMIC

  • meconium ileus
  • meconium plug
  • congenital atresia
  • Hirschsprung’s disease
  • imperforate anus
  • volvulus neonatorum
  • intussusception

ADYNAMIC
- necrotizing enterocolitis

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2
Q

How does neonatal intestinal obstruction present?

A
  • recurrent vomiting & dehydration
  • absolute constipation
  • abdominal distention
  • crying and flexion of hip (colicky abdominal pain)
  • sepsis, & shock
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3
Q

What are the signs of neonatal intestinal obstruction?

A
  • dehydration, sepsis, & shock
  • distention, visible peristalsis, hernia, imperforate anus
  • tenderness, rigidity, palpable abdominal mass
  • hyper resonance
  • hyper audible intestinal sounds or dead silent abdomen
  • empty rectum, bleeding, grips on examining finger
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4
Q

What investigations are done to diagnose intestinal obstruction?

A

PLAIN X-RAY -> more than 3 fluid levels
pelvi-abdominal US & CT
exclude VACTERL

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5
Q

What is meconium ileus associated with?

A

cystic fibrosis

  • characterized by viscous secretions affecting more than just the intestine
  • manifests occur within -> 24-48hrs after birth
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6
Q

How can u diagnose meconium ileus?

A

X-ray -> dilated bowel with absent air fluid levels

Gastrografin enema -> most diagnostic & therapeutic

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7
Q

How should meconium ileus be treated?

A

1) contrast enema to dissolve & wash out meconium
2) enterostomy with irrigation with N-acetyl cysteine
3) exploration if perforated

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8
Q

What is the cause of Meconium plug syndrome?

A
  • occurs in relation to Hirschsprung’s disease

- contrast enema is diagnostic & therapeutic

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9
Q

What is the cause of duodenal atresia?

A

failure of canalization of duodenum

- presented with: recurrent vomiting (bilious or non-bilious)

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10
Q

What is the diagnostic sign in duodenal atresia?

A

DOUBLE BUBBLE SIGN

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11
Q

How should duodenal atresia be treated?

A

duodenoduodenostomy after pre-op prep

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12
Q

What is the commonest type of GI atresia?

A

Jejunal atresia

  • presents by bilious vomiting & upper abdominal distention
  • treated by resection & anastomoses
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13
Q

How is colonic atresia treated?

A
  • confirmed by contrast enema

- treated by diverting colostomy -> 2nd set for reconstruction

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14
Q

Which type of dynamic intestinal obstruction requires urgent exploration?

A

VOLVULUS NEONATORUM

resect gangrenous gut & untwist viable gut

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15
Q

What are the types of abnormal gut rotation?

A
  • GUT NON ROTATION -> volvulus
  • GUT INCOMPLETE ROTATION -> volvulus neonatorum
  • INCOMPLETE FIXATION -> left mesocolic internal hernia
  • INCOMPLETE REDUCTION -> congenital umbilical hernia
  • FAILURE OF DESCENT -> subhepatic caecum
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16
Q

What is the cause of volvulus neonatorum?

A
  • incomplete rotation of the gut -> twist gut along the axis of SMA -> strangulation of midgut
17
Q

How does a neonate present with volvulus neonatorum?

A
  • intestinal obstruction with peritonitis due to massive strangulation
  • rapidly progressive associated with septic & hypovolemic shock
18
Q

when does necrotizing enterocolitis occur?

A

2nd - 3rd week of life in premature infants

- characterized by variable damage to intestinal tract

19
Q

What are the manifestations of necrotizing enterocolitis?

A 
Intestinal Obstruction 
bleeding/rectum 
peritonitis 
septic or hypovolemic shock 
in pneumoperitoneum -> surgery
20
Q

absence of ganglionic cells in the distal colon & rectum is known as?

A

HIRSCHSPRUNG’S DISEASE

  • failure of migration of ganglionic cells along neural crest to developing gut
  • failure of relaxation of lower rectum during defecation
21
Q

What is the most effected site in Hirschsprung’s disease?

A

anorectal junction up to rectosigmoid junction

22
Q

what is the macroscopic picture of Hirschsprung’s disease?

A
  • distal spastic segment -> aganglionic
  • middle conical zone -> transitional zone
  • proximal dilated zone -> normal segment
23
Q

What is the microscopic picture of Hirschprung’s disease?

A
  • absence of Aurebach’s & Meissner’s plexus

- hypertrophic nerve fibers

24
Q

What is the clinical picture of Hirschsprung’s disease?

A
  • delayed passage of meconium >24hrs
  • chronic constipation -> defecation after several days & only after insertion of mother’s finger
  • abdominal distention & visible peristalsis
  • doughy mass in left iliac fossa
  • hyperresonant
  • early -> hyperperistaltic late -> diminished intestinal sounds
25
Q

What are the complications of Hirschsprung’s disease?

A
  • growth retardation
  • acute on top of chronic obstruction
  • fatal obstructive toxic enterocolitis
26
Q

What is the most diagnostic method of investigation in case of Hirschsprung’s disease?

A

RECTAL BIOPSY -> absent ganglionic cells + hypertrophied nerve fibers

Gastrografin enema -> megacolon with very characteristic funneling

Anorectal manometry -> failure of relaxation in response to rectal distention

27
Q

How should Hirschsprung’s disease be treated?

A

if there is intestinal obstruction

  • conservative -> no response -> colostomy
    - > responding -> definitive operation
If the is no intestinal obstruction 
- pre-op prep 
- elective definitive operation 
Swenson's operation 
Soave's operation 
Duhmel's operation
28
Q

What are the high anorectal anomalies?

A

HAVE DEFECTIVE ANAL SPHINCTER

  • anorectal agenesis -> rectum forms blind pouch above pelvic floor with fistulous connection in vagina or urethra
  • rectal atresia -> rectum forms blind pouch above pelvic floor -> anal canal forms blind pouch below pelvic floor
29
Q

What are the low anorectal anomalies?

A

INTACT ANAL SPHINCTER

  • covered anus -> anal canal covered by skin -> ectopic anus
  • membranous anus -> membrane at level of dentate line
30
Q

What is the clinical picture of an imperforate anus?

A
  • neonatal intestinal obstruction
  • meconium at urethral opening
  • anal dimple
  • ectopic anus
31
Q

What investigations could be used to diagnose imperforate anus?

A

INVERTOGRAM
- differentiates between high & low anomalies

URINE ANALYSIS
- detection of meconium in urine

32
Q

What is the treatment of high anomalies?

A

3 stage operation

  • temporary colostomy
  • anorectal pull through
  • closure of colostomy

continence may be affected

33
Q

What is the treatment of low anorectal anomalies?

A
  • anal stenosis -> regular anal dilatation
  • imperforate without fistula -> PSARP
  • anteriorly displaced with long gap -> transposition anoplasty
  • anteriorly displaced with short gap -> cutback anoplasty

Surgery M4 part 2 (36 decks)

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