Pediatrics 3 Flashcards
(33 cards)
What are the types of neonatal obstruction?
DYNAMIC
- meconium ileus
- meconium plug
- congenital atresia
- Hirschsprung’s disease
- imperforate anus
- volvulus neonatorum
- intussusception
ADYNAMIC
- necrotizing enterocolitis
How does neonatal intestinal obstruction present?
- recurrent vomiting & dehydration
- absolute constipation
- abdominal distention
- crying and flexion of hip (colicky abdominal pain)
- sepsis, & shock
What are the signs of neonatal intestinal obstruction?
- 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
What investigations are done to diagnose intestinal obstruction?
PLAIN X-RAY -> more than 3 fluid levels
pelvi-abdominal US & CT
exclude VACTERL
What is meconium ileus associated with?
cystic fibrosis
- characterized by viscous secretions affecting more than just the intestine
- manifests occur within -> 24-48hrs after birth
How can u diagnose meconium ileus?
X-ray -> dilated bowel with absent air fluid levels
Gastrografin enema -> most diagnostic & therapeutic
How should meconium ileus be treated?
1) contrast enema to dissolve & wash out meconium
2) enterostomy with irrigation with N-acetyl cysteine
3) exploration if perforated
What is the cause of Meconium plug syndrome?
- occurs in relation to Hirschsprung’s disease
- contrast enema is diagnostic & therapeutic
What is the cause of duodenal atresia?
failure of canalization of duodenum
- presented with: recurrent vomiting (bilious or non-bilious)
What is the diagnostic sign in duodenal atresia?
DOUBLE BUBBLE SIGN
How should duodenal atresia be treated?
duodenoduodenostomy after pre-op prep
What is the commonest type of GI atresia?
Jejunal atresia
- presents by bilious vomiting & upper abdominal distention
- treated by resection & anastomoses
How is colonic atresia treated?
- confirmed by contrast enema
- treated by diverting colostomy -> 2nd set for reconstruction
Which type of dynamic intestinal obstruction requires urgent exploration?
VOLVULUS NEONATORUM
resect gangrenous gut & untwist viable gut
What are the types of abnormal gut rotation?
- 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
What is the cause of volvulus neonatorum?
- incomplete rotation of the gut -> twist gut along the axis of SMA -> strangulation of midgut
How does a neonate present with volvulus neonatorum?
- intestinal obstruction with peritonitis due to massive strangulation
- rapidly progressive associated with septic & hypovolemic shock
when does necrotizing enterocolitis occur?
2nd - 3rd week of life in premature infants
- characterized by variable damage to intestinal tract
What are the manifestations of necrotizing enterocolitis?
Intestinal Obstruction bleeding/rectum peritonitis septic or hypovolemic shock in pneumoperitoneum -> surgery
absence of ganglionic cells in the distal colon & rectum is known as?
HIRSCHSPRUNG’S DISEASE
- failure of migration of ganglionic cells along neural crest to developing gut
- failure of relaxation of lower rectum during defecation
What is the most effected site in Hirschsprung’s disease?
anorectal junction up to rectosigmoid junction
what is the macroscopic picture of Hirschsprung’s disease?
- distal spastic segment -> aganglionic
- middle conical zone -> transitional zone
- proximal dilated zone -> normal segment
What is the microscopic picture of Hirschprung’s disease?
- absence of Aurebach’s & Meissner’s plexus
- hypertrophic nerve fibers
What is the clinical picture of Hirschsprung’s disease?
- 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
