03.07 Obstruction in Neonates, Infants and Children

Question 1

In the neonatal period, bile in the vomitus should be considered to be due to ____, until proven otherwise

Answer 1

IO

Question 2

Hourly nasogastric aspirate of more than ___ in a neonate is an evidence of significant gastric retention

Answer 2

20cc

Question 3

Etiologies of vomiting can be ___, ____, and ____

Answer 3

Mechanical
Reflex
Central

Question 4

Characteristics of significant vomiting

Answer 4

Bile-stained
Bloody
Projectile
Persistent

Question 5

Extreme danger in vomiting

Answer 5

Aspiration

Question 6

To minimize aspiration, insert an ___ to decompress the stomach

Answer 6

OGT/NGT

Question 7

Congenital defect of the abdominal wall in which the bowel and solid viscera are covered by peritoneum and amniotic membrane

Answer 7

Omphalocele

Question 8

Congenital anomaly characterized by a defect in the anterior abdominal wall through which the intestinal contents freely protrude

Answer 8

Gastroschisis

Question 9

Abnormal contour of the abdomen

Answer 9

Bulges

Question 10

Passed within 24 hours

Answer 10

Meconium

Question 11

Meconium is abnormal if:

Answer 11

None is passed
Delayed more than 24 hours
Brown, malodorous, whitish, mucoid, passed only by rectal washout

Question 12

Smooth, firm mass that emerges through the external inguinal ring lateral to the pubic tubercle and enlarges with increased intraabdominal presure

Answer 12

Inguinal hernia

Question 13

The first consideration we have to look for in an imperforate anus is if the patient has a ____

Answer 13

Fistula

Question 14

Pouch of air in the rectum can be demonstrated through ___ within ____ after birth

Answer 14

Invertogram

18-24 hours

Question 15

X-ray of the entire baby in one film

Answer 15

Babygram

Question 16

If pre-sacral air is absent:

Answer 16

Obstruction

Question 17

If pre-sacral air is present:

Answer 17

Normal
Ileus
Partial obstruction

Question 18

Important to children up to ____ since they do not have true pelvises yet

Answer 18

2 years of age

Question 19

Polyhydramnios, no diabetes
Vomited after each feeding
Bilious vomitus
Vigorous cry, normal VS, well-hydrated
Upper abdomen is full
Microcolon in barium enema

Answer 19

Small bowel atresia

Question 20

Hallmark of duodenal obstruction

Answer 20

Bilious vomiting without abdominal distention

Question 21

Difficulty with feedings
Nonbilious vomitus
Always hungry
Dehydrated
Pulsion like wave starting in the upper quadrant moving to the right
Vomited curdled milk
Fingernail-size firm mobile mass (olive tumor) could be palpated in the epigastrium
String sign

Answer 21

Pyloric stenosis

Question 22

In HPS, pyloric muscle wall thickness > ___

Answer 22

4mm

Question 23

In HPS, pyloric channel length > __

Answer 23

14mm

Question 24

HPS occurs from the ___

Answer 24

1st-2nd month of life

Question 25

HPS is repaired through ____

Answer 25

Myotomy (Fredet-Ramstedt pyolomyotomy)

Question 26

``` Poor feeding since birth Bilious vomiting of 12 hours duration Passage of meconium Irritable neonate with minimal abdominal distension Double bubble sign ```

Answer 26

Malrotation

Question 27

Common causes of duodenal obstruction | Beak sign, sudden cutoff sign

Answer 27

Malrotation Annular pancreas Duodenal atresia

Question 28

There is a formation of ____ in malrotation

Answer 28

Peritoneal bands (Ladd's bands)

Question 29

CC of malrotation

Answer 29

Unexplained bilious vomiting

Question 30

``` Nonbilious vomiting Extremely healthy Better in between bouts of apparent pain Cry and become pale Runny nose in the previous week Blood in the stool After crying, upper quadrant fullness Currant jelly/tomato juice ```

Answer 30

Ileo-ceocal intussusception

Question 31

Most common cause of intussuscpetion in infancy

Answer 31

Idiopathic

Question 32

Sudden onset, in a previously well child, of severe paroxysmal colicky pain that recurs at frequent intervals and is accompanied by straining efforts with legs and knees flexed and loud cries

Answer 32

Intussusception

Question 33

Progressive abdominal distension Full term Vomited several times Passage of large stool after withdrawing the rectal thermometer

Answer 33

Hirschprung disease

Question 34

Pathology of neonatal Hirschprung disease

Answer 34

Congenital absence Ganglion cells Auerbach/meissner's plexi

Question 35

Functional instestinal obstruction | Non-propulsive, fails to relax

Answer 35

Neonatal Hirschprung disease

Question 36

Classic triad of intussusception

Answer 36

Pain Palpable sausage-shaped abdominal mass Bloody or currant jelly stool

Question 37

A child with Hirschprung disease is seen to have abnormally increased contraction of the anal canal and no relaxation of the internal sphincter with rectal distention in what test

Answer 37

Anorectal manometry

Question 38

Rectal biopsy in Hirschprung disease

Answer 38

Absence of ganglion cells | Presence of hypertrophied nerve bundles

Question 39

Confimatory staining procedures for HD

Answer 39

Acetylcholinesterase staining | Calretinin staining

Question 40

Alternative to colonostomy

Answer 40

Colonic irrigation

Question 41

Colonic irrigation

Answer 41

Wam saline Effluent clear Daily Up to right colon

Question 42

Treatment for HD

Answer 42

Colonic irrigation | Swenson pull-through procedure