Failure to Pass Meconium

Question 1

first question to think about when trying to dx slow moving colon?

Answer 1

what age is pt?

Question 2

FTPM

Answer 2

failure to pass meconium in 48 hours

• most kids pass by 24 hrs

Question 3

FTPM dx

Answer 3

• any upper obstruction (think bilious emesis)
• imperforate anus
• meconium ileus
• hirschbrung’s

Question 4

constipation ddx

Answer 4

voluntary holding
hirschbrung’s
medication problems
diet

Question 5

imperforate anus patho

Answer 5

part of VACTERL
- no anal opening
may be stooling via fistula

Question 6

imperforate anus dx

Answer 6

cross table xray

Question 7

tx imperforate anus

Answer 7

mild: fix now surgery
severe: wait for baby to get bigger, place colostomy now, surg later

Question 8

imperforate anus f/u

Answer 8

VACTERAL

• vertebral anomalies
• imperforate anus
• cardiac issue
• tracheoesophageal fistula
• renal
• limb
• U/S sacrum
• xray anus
• echocardiogram
• catheter with xray
• voiding cug
• xray wrist

** must be done prior to imperforate anus surg

Question 9

meconium ileus aka

Answer 9

CF

Question 10

meconium ileus sx

Answer 10

FTPM

• know CF from screen
• or pt w/o screen

Question 11

meconium ileum dx

Answer 11

xray: transition gas filled plug

Question 12

meconium ileus tx

Answer 12

water enema

Question 13

f/u meconium ileus

Answer 13

sweat cholride test confirm

• give DEAK vitamins
• pancreatic enzymes
• pulmonary toliet test

Question 14

hirschbrung’s patho

Answer 14

• failure of migration of inhibitory neurons for relaxation in auerbach and meisner plexus do not descend fully to innervate colon
• distal colon not innervated innervated

Question 15

hirschbrung sx

Answer 15

FTPM within 48 hrs
palpable colon
explosive diarrhea on rectal exam

10% have chronic diarrhea, overflow incontinence

Question 16

hirshbrungs dx

Answer 16

xray: good colon = dilated, bad colon looks normal

90% will go for contrast enema look for transition pt

10% do anorectal mamometry which will show increased tone

best test: bx

Question 17

hirschbrungs tx

Answer 17

surgically resect bad colon (remove part that looks normal)

Question 18

voluntary holding why?

Answer 18

pain, embarrassment, cognitive impairment

Question 19

two main times holding shows up

Answer 19

toliet training
going to school

voluntary can turn into involuntary

see: overflow incontinence

Question 20

encopresis

Answer 20

overflow incontinence

severe constipation

Question 21

dx voluntary holding

Answer 21

clinical

Question 22

voluntary holding tx

Answer 22

bowel regimen
behavior

rare: disimpact (anesthesia for kid)