Chapter 39

Question 1

Cleft Lip and Cleft Palate

Answer 1

Cleft lip
- Caused by the incomplete fusion of the nasomedial or intermaxillary process during the fourth week of embryonic development
- Commonly occurs under one nostril, but the defect can be bilateral and symmetric or asymmetric

Cleft palate
- Commonly associated with cleft lip but can occur without it
- May affect only the uvula and soft
palate or may extend forward to the
nostril and involve the hard palate and
the maxillary alveolar ridge

Question 2

Esophageal Atresia

Answer 2

• esophagus ends in a blind pouch
• Usually accompanied by a tracheoesophageal fistula
• Associated with many anomalies and syndromes
• Environmental and genetic risk factors
• Antenatal diagnosis increases with finding of
  polyhydramnios, confirmed by inability to pass gastric tube after birth

Question 3

Infantile Hypertrophic Pyloric Stenosis

Evaluation and treatment?

Answer 3

• narrowing and distal obstruction of the pylorus
• Etiology is unknown
• Forceful, nonbilious vomiting immediately after feeding starting 2-3 weeks after birth
• Vomiting causes weight loss, electrolyte imbalances, and dehydration
• Infant irritable as a result of hunger and esophageal
  discomfort
• Evaluation and treatment
   Hypertrophic pylorus is palpable in the RUQ
   Standard treatment is pyloromyotomy

Question 4

Intestinal Malrotation

Clinical manifestation

Evaluation and treatment


Answer 4

-Small intestine lacks normal posterior attachment
- Intestine twists upon itself (volvulus)
-Most cases develop during neonatal period

 Clinical manifestations
 Intermittent or persistent bile-stained vomiting
 Dehydration and electrolyte imbalances
 Fever, pain, scanty stools, diarrhea, and bloody stools

 Evaluation and treatment
 Clinical manifestations and x-rays
 Laparoscopic or open surgery to reduce volvulus

Question 5

Meckel Diverticulum

Answer 5

• Out pocketing of all layers of the small intestinal wall (usually in the ileum)
• “Rule of 2s”
• Most asymptomatic
• Most common symptom is painless rectal bleeding
• Intestinal obstruction, intussusception, and
  volvulus can occur

Question 6

Meconium Syndromes

Answer 6

• Meconium is a substance that fills the intestine before birth

-Meconium ileus (MI)
 Meconium-caused intestinal obstruction in a newborn
 - Two types
 - Simple
 - Complex: medical emergency

• Meconium plug syndrome
   - Transient
   - Characterized by delayed passage of meconium and intestinal dilatation
• Distal intestinal obstruction syndrome
   - Characterized by complete or incomplete intestinal obstruction of viscid fecal accumulation in the terminal ileum and proximal colon