Congenital Gastric And Duodenal Anomalies

Question 1

Hypertrophic Pyloric Stenosis

Answer 1

Presentation: projectile non bloody emesis at 3-6 weeks. Dehydration, weight loss, FTT< jaundice, persistent hunger. Hypochloremic, hypokalemic metabolic alkalosis.
DDX: GER, Increased ICP, pylorospasm, metabolic disorder, other causes of gastric outlet obstruction.
PEx: palpable olive.
US: target sign. UGIS: “string sign.”
Management: correct electrolytes, then surgery.

Question 2

Pyloric atresia/webs

Answer 2

Clinical sxs: dependent on degree of obstruction (antenatal polyhydramnios, nonbilious vomiting, early satiety, and weight loss).
Diagnosis: XR: solitary gastric bubble, US, UGIS.
Management: correct electrolytes, then surgery.

Question 3

Microgastria

Answer 3

Solitary or Syndromic (intestinal malrotation, VACTERL).
GER, vomiting, aspiration pneumonia, FTT.
Prenatal US: mimic esophageal atresia: mega esophagus, failure to visualize distended stomach.

Question 4

Gastric Duplications

Answer 4

Usually doesn’t communicate with stomach.
May contain ectopic gastric or ectopic pancreatic tissue.
Vomiting, feeding intolerance, palpable mass, PUD-like, Perforation.
Diagnosis: US: antenatal. CT: postnatal.

Question 5

Duodenal Duplications

Answer 5

Obstructive symptoms related to compression.
Diagnosis: US: antenatal. CT: postnatal.

Question 6

Gastric Volvulus: Emergency

Answer 6

Acute: sudden onset, severe epigastric abdominal pain, respiratory distress, nonbilious emesis.
Chronic: recurrent emesis, distension, FTT
Dx: unable to pass NGT, AXR, UGIS.

Question 7

Bezoars

Answer 7

Trichobezoar: hair
Pharmacobezoar: drugs
Lactobezoar: milk
Vegetable: phylobezoar.
Tx: surgical.

Question 8

Gastric perforation: neonates

Answer 8

Spontaneous: RF: asphyxia, prematurity, steroids, NEC.
Traumatic: intubation, NGT
Clinical: acute surgical abdomen, sepsis, high mortality.
Management: surgery

Question 9

Gastric perforation: children

Answer 9

Trauma/child abuse

Question 10

Duodenal hematoma

Answer 10

Blunt abdominal trauma,
Post EGD (coagulopathic, BMT)
SXS: obstructive with vomiting, abdominal pain,
+/- pancreatitis, biliary obstruction.
Anemia.
Diagnosis: imaging: filling defect on UGIs, CT.
Managment: conservative, responds with time.