digestive Flashcards
(32 cards)
what is duodenal atresia
a malformation of the duodenum ( due to failure of recanalisation) that prevents bolus from leaving the stomach. It is associated with down’s syndrome
What are the categories of duodenal atresia
Type 1 (most common): A mucosal web or diaphragm obstructs the duodenal lumen, causing proximal dilatation Type 2: The proximal and distal segments of the duodenum are connected by an atretic cord. Type 3: The proximal and distal segments of the duodenum are completely separated.
Clinical signs and symptoms of duodenal atresia
- Abundance of bilious vomiting occurs in the first 24-36 hours after delivery.
- Abdominal distention
- absence of bowel movements
Diagnosis of duodenal atresia
Prenatal ultrasound: Polyhydramnios
Xray: Double bubble ( absence of gas in remaining bowel)
Treatment of duodenal atresia
Parenteral nutrition
Gastric decompression
duodenoduodenostomy
What is colonic atresia
A type of intestinal atresia, which involves blocked or missing sections anywhere along the large intestine
What causes colonic atresia
Decrease in the blood flow to the large intestine:
Invagination, volvulus, intestinal hernia, laparoschisis
Anatomical classification of colonic atresia
Type 1- membranous atresia( bowel lumen connected with membrane)
Type 2 - The bowel is discontinuous, with portions connected by a fibrous cord
Type 3 - The bowel ends are completely separated, and the mesentery has a gap
Diagnosis of colonic atresia
- Vomiting: late after delivery (around 24 hours)
- Impressive abdominal distention
- Meconium is not eliminated
- Invertography, US: polyhydramnios, dilated bowel loops
Treatment of colonic atresia
Proximal dilated part resected and anastomosed with healthy portion of bowel
What is volvulus
Intestine and mesentery rotates around itself cutting off its blood supply
What are the symptoms of volvulus
bilious vomiting severe abdominal pain abdominal distention bloody stools septic shock
What is the treatment for acute volvulus
Untwist the intestine, and attach it to the abdominal wall to prevent from twisting again.
resection of infarcted parts
What is Hirschsprung disease
There is an absence of parasympathetic ganglion cells in the rectum, and sometimes also in the colon. results in a constantly constricted section of bowel which causes a functional obstruction when the child is born
symptoms of Hirschsprung disease in newborn
Failure to pass meconium within 48 hours of birth
Abdominal distension
Vomiting – may include bile staining
Rectal examination- may be watery stool
symptoms of Hirschsprung’s Enterocolitis
bloody diarrhea, abdominal distension, pain, fever, foul smelling stools vomiting.
Symptoms of Hirschsprung in older children
Chronic constipation Failure to thrive Abdominal distension Early satiety Flared thoracic cage
Diagnosis of Hirschsprung(excluding history)
DRE- Empty ampulla
Abdominal palpation- depressible masses like butter
Abdominal Xray- dilated bowel loops
Barium Enema - funnel shape ( narrowing of rectum)
rectal biopsy-Absence of ganglion cells in the myenteric plexus, Presence of Ach positive nerve trunks
Differential diagnosis of Hirschsprung in newborns
- Acute enterocolitis-
- Meconium plug syndrome-
- Meconium ileus:
- Syndrome of intestinal motility troubles
Differential diagnosis of Hirschsprung in children
- Chronic constipation (idiopathic megacolon)
- tumour in the space between rectum and sacrum
- Neuronal intestinal dysplasia:
- anal stenosis(acquired/congenital) can cause an obstruction in evacuating feces
Treatment of Hirschsprung
Colonic enema- 3-4/d, insert salt solution through tube
Colostomy- if enterocolitis
radical treatment- resection of affected area without ganglions,. 3 techniques, swenson ( most popular) Duhamel, stove
Define anorectal malformation
Abnormal opening of anus and rectum
What are the types of anorectal defects in males
- Perineal fistula
- Recto-urethral fistula (bulbar, prostate)
- Recto-vesicular fistula (bladder neck)
- Anal imperforation without fistulas
- Rectal atresia
What are the types of anorectal defects in females
- Perineal fistula
- Vestibular fistula
- Anal imperforation without fistula
- Rectal atresia
- Cloaca
- Complex malformations
