Peds GI Surgery - Opheim - Bare Essentials

Question 1

Explain the normal embryology and what causes malrotation:

Answer 1

• 4th week, midgut herniates outside
• 270 degree counterclockwise rotation around superior mesenteric artery
• midgut returns into the abdomen at 10th week

In malrotation, often non-rotation occurs. The normal large bowel C-loop never forms.
Small bowel is prone to twisting and volvulus

Question 2

Once the diagnosis of pyloric stenosis has been made using ultrasound, what should be the next step???

Answer 2

FIRST medical managment!

This means IV hydration and correcting the electrolytes

Question 3

What are going to be the electrolyte imbalances seen in pyloric stenosis? Why?

Answer 3

Hypokalemic
Hypochloremic
Metabolic Alkalosis

Kidneys are retaining H+ and losing K+ as a result
Emesis = loss of HCl

Question 4

Patient presents 3.5 weeks after birth with bilious vomiting and lethargy.
An upper GI contrast study shows a bird’s beak appearance in the small bowel, and the duodenum does not cross the midline.
Diagnosis?

Answer 4

Malrotation!

• Resuscitate with IV fluid
• Place an NG tube and catheter
• Perform Ladd’s procedure

Question 5

Clinical triad of intssusception?

Answer 5

• colicky abdominal pain
• bilious emesis
• current-jelly stools

Question 6

Why is it that Meckel’s Diverticulum often causes a painless lower Gi bleed?

Answer 6

It is often due to gastric tissue contained within the diverticulum

Bleeding occurs on the wall opposite of the Meckel’s

Question 7

A newborn fails to pass meconium in the first 24 hour hours. The abdomen appears distended and the infant has had bilious emesis.
What do you think it is?

Hint: A rectal biopsy would be the gold standard for diagnosis

Answer 7

Hirschsprung’s disease

-more common in Down Syndrome patients and is due to an absence of ganglion cells in the myenteric and submucosal plexuses.