Upgrade to remove ads
Only $2.99/month

GI disorders in children

Terms in this set (17)

Esophageal Atresia / Tracheoesophageal fistula
A single artery umbilical cord is frequently present at birth;
Mostly the fistula is bw the distal esophagus and the airway ; may also have variant with no fistula--two blind pouches
> common: single artery umbilical cord @ birth and polyhydramnios
> Presentation: copious secretions, choking, cyanosis, and resp distress in the first hours of life
> Diag: confirmed with chest x-ray. NG tube is placed and met with resistance.
> If a transesophageal fistula is present to the distal esophagus, gas will be present in the bowel. If esophageal atresia w/o tracheoesophageal fistula there is no air in bowel
> Tx- NG tube in proximal pouch on intermittent suction to drain secretions and prevent aspiration, elevate head of bed (prevent reflux of gastric contents through the distal fistula into lungs). Need surgery!! Prognosis: poor, reconstructed esophagus is prone to poor motility and recurrent fistula. Tracheomalacia and wheezing is common
Pyloric stenosis
Hypertrophic pyloric stenosis may cause almost complete gastric outlet obstruction. It affects 2 to 3 out of 1000 infants and is more common among males by a 5:1 ratio, particularly firstborn males. It occurs most often between 3 wk and 6 wk of age and rarely after 12 wk. Fam hx in 13%. Related to maternal smoking also.
>Presentation: projectile vomiting (2-4 wks), vomit is never bilious. Are ravenously hungry and nurse avidly, become more lethargic with increasing malnutrition and dehydration. Upper abdomen may be distended after feeding, and prominent gastric peristaltic waves from left to right may be seen. An oval mass in the right upper abdomen can be felt, esp after vomiting (this palpable hypertrophied pylorus is described as an olive)
Diagnostics for pyloric stenosis
hypocholremic, hypokalemic, metabolic alkalosis with elevated BUN:Cr
Dehydration causes elevated hemoglobin and hematocrit
US- elongation and thickening of pylorus
Barium upper GI series- retention of contrast in the stomach and a long narrow pyloric channel with a double track of barium
(infants younger than 21 days may need clinical diagnosis- harder to tell from US)
Tx of pyloric stenosis
tx dehydration and electrolyte imbalance first; IV cimetidine and other acid-blocking agents can correct metabolic alkalosis.
*Laparoscopic pyloromyotomy- pyloric muscle is incised longitudinally to release the constriction -sparing the mucosa
what composes the Midgut?
duodenojejunal junction to the mid-transverse colon--in peds?
Midgut malrotation
During gestation the midgut elongates into the umbilical sac, returning to an intra-abdominal position during the 10th week of gestation. When rotation is incomplete, the dorsal fixation of the mesentery is defective and shortened so that the bowel from the ligament of Treitz to the mid-transverse colon may rotate around its narrow mesenteric root and occlude the SMA or cause intestinal obstruction. Malrotation leads to volvulus and account for 10% of neonatal intestinal obstruction
Midgut malrotation physiology
Malrotation of the bowel is failure of the bowel to assume its normal place in the abdomen during intrauterine development.

During embryonic development, the primitive bowel protrudes from the abdominal cavity. As it returns to the abdomen, the large bowel normally rotates counterclockwise, with the cecum coming to rest in the right lower quadrant. Incomplete rotation, in which the cecum ends up elsewhere (usually in the right upper quadrant or midepigastrium), may cause bowel obstruction due to retroperitoneal bands (Ladd bands) that stretch across the duodenum or due to a volvulus of the small bowel, which, lacking its normal peritoneal attachment, twists on its narrow, stalk-like mesentery. Other malformations occur in 30 to 60% of patients, most commonly other GI malformations (eg, gastroschisis, omphalocele, diaphragmatic hernia, intestinal atresia).
Clinical presentation of midgut malrotation
infants present in 1st 3 wks of life (can also be 6 months-childhood presentation) with bile stained vomiting or with overt small bowel obstruction

- note: older children and adults with undiagnosed malrotation typically present with chronic GI symptoms of N/V, diarrhea, abdominal pain, dyspepsia, bloating, and early satiety.
Diagnosis of midgut malrotation
Lecture: Upper GI series gold standard
- confirmed by barium enema
- CT scan and US

Merck manuals:
Plain films of the abdomen should be done immediately. If they show dilated small bowel, a paucity of bowel gas distal to the duodenum, or both (suggesting a midgut volvulus), further diagnosis and treatment must be done emergently. Barium enema typically identifies malrotation by showing the cecum outside the right lower quadrant. If the diagnosis remains uncertain, an upper GI series can be done cautiously.
Tx of midgut malrotation
- Surgical tx: Ladd procedure- The procedure involves surgical division of Ladd's bands, widening of the small intestine's mesentery, performing an appendectomy and correctional placement of the cecum and colon
- Midgut volvulus is a surgical emergency- bowel necrosis from occlusion of SMA. One of the most common indications for small bowel transplant in children
Intestinal Atresia
several forms. One or more segments of the bowel may be missing completely or in remnants that are cord like.
Presentation of intestinal atresia
polyhydramnios, abdominal distention, bilious vomiting
Dx and Tx of intestinal atresia
X-ray: dilated loops of small bowel and absence of colonic gas
Contrast radiographs: christmas tree deformity
Tx: Surgery after hemodynamic stabilization, NG suction, broad spectrum abx
Intussusception
Invagination/telescoping of one segment of intestine into another. usually starts proximal to the ileocecal valve and extends varying distances into the colon. Causes intestinal obstruction and sometimes intestinal ischemia.
Clinical presentation of intussusception
previously healthy infant 3-12 months develop recurring paroxysms of abdominal pain, screaming, drawing up of knees. V/D occur soon after, and blood bowel movement with mucus appear within next 12 hours. Abdomen tender and distended. Sausage shaped mass may be palpated in the upper mid abdomen. Child is lethargic bw paroxysms and may be febrile.

*Physicians should not wait for passage of a currant-jelly stool to suspect intussusception because it is a late occurrence.
Diagnostics
Air enema and Barium enema are diagnostic and therapeutic
- dont do barium enema if signs of strangulated bowel, perforation or toxicity are present.
Surgery if enema unsuccessful or if perforation present

- Abdominal US
Tx
Pneumatic reduction (aka air enema)
Care is required in patient selection for either air or barium enema because if ischemic damage to the intestine is suspected based on symptom severity (shock or sepsis), the risk of perforation increases and surgical reduction is preferred. Surgery is required for extremely ill patients, patients with evidence of bowel perforation, or in those in whom hydrostatic or pneumatic reduction has been unsuccessful.
THIS SET IS OFTEN IN FOLDERS WITH...