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Questions and Answers
What is the most common type of duodenal atresia?
What is the characteristic radiological sign of duodenal atresia?
What is the surgical procedure of choice for duodenal atresia?
What is the most common associated anomaly with duodenal atresia?
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What is the common complication of duodenal atresia repair?
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What is the common presenting feature of duodenal atresia?
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What is the main cause of Congenital Pyloric Stenosis?
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What is the characteristic sign seen on Ultrasound in Pyloric Stenosis?
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What is the surgical procedure used to manage Pyloric Stenosis?
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What is the characteristic electrolyte imbalance seen in Pyloric Stenosis?
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What is the percentage of associated anomalies seen in Pyloric Stenosis?
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What is the typical age range for the presentation of Pyloric Stenosis?
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What is the most dreaded complication of malrotation?
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At what week of gestation is the Primitive Intestinal Tract completed?
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What is the normal location of the Duodenojejunal Junction?
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What is the axis of rotation of the GIT in malrotation?
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What is the characteristic radiographic finding in malrotation?
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What is the term for the abnormal rotation of the intestine during fetal development?
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Study Notes
Malrotation of the Intestine
- Normal rotation of the human intestine occurs between 4-12 weeks of gestation, involving herniation, rotation, retraction, and fixation
- Arrest in any of these steps can result in malrotation
- Malrotation can lead to midgut volvulus, the most dreaded complication
- Signs of malrotation:
- Gastric and/or duodenal distention
- Single bubble sign
- Bowel wall thickening or edema
- Gasless abdomen
- Rectal gas
- Contrast radiograph can help delineate the duodenojejunal junction
- Abnormal findings:
- Duodenojejunal junction to the right of the spine
- Coil spring or corkscrew appearance
- Beak appearance
Rotational Disorders
- Forms of rotational disorders:
- Non-rotation
- Incomplete rotation (90, 180, or 270 degrees)
Pyoric Stenosis
- Common in Caucasians (1-3:1,000)
- Male-to-female ratio: 4:1
- Maternal and paternal history: 19% Male, 7% Female; 5% Male, 2.5% Female
- 7% have associated anomalies
- Congenital vs acquired:
- Congenital: due to abnormal pyloric innervation, decreased pacemaker cells, and marked muscle hypertrophy
- Acquired: due to gastric hyperacidity, muscle spasm, and hypertrophy of the pylorus
- Symptoms:
- Non-bilious vomiting at 2-8 weeks of life
- Always hungry
- Hypochloremic, hypokalemic alkalosis
- Visible gastric peristaltic wave
- Palpable pyloric "tumor" (olive-shaped)
- Diagnosis:
- Ultrasound: target sign (thickened pyloric muscle and narrow lumen)
- UGIS: string sign
- Management:
- Counseling
- Preoperative resuscitation
- Surgery: Fredet-Ramstedt procedure
Duodenal Atresia
- Incidence: 1 in 6,000
- 50-75% diagnosed in the first month of life
- 90% are diagnosed in girls
- 30% have Trisomy 21
- Embryology:
- 3rd-4th week: duodenum develops from the distal foregut and proximal midgut
- 5th-6th week: duodenal canal obliterates due to epithelial cell proliferation
- 8th-10th week: coalescent of vacuoles
- 11th week: recanalization
- Etiology:
- Failure of recanalization
- Periampullary pathology
- Clinical manifestations:
- Bilious vomiting at birth
- Upper abdominal fullness
- No abdominal distension
- Sepsis
- Diagnosis:
- Prenatal ultrasound
- Abdominal X-ray: double bubble sign
- UGIS
- Management:
- Whipple's procedure (resection of atretic part + reconstruction of bowel continuity)
- Postoperative care: anastomotic leak, functional obstruction
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Description
This quiz covers the embryological development of the duodenum, including the timing of key events and the effects of rotation. It also touches on the incidence and diagnosis of related anomalies, such as Trisomy 21.
