18 Questions
What imaging study is typically used to diagnose malrotation?
Upper GI series
Which condition is characterized by a newborn-1 month old patient with bilious vomiting and diffuse abdominal tenderness?
Midgut volvulus
How is midgut volvulus differentiated from intussusception in infants?
Drawing the legs to the chest in pain
What is the common presenting symptom in a patient with duodenal atresia or annular pancreas?
Coffee bean appearance on imaging
Which condition is commonly associated with Down's Syndrome?
Duodenal atresia
What procedure may be performed as a treatment for malrotation?
Ladd procedure
What symptom might a patient with midgut volvulus exhibit due to abnormal bowel rotation?
"Draw the legs to the chest"
Which of the following conditions can lead to an abnormal rotation of bowel secondary to adhesions?
'Twist' around the SMA
What is a characteristic feature of a preemie with necrotizing enterocolitis?
Sudden, bloody bowel movement
What is the main pathology associated with a newborn who is often found gurgling or coughing?
Esophageal atresia with tracheoesophageal fistula
What is the diagnostic test used to identify esophageal atresia with tracheoesophageal fistula?
Inserting an NG tube
What is the treatment for a baby with no meconium and no open-ended anus on exam?
Perforation or colostomy
What is the main difference between gastroschisis and omphalocele?
Presence of a surrounding membrane
What is the danger associated with congenital diaphragmatic hernia?
Hypoplastic lung
What is the main symptom of biliary emesis in newborns?
Double bubble on X-ray
What is the diagnostic test used to identify congenital diaphragmatic hernia?
Chest X-ray
What is the special note to consider in patients with esophageal atresia with tracheoesophageal fistula?
The possibility of an underlying congenital diaphragmatic hernia
What is the treatment for bladder extrophy?
Surgical repair
Study Notes
Malrotation
- Normal gas pattern distally on X-ray
- Diagnosed with contrast enema or upper GI series
- Treated with possible surgical correction or LADD procedure
Duodenal Atresia or Annular Pancreas
- No gas on X-ray
- Associated with Down's Syndrome
- Treated with surgical correction
Midgut Volvulus
- Presentation: uncomfortable-appearing baby with episodic, bilious vomiting and diffuse tenderness on abdominal examination
- May "draw the legs to the chest" in pain
- Pathology: Occurs due to an abnormal rotation of bowel secondary to adhesions which ultimately "twist" around the SMA
- Associated with underlying gastroschisis, omphalocele, and Hirschsprung's Disease
- Diagnosed with abdominal series (XR) showing multiple air-fluid levels and dilated small bowel, or upper GI barium enema showing a "coffee bean" appearance
- Treated with emergency surgery
Necrotizing Enterocolitis (NEC)
- Presentation: preemie with sudden, bloody BM
- Premature babies (born under 37 weeks of gestation) are at risk
Tracheoesophageal Fistula (TE Fistula)
- Presentation: newborn gurgling or coughing
- Pathology: Due to an atretic esophageal segment with fistula formation into the trachea, related to maternal polyhydramnios in utero
- Diagnosed by inserting an NG tube which will "coil" on X-ray
- Treated with surgical repair
- May be part of VACTRL syndrome, which includes:
- Vertebral anomalies (diagnosed by XR)
- Anal atresia
- Cardiac Defects (diagnosed by ECHO)
- Renal Disease (diagnosed by CMP)
- Limb abnormalities
- Imperforate anus
Imperforate Anus
- Presentation: No meconium and no open-ended anus on exam
- Diagnosed with cross-table XR
- Treated with perforation (if mild) or colostomy (if severe)
Gastroschisis vs Omphalocele vs Exstrophy of Bladder
- Gastroschisis: Bowel without surrounding membrane, located right of the midline
- Treated with silo (pushing the bowel back in)
- Omphalocele: Bowel with a surrounding membrane, located midline
- Treated with silo (LET'S)
- Exstrophy of Bladder: Wet, shiny, red sack at the midline
- Treated with surgical repair
Congenital Diaphragmatic Hernia
- Presentation: Scaphoid abdomen with bowel sounds in the chest
- Diagnosed with CXR
- Treated with surgical repair
- Associated risk: Underlying hypoplastic lung, requiring emergent intubation and provision of surfactant to optimize survival
Causes of Biliary Emesis in the Newborn
- All patients show a "double bubble" and have green or yellow-appearing vomit within the first week of life
Test your knowledge on pediatric gastrointestinal disorders focusing on esophageal atresia with tracheoesophageal fistula (TEF) in newborns. Learn about the pathology, diagnosis, treatment, and related conditions like VACTRL association. Be prepared to identify and manage this condition in clinical settings.
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