original Pediatric gastro (1).pptx

Pediatric gastro Aviva R Schaefer, MD, MPH TE FISTULA This is a newborn who is often found gurgling or coughing Pathology: Due to an atretic esophageal segment with fistula formation into the trachea, related to maternal polyhydramnios in utero Dx: Stick an NG tube in the kid – it will “coil” on XR...

Pediatric gastro Aviva R Schaefer, MD, MPH TE FISTULA This is a newborn who is often found gurgling or coughing Pathology: Due to an atretic esophageal segment with fistula formation into the trachea, related to maternal polyhydramnios in utero Dx: Stick an NG tube in the kid – it will “coil” on XR Tx: Surgical repair (good outcome) Special note: This may be a part of “VACTRL” so r/o other underlying pathologies as well! Vertebral anomalies (get XR) Anal atresia Cardiac Defects (get ECHO) TE Fistula Renal Disease (get CMP) Limb abnormalities Imperforate anus A baby with no meconium and no open-ended anus on exam Dx: Cross-table XR Tx: If mild, perforate; if severe, do colostomy Gastroschisis vs omphalocele vs extrophy of bladder Each can present somewhat similarly so it is critical to note the differences Gastroschisis Patient will have bowel without any surrounding membrane which is located right of the midline Tx: Silo – this pushes the bowel back in Omphalocele Pt will have bowel with a surrounding membrane which is midline Silo LET’S Extrophy of Bladder SEE Pt will have a wet, shiny, red sack which appears at the midline (most confused with omphalocele) SOME Tx: Surgical repair PICTUR A silo “Wet, shiny sack” Bladder Extophy Congenital diaphragmatic hernia The newborn baby will have a “scaphoid abdomen” with bowel sounds in the chest Dx: CXR Tx: Surgical repair Special note: The real danger in these patients is the possibility of an underlying hypoplastic lung, the result of bowel pushing down the lung in-utero – these babies may require emergent intubation and provision of surfactant to optimize their chance of survival Causes of biliary emesis in the newborn ALL of these patients will show a “double bubble” and have green or yellow-appearing vomit within the first week of life – how do you tell them apart? Malrotation Will show a “normal gas pattern distally” Dx: Contrast enema or upper GI series Tx: Possible surgical correction OR LADD procedure Duodenal Atresia or Annular Pancreas Intestinal Patient will have NO GAS on XR A/w Down’s Syndrome Tx: Surgical Atresia Will show “multiple air fluid levels” Mom will typically be a cocaine user Midgut Volvulus This newborn–1 month old patient will present with uncomfortable-appearing, with episodic, bilious vomiting and diffuse tenderness on abdominal examination The patient may also “draw the legs to the chest” in pain (do not confuse with intussusception which will typically be seen in a toddler) Path: Occurs due to an abnormal rotation of bowel secondary to adhesions which ultimately “twist” around the SMA A/w underlying gastroschisis, omphalocele and Hirschsprung’s Disease Confirm with either abdominal series (XR) which shows multiple air-fluid levels and dilated small bowel OR upper GI barium enema which shows a “coffee bean” appearance Tx: Emergency surgery nec This will be a preemie who has a sudden, bloody BM Don’t forget babies born under 37 weeks of gestation are “premature” However, in questions, the baby is almost always