Topic 4 acute abdomen 2

Duodenal atresia definition

- Congenital complete obstruction of duodenum.

Duodenal atresia diagnostics & sympoms

Prenatal ultrasound (polydramnion, double bubble/2 levels of amniotic fluid)

Postnatal Xray (double bubbel/2 air and fluid levels)

Vomiting with bile

low birth weight,feeding intolerance

Duodenal atresia Treatment

Urgent surgery - 24-72h - Duodeno-duodenostomy (connect both sides)

Postoperative: nasogastric tube (decompression) & Trans-Anastomotic Tube (feeding) 2 weeks

Jejuno-ileal atresia

atresia of small intestine

type depends on length of gastrointestinal trackt

proximal part verry swollen, distal part underdeveloped as never been used

Jejuno-ileal atresia diagnostics

prenatal ultrasound, polyhydramnion/dilated intestinal loops, gas/fluid levels

fetal MRI

Xray

vomiting with bile

distended abdomen

asymptomatic at start while GI tract fills up

risk for short bowel syndrome

Jejuno-ileal atresia treatment

The lower the obstruction the more urgent

immediate (first 6h) surgical resection/anasomosis (flush after surgery to see if successful)

Complications - Short bowel syndrome, Sepsis, Adhesions

Hirschsprung Disease defintion

ganglior Nerves missing from intestine (large)

Hirschsprung Disease Sympoms & complications

Constipation - failure to pass meconium after birth

abdominal swelling, vomiting, poor weight gain

Downsyndrome (likned with genetic mutation)

Complications:
Hirschsprung assosciated enterocolitis (fever, foul smelly diarrhea → antibiotics)
parts of transition zone failrd to remove

Hirschsprung Disease Diagnosis

Rectal biopsy

Anorectal manometry, barium enema (picture, contrast Xray)

Enema determines severity

Hirschsprung Disease treatment

pull-through surgery- removeal of aganglionic segment and transition zone

Hypertrophic Pyloric Stenosis (HPS) definition

Progressive thickening of the pyloric sphincter muscle creating a high-grade gastric outlet obstruction.

Hypertrophic Pyloric Stenosis (HPS) complications

leading to a functional gastric outlet obstruction

linked to neonatal exposure to macrolide antibiotics (erythromycin)

Hypertrophic Pyloric Stenosis (HPS) sympoms

Non bile vomiting, hungry

olive sign - olive shaped mass in right upper quadrant

Visible Peristalsis
Alkalosis

Hypertrophic Pyloric Stenosis (HPS) treatmet

Abdominal ultrasound - gold standard

feeding started gradually hours after operation

Stop oral feeding, IV fluids/electrolytes/salin/potassium

Surgical repear if no alkalosis (→ postoperative apnea)

Ileus definition

Gastrointestinal tract evacuation disorders (movment disturbances) of any origin

Illeis classification

illeus diagnostic & sympoms

Lab: leikocytosis, cytokines, blood gas, electrolytes

Xray - small and large bowel with air/fluid levels

US, MRI

Endoscopy - fibrogastroduodenoscopy, colonoscopy

SYmpoms:
Abdominal pain
bile/non bile bloody vomiting/stool

abnomral bowl sounds

ileus treatment

Gastrointestinal decompression (nasogastric tube)
NSAIDS
Fluid resucitation

non surgical management for up to 72h if surgery not indicated
Surgical indications: peritonitits, stragulation, bowel ischemia

ileostomy/colostomy Surgery: laparoscopy, laparotomy - remove cause of GI obstruction