Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pediatric GI Disorders - Coggle Diagram
Pediatric GI Disorders
Malrotation
Embryology
4 Main Steps: Herniation, Rotation, Retraction, Fixation
-
Normal Rotation: DJ flexure lies in LUQ, IC junction lies in RLQ, base of small bowel mesentery
-
Clinical Presentation
Acute
Present in 1st month of life, but develops feeding difficulties with bilious vomiting, develops abdominal distension with tenderness or erythema and blood per rectum
Chronic
Frequent vomiting, intermittent crampy abdominal pain, diarrhea or constipation, Hematemesis, Malabsorption of failure to thrive
Treatment
-
Surgery: Derotation of a midgut volulus, divid Ladd's bands, breaden amse of mesetery, appendectomy
-
Pyloric Stenosis
Clinical Presentaion
Age (2-8 Weeks), Progressive projectile non bilious emesis, Dehydration (fontanelle, eyes, Mucous membranes, skin turgour, urinary output), Jaundice
DDx
Pyloric Stenosis, Feeding intolerance, GERD, Infections (UTI, CNS, GI)
Physical Exam
Palpable olive in RUQ, or epigastrium, Visible gastric peristaltic waves, Gastric distension
-
Pre Operative Care
Metabolic Alkalosis, Hypochloremia, Hypokalemia, Paradoxical aciduria
Treatment
Priority: Fluid resuscitation, and correcting electrolyte and metabolic abnormalities
-
Meckel's Diverticulum
Embryology
-
Proximal portion of canal does not close completely -> Diverticulum is left on anti mesenteric side of distal small intestine
-
Clinical Presentation
Bleeding
-
-
-
Blood loss may be massive to lower hemoglobin, necessitating a blood transfusion
-
-
Inflammation
-
DDx: Gastroenteritis, Chron's, Peptic Ulcer, Biliary Colic
Intussusception
-
Investigations
Pseudokidney Sign
Target/doughnut Sign
-
-
Hirschsprung's Disease
Embryology
Neuroblasts from neural crest precursors at 5th week gestation begin maturation, and caudal migration
From Proximal to distal
6th week: Ganglion in esophagus, 8th week gestation: Ganglion on T colon, 12 week gestation: Ganglion in rectum
Etiology
Interrupted development of myenteric nervous system leading to absence of interstitial ganglion cells
-
Pathophysiology
Relative reduction in NOS, failure to relax
-
-
Presentation
90% in neonateal period
Delayed passage of meconiumn, bilious vomiting, abdominal distension, explosive diarrhea on rectal exam
Beyond neonatal period
Chronic constipation, abdominal distension, malnutrition, failure to thrive and short stature
Investigations
Contrast enema (Recto,sigmoid ratio) , Manometry (Internal sphincter tone elvated, absence of relaxation of internal sphincter with rectal distension), Rectal biopsy (absence of ganglion cells, hypertrophic nerve trunks, msucualr hypertrophy)
Treatment
Preoperative: Fluid resuscitation, antibiotics, Rectal wash outs
Surgery: Resection of aganglionic colon, anastomosis 1cm above dentate line