INTESTINAL OBSTRUCTION
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INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
By: Brig Mushahid AslamBy: Brig Mushahid Aslam
“Neither sun shall rise nor set on patient of intestinal obstruction”
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SequenceSequence
Duodenal AtresiaDuodenal Atresia
Jejuno-ileal AtresiaJejuno-ileal Atresia
Meconium IleusMeconium Ileus
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Definitions AgenesisAgenesis absence of organ or primordiumabsence of organ or primordium AplasiaAplasia absence of organ due to failure absence of organ due to failure
of of primordiumprimordium AtresiaAtresia absence of an openingabsence of an opening HypoplasiaHypoplasia incomplete development of an incomplete development of an
organorgan HyperplasiaHyperplasia overdevelopment of an organoverdevelopment of an organ DysplasiaDysplasia abnormal cell organizationabnormal cell organization
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Duodenal AtresiaDuodenal Atresia
1: 50001: 5000 Associated AnomaliesAssociated Anomalies
Down’s Syndrome 30 % Congenital Heart Diseases Malrotation Anorectal Malformations
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Congenital Atresia of the Small Intestine“Vascular Accidents”
blood supply to a region of the bowel is compromised and a segment “dies”,
resulting in narrowing or complete loss of that region
50%a
region of the bowel
is lost
20%a
fibrous cord remains
20%narrowing, with a thin diaphragm
separating the larger and smaller pieces of
bowel
N.B. stenoses (5%) and multiple atresias (5%) account for the remaining defects
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PresentationPresentation AntenatalAntenatal
USG Polyhydramnios Distended stomach and 1st part Duodenum
NewbornNewborn Feeding Intolerance Bilious Vomiting Scaphoid Abdomen Failure to pass Meconium
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AssociationAssociation
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TypesType I:Complete membrane obstructing the lumen
Type II:A pouch with a fibrous cord connecting to the distal duodenum
Type III:blind-ending pouch with no connection to the distal duodenum
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InvestigationsInvestigations
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ManagementManagement
NPONPO Nasogastric aspirationNasogastric aspiration Intravenous fluidsIntravenous fluids AntibioticsAntibiotics SurgerySurgery
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5’ Hs5’ Hs
HypothermiaHypothermia HypoxiaHypoxia HypovolemiaHypovolemia HypoglycaemiaHypoglycaemia HypoprothrombinaemiaHypoprothrombinaemia
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ManagementManagement
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ManagementManagement
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Jejuno-ileal Atresia Jejuno-ileal Atresia
1/2000 1/2000 Vomiting Vomiting Abdominal DistensionAbdominal Distension Failure to pass meconiumFailure to pass meconium
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Pathogenesis
Mesenteric vascular accidents during early embryologic development infarction organization + resorption of the necrotic segment The bowel segment distal to the atresia may contain meconium, indicating previous continuity of the intestine
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Types Types
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Types Types
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“APPLE PEEL” ATRESIA
CONGENITAL MIDGUT ATRESIA
TypesTypes
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InvestigationsInvestigations
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ManagementManagement
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ManagementManagement
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Meconium IeusMeconium Ieus
30 % intestinal obstruction30 % intestinal obstruction Associated AnomaliesAssociated Anomalies
Cystic Fibrosis 15% Atresia Malrotation
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PresentationPresentation
NewbornNewborn Feeding Intolerance Bilious Vomiting Abdominal Distention Failure to pass Meconium
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InvestigationsInvestigations
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TreatmentTreatment
Hypertonic Enema WashoutsHypertonic Enema Washouts Gastrograffin 25-50 %
Effective 30-60 % cases
N-Acetyl cysteine 10 %
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ManagementManagement
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