NEONATAL LOWER INTESTINAL OBSTRACTION. Lower GI Obstraction.
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Transcript of NEONATAL LOWER INTESTINAL OBSTRACTION. Lower GI Obstraction.
NEONATAL LOWER NEONATAL LOWER INTESTINAL INTESTINAL
OBSTRACTIONOBSTRACTION
Lower GI ObstractionLower GI Obstraction
Distal ObstructionDistal Obstruction
Signs of Intestinal Signs of Intestinal Obstruction:Obstruction:
1- pain>colic 1- pain>colic
2-vomiting >depend on the level2-vomiting >depend on the level
3-distention> the distal the obstruction the 3-distention> the distal the obstruction the more the distentionmore the distention
4-absolute constipation > early in large 4-absolute constipation > early in large bowel & late in small bowel .bowel & late in small bowel .
Hirchsprung’s DiseaseHirchsprung’s Disease
Barium EnemaBarium Enema
-common in males-common in males
-recto-sigmoid is most common-recto-sigmoid is most common
-s/s:failure to pass meconium in the 24h of life( imp)-s/s:failure to pass meconium in the 24h of life( imp)
,abdominal distention ,bilious vomiting ,abdominal distention ,bilious vomiting - In older children> constipation In older children> constipation - Dx: xray >dilated colonDx: xray >dilated colon
PR> gush of stoolsPR> gush of stools
unprepared enema> retention of bariumunprepared enema> retention of barium
Biopsy (gold one) Biopsy (gold one)
-Rx:- resuscitation-Rx:- resuscitation
- pull through procedure ( can be done after - pull through procedure ( can be done after colostomy) colostomy)
Cutaneous fistula rectourethral fistulaCutaneous fistula rectourethral fistula
Anorectal MalformationAnorectal Malformation
Cutaneous fistulaCutaneous fistula
recto-vistibular fistularecto-vistibular fistula
ARM( invertogram) ARM( invertogram)
Invertogram Cross table
ARM(rectal gas)ARM(rectal gas)
Distal LoopogramDistal Loopogram
Recto urethral Fistula
Colostomy PSARPColostomy PSARP
-It can be high or low type according to puborectalis -It can be high or low type according to puborectalis -low> female > recto-vistibular fistula-low> female > recto-vistibular fistula
-high> male> recto vasical-high> male> recto vasical
-associated with VACTERL -associated with VACTERL
-s/s:no anus ,fistula, UTI, bowel obstruction.-s/s:no anus ,fistula, UTI, bowel obstruction.
-Dx: physical examination ( the imp)-Dx: physical examination ( the imp)
cross table cross table
invertogram invertogram
xray> for rectal gas xray> for rectal gas
USUS
Rx:Rx:
Low type with fistula>>repair the fistula & Low type with fistula>>repair the fistula & anoplastyanoplasty
High type>>colostomy then anoplastyHigh type>>colostomy then anoplasty
X-Ray Muconium ileusX-Ray Muconium ileus
Muconium ileusMuconium ileus
Muconium ileusMuconium ileus
-solid muconium-solid muconium-15% of cyctic fibrosis 15% of cyctic fibrosis
-s/s: bilious vomiting ,distention ,no passing of -s/s: bilious vomiting ,distention ,no passing of meconiummeconium
Dx: FHx of CF, Xray ( air fluid levels- soap Dx: FHx of CF, Xray ( air fluid levels- soap bubble ) , enema ( microcolon)bubble ) , enema ( microcolon)
-Rx: non-surgical>>>Gastrografin enema & -Rx: non-surgical>>>Gastrografin enema & pancreatic enzymes replacement pancreatic enzymes replacement
If not surgically by ( enterotomy )If not surgically by ( enterotomy )
Muconium PlugMuconium Plug it is a major DDx of it is a major DDx of Hirchsprung’s DiseaseHirchsprung’s Disease
Colonic AtresiaColonic Atresia