CC March 2016 Duodenal atresia

echoecho's version from 2016-06-05 19:17


Question Answer
Congenital duodenal atresia complicates about 1 in _____ to ____ births in the US?2,500; 40,000
First described in Great Britian in early 18th century, DA was fatal until advances were made in the 20th century and survival currently exceeds ____%?90
Describe DA?proximal duodenum ends in a blind pouch, as does the distal duodenum, most commonly in the region of the ampulla of Vater
Define duodenal stenosis?when a tenuous connection occurs between the two segments (proximal duodenuma nd distal duodenum)
Etiology of DA?unknown but it often occurs in patients with intestinal malrotations
Up to 1/3 of patients with DA have what syndrome (but this is not considered an independent risk factor)?Down
*** In one European study, up to 1/2 of children ultimately diagnosed with the disorder had it detected by what? prenatal US
What is the ultrasonographic sign of DA?"double bubble" (dilated small intestine seen both proximal and distal to the obstruction)
Prenatal dx allows what to be arranged?for delivery at a teritary care center where surgical correction can be accomplished after delivery
Why should DA be evaluted immediately?because of the presentation of repetitive bilious vomiting in the hours after birth. Epigastric fullness may also be present
If DA is left uncorrected, what can occur?dehydration, weight loss and hypokalemia
Plain x-ray of the abdomen shows what in DA? What other view can futher demonstrate the obstruction?1) double bubble sign 2) lateral decubitus view
What does lack of bowel gas in the distal small intestine and large intestine mean?complete atresia
What should be corrected preoperatively?dehydration and electrolyte abnormalities
What is the definitive treatment of DA?duodenoduodenostomy (either open or laparoscopic)
Where do the infants recover after surgery?NICU
List the late complications from surgery, althouth uncommon?1) gastritis 2) pancreatitis 3) cholecystitis 4) GERD
Define pyloric stenosis?1) typically presents at 3-6 weeks of life 2) projectile vomiting 3) classic "olive" mass in right upper quadrant
Define volvulus?1) associated with intestinal malrotation 2) may occur withother intestinal obstructions but would not show the above radiographic findings
Define Hirschsprung's disease?1) failure to pass meconium 2) subsequent bilious vomiting and abdominal distention as the distal intestinal obstruction worsens
Define esophageal atresia?1) excessive oral secreations and respiratory distress especially after feeding 2) does not present with bilious vomiting
*** SUMMARY = Prenatal dx is possible with US, what is seen?"double-bubble" (dilated small intestine seen both proximal and distal to the obstruction)
*** SUMMARY = Presentation of DA is what?1) repetitive bilious vomiting 2) epigastric fullness
*** SUMMARY = What is the definitive treatment?duodenoduodenostomy