Medicine an Surgery notes

Apr 24th, 2015
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INTESTINAL OBSTRUCTION IN PEDRIATRICSCommon Causes of intestinal obstruction A. Extramural causes1.Congenital hernia2.Malrotation 3.Peritoneal bands or volvulus4.Annular pancreasB. Intra luminal causes1.Intestinal atresia or stenosis2.Congenital hypertrophic pyloric stenosis3.Meconium ileus4.Meconium plug syndrome5.Feccal impaction6. Intussusceptions7.Anorectal malformation .Also involve the wall defectsC. Mural causes/within wall1.Hirschsprung's disease2. Neonatal small left colon syndrome.3.Paralytic ileus-infections, electrolyte imbalancesClinical presentationThe cardinal signs and symptoms of intestinal obstruction are (1) Polyhydramnios in the mother-prenatal diagnosis(2) Vomiting(3) Abdominal distention(4) Failure to pass meconium 1-Polyhydramnios is related to the level of obstruction and occurs in approximate 5% of women who have infants with duodenal atresia and 15% of those who have infants with ileal atresia.2-Vomiting occurs early in upper intestinal obstruction, and it is bile-stained if the obstruction is distal to the ampulla of Vater. Lead to:Dehydration - most commonly in small bowel obstruction Signs of Shock - ?urine output (Children- 0.5-1ml/Kg/hr), ?pulses, ?BPHypochloraemic metabolic alkalosis with Paradoxical aciduriaHypokalaemia-loss of electrolytes in vomiting.3-Abdominal distention is related to the level of obstruction, being most marked for distal obstructions. 4-Failure to pass Meconium is passed in 30-50% of newbo

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