Duodenal atresia: Difference between revisions

Revision as of 11:54, 7 February 2016

Background

During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10
Duodenal atresia is thought to result from failure of recanalization
Often associated with other malformations such as biliary atresia or gallbladder agenesis
May also be associated with cardiac, renal, or vertebral abnormalities
About a quarter of patients born with duodenal atresia have Downs syndrome

Clinical Features

Presentation is very early in the postnatal period

History

Abdominal distention and vomiting

Physical Exam

Dry mucus membranes, poor skin turgor, and sunken fontanelle
Signs of other congenital anomalies
The abdomen is often markedly distended with visible or palpable loops of bowel
Examine perineum and assess for patency of the anus

Differential Diagnosis

Malrotation with volvulus
Hirschsprung disease
Meconium ileus
Intestinal atresia

Nausea and vomiting (newborn)

Newborn	'
Obstructive intestinal anomalies	Esophageal stenosis/atresia Pyloric stenosis Intestinal stenosis/atresia Duodenal atresia Malrotation ± volvulus Incarcerated hernia Meconium ileus/plug Hirschsprung's disease Imperforate anus Enteric duplications
Neurologic	Intracranial bleed/mass Hydrocephalus Cerebral edema Kernicterus
Renal	Urinary tract infection Obstructive uropathy Renal insufficiency
Infectious	Viral illness Acute gastroenteritis Meningitis Sepsis
Metabolic/endocrine	Inborn errors of metabolism Adrenal insufficiency Congenital adrenal hyperplasia
Miscellaneous	Ileus Gastroesophageal reflux disease Necrotizing enterocolitis Milk allergy, FPIES GI perforation

Diagnosis

Imaging
- AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction
- Classic double bubble sign due to dilation of the stomach and proximal duodenum
- Absent distal gas

Management

- NPO
- NG tube to suction
- Correct fluid and electrolyte abnormalities
- Ampicillin and gentamicin (to prevent post-op infection)
- Surgery

Disposition

Admission

References

Authors:

@@ Line 2: / Line 2: @@
 *During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10
 *Duodenal atresia is thought to result from failure of recanalization
-==Clinical Features==
-*Often presents with gastric distension and vomiting
 *Often associated with other malformations such as biliary atresia or gallbladder agenesis
 *May also be associated with cardiac, renal, or vertebral abnormalities
 *About a quarter of patients born with duodenal atresia have Downs syndrome
-*Presentation is very early in the postnatal period
+==Clinical Features==
+''Presentation is very early in the postnatal period''
-*History
+===History===
-**Often includes history of abdominal distention and vomiting
+*Abdominal distention and vomiting
-**Obtain hx of whether vomiting is bilious or nonbilious and if vomiting follows feeds
-*Physical Exam
+===Physical Exam===
-**Dry mucus membranes, poor skin turgor, and sunken fontanelle
+*Dry mucus membranes, poor skin turgor, and sunken fontanelle
-**Document signs of other congenital anomalies
+*Signs of other congenital anomalies
-**The abdomen is often markedly distended with visible or palpable loops of bowel.
+*The abdomen is often markedly distended with visible or palpable loops of bowel
-**Examine perineum and assess for patency of the anus
+*Examine perineum and assess for patency of the anus
 ==Differential Diagnosis==
@@ Line 39: / Line 36: @@
 **NG tube to suction
 **Correct fluid and electrolyte abnormalities
-**Ampicillin and gentamicin (to prevent post-op infection)
+**[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection)
 **Surgery