Duodenal atresia: Difference between revisions

Revision as of 19:12, 21 August 2019

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

Presentation is very early in the postnatal period

Abdominal distention and bilious emesis within first 24 hours of birth
- Abdomen often markedly distended, with visible or palpable loops of bowel
- NG tube aspirate >20 mL
Signs of dehydration (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle)
+/- Signs of other congenital anomalies

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

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

Authors:

@@ Line 8: / Line 8: @@
 ==Clinical Features==
 ''Presentation is very early in the postnatal period''
+*Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth
-===History===
+**Abdomen often markedly distended, with visible or palpable loops of bowel
-*Abdominal distention and bilious emesis within first 24 hours of birth
+**NG tube aspirate >20 mL
+*Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle)
-===Physical Exam===
+*+/- Signs of other congenital anomalies
-*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
-*NG tube aspirate >20 mL
-*Examine perineum and assess for patency of the anus
 ==Differential Diagnosis==
-*Malrotation with volvulus
+*Malrotation with [[volvulus (peds)|volvulus]]
-*Hirschsprung disease
+*[[Hirschsprung's disease]]
-*Meconium ileus
+*Meconium [[ileus]]
-*Intestinal atresia
+*Other intestinal atresia
 {{N/v peds newborn}}
@@ Line 36: / Line 31: @@
 *NPO
 *NG tube to suction
-*Correct fluid and electrolyte abnormalities
+*Correct fluid and [[electrolyte abnormalities]]
 *[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection)
 *Surgery