Duodenal atresia: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Peds" to "Category:Pediatrics") |
ClaireLewis (talk | contribs) |
||
| (8 intermediate revisions by 5 users not shown) | |||
| Line 2: | Line 2: | ||
*During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10 | *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 | *Duodenal atresia is thought to result from failure of recanalization | ||
*Often associated with other malformations such as biliary atresia or gallbladder agenesis | *Often associated with other malformations such as [[biliary atresia]] or gallbladder agenesis | ||
*May also be associated with cardiac, renal, or vertebral abnormalities | *May also be associated with cardiac, renal, or vertebral abnormalities | ||
*About a quarter of patients born with duodenal atresia have | *About a quarter of patients born with duodenal atresia have [[Down syndrome]] | ||
==Clinical Features== | ==Clinical Features== | ||
''Presentation is very early in the postnatal period'' | ''Presentation is very early in the postnatal period'' | ||
*Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth | |||
**Abdomen often markedly distended, with visible or palpable loops of bowel | |||
*Abdominal distention and vomiting | **[[NG tube]] aspirate >20 mL | ||
*Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle) | |||
*+/- Signs of other congenital anomalies | |||
* | |||
*Signs of other congenital anomalies | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Malrotation with volvulus | *Malrotation with [[volvulus (peds)|volvulus]] | ||
*Hirschsprung disease | *[[Hirschsprung's disease]] | ||
*Meconium ileus | *Meconium [[ileus]] | ||
* | *Other intestinal atresia | ||
{{N/v peds newborn}} | {{N/v peds newborn}} | ||
== | ==Evaluation== | ||
[[File:DuodenalAtresiaXR.png|thumb|Double Bubble sign]] | |||
*Imaging | *Imaging | ||
**AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction | **AP, lateral, and cross table [[KUB|XR]] should be obtained on all infants with concern for obstruction | ||
**Classic double bubble sign due to dilation of the stomach and proximal duodenum | **Classic double bubble sign due to dilation of the stomach and proximal duodenum | ||
**Absent distal gas | **Absent distal gas | ||
| Line 34: | Line 31: | ||
==Management== | ==Management== | ||
*NPO | *NPO | ||
*NG tube to suction | *[[NG tube]] to suction | ||
*Correct fluid and electrolyte abnormalities | *Correct [[IVF|fluid]] and [[electrolyte abnormalities]] | ||
*[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection) | *[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection) | ||
*Surgery | *Surgery | ||
| Line 43: | Line 40: | ||
==References== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Surgery]] | |||
Latest revision as of 16:30, 28 October 2019
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 Down syndrome
Clinical Features
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
Differential Diagnosis
- Malrotation with volvulus
- Hirschsprung's disease
- Meconium ileus
- Other intestinal atresia
Nausea and vomiting (newborn)
| Newborn | ' |
| Obstructive intestinal anomalies |
|
| Neurologic |
|
| Renal |
|
| Infectious | |
| Metabolic/endocrine | |
| Miscellaneous |
|
Evaluation
- 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