Pediatrics

TEST TAKING TIPS

Is bilious vomiting a surgical emergency in the newborn and why?

• Must rule out malrotation with mid-gut volvulus in a patient with proximal obstruction because the gut can be strangulated (time = bowel).

• Differential diagnosis—(memorize this list—the ABSITE will point you toward one of these!) annular pancreas, malrotation, jejunoileal atresia, meconium ileus, meconium plug syndrome, duodenal web/atresia, Hirschsprung, hypoplastic left colon. Always remember 1 anomaly begets additional associated anomalies.

Meconium ileus is associated with what anomaly?

• Cystic fibrosis

Duodenal atresia and malrotation are associated with what anomaly?

• Down syndrome

What other abnormalities are associated with malrotation?

• Diaphragmatic hernia, jejunoileal atresia, abdominal wall defects

Which abdominal wall defects are associated with malrotation?

• Both omphalocele and gastroschisis

What is the diagnostic study of first choice to rule in malrotation with midgut volvulus?

• Upper gastrointestinal

Surgical procedure for malrotation:

• Ladd procedure

• Counterclockwise rotation, divide peritoneal bands crossing the duodenum, position SB to right and colon to the left

• Look for other abnormalities (see above)

• Appendectomy (cecum is now on the left side of the abdomen, perhaps delaying the diagnosis of acute appendicitis.)

Why do patients with malrotation have bilous vomiting?

• Ladd bands cross the duodenum

• Remember that BILIOUS vomiting in newborn is malrotation until proven otherwise. (most common presentation)

Why is blood flow to ...