What is gastroesophageal reflux?
Intrusion of acids into the dilated esophagus resulting into the deterioration of the esophagus' epithileum & stimulation of the vomiting reflex.
What is the etiology of gastroesophageal reflux?
Low cardiac sphincter pressure
Short cardiac sphincter
Transient/prolonged relaxation of LES
Poor coordination of esophageal motility
What are signs & symptoms of GERD?
Crying w/ feeding
Choking/gagging with feeding
What medical problems can GERD lead to?
Poor weight gain
How do you diagnose GERD?
Clinical s/s often adequate to diagnose
Esophageal pH monitoring w/ a probe for 24 hrs
What is the treatment for GERD?
Usually resolves w/ age
Mild GERD = no treatment.
Thickened feeds OR small frequent feeds w/ freq. burping
Gastric acid blockers, metoclopramide (reglan), & antacids
Surgery (gastropexy or fundoplication - recreates a valve by wrapping fundus of stomach around the esophagus)
What is esophageal atresia (EA)?
When the esophagus ends in a blind pouch & does not connect to the stomach
Can happen in conjunction w/ tracheoesophageal fistula
What is a tracheoesophageal fistula (TEF)?
An abnormal connection btwn the esohagus & the trachea
Can happen in conjunction with esophageal atresia
What is the etiology of esophageal atresia & tracheosophageal fistula?
An incomplete division of the oforegut into the respiratory & digestive portions at wk 4 of gestation.
Esophageal atresia & tracheoesophageal fistula can be an isolated defect or appear as part of what syndrome(s)?
VATER, VACTERL, & CHARGE
What does VATER syndrome/ VATERL syndrome stand for?
Anomalies of the following:
What does CHARGE syndrome stand for?
Atresia of nasal passage/choana
Retardation of growth/dvlpment
What are prenatal s/s of esophageal atresia & tracheosophageal fistula?
no stomach bubble in US
What are postnatal s/s of esopheal atresia & tracheoesophageal fistula?
OG/NG tube does not pass
Respiratory distress w/ feeds
Abdominal distention (TEF when abdomen fills w/ air)
What is the treatment for esophageal atresia & tracheosophageal fistula?
Usu. diagnosed @ birth
Inability to pass NG/OG tube
What medical problems can esophageal atresia & tracheoesophageal fistula lead to?
What is the treatment for esophageal atresia & tracheoesophageal fistula?
Surgery to restore esophageal continuity & eliminate fistula.
What is duodenal atresia?
The complete closure of the duodenum - causes an intrinsic obstruction
What is the etiology of duodenal atresia?
Failure of bow to recannulize in 2nd month of gestation.
What are prenatal s/s of duodenal atresia?
What symptom is a medical emergency until proven otherwise?
What are postnatal s/s of duodenal atresia?
Bilious emesis - 1st 24 hrs of life
Abdominal distention of upper quadrants
KUB = double bubble (see pic showing air trapped in stomach & air trapped in proximal duodenum; separated by the pyloric sphincter - why looks like double bubble)
What is the treatment for duodenal atresia?
What disorders have a high rate of association w/ duodenal atresia?
What extrinsic causes could result in duodenal obstruction?
What is an annular pancreas?
when the pancreas surrounds the second part of the duodenum causing constriction or blockage of the intestines.
What is the etiology of the annular pancreas?
when the ventral bud rotates counter-clockwise
What are the s/s of annular pancreas?
Low birth weight
What is the treatment for annular pancreas?
Surgical bypass of the blocked part of the duodenum
What is a malrotation?
When the intestines fail to rotate properly and affix improperly (the cecum ends up in the RUQ instead RLQ) & an abnormal membrane called the Ladd's band may obstruct the duodenum (see pic)
Leads to an increase likelihood of volvulus.