BIOMED
Pathophysiology
Everything be alphabetical here (except for Homeostasis at the bottom) 😘
(& Mental Health, Lmao)
There are a lot of neonatal conditions covered, seen in high level NICU/NCCU Units.
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Table of Contents:
1 | Ageing
2 | Canc...
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Jejunoileal Atresia This form of atresia is an obstruction of the jejunum (middle region) or ileum (lower region) of the small intestine. The duodenum before the point of obstruction becomes severely dilated, hindering ability to absorb nutrients and propel contents through the GI tract.
10 to 15% of these infants will have a portion of the intestine die during fetal development, and a significant percentage of infants also have anomalies of intestinal rotation and fixation, as well as cystic fibrosis that is an associated disorder that can seriously complicate management of this form of atresia. All babies with jejunoileal atresia.
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There are four kinds of jejunoileal atresia.
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Regardless of subtype, infants will usually present with bilious vomit within 24 hours of life. If the obstruction is farther down however, vomiting might begin until two to three days later.
Infants will have a distended abdomen and no expected bowel movement during first day of life. Abdominal X-ray will be taken on these symptoms to establish a diagnosis.
Colonic Atresia Rare, with less than 15% of all intestinal atresias, in colonic atresia, the bowl becomes severely dilated and the patient will display symptoms similar to jejunoileal atresia. This may occur with small bowel atresia, Hirschsprung's disease (see chap for more info), or gastroschisis (see chap for more info).
Diagnosis of Atresia & Stenosis Prenatal ultrasound can pick up polyhydramnios (excess amniotic fluid) caused by failure of the intestine to properly absorb the amniotic fluid, indicating that there may be an intestinal atresia or stenosis present. If this is suspected, neonates will undergo these diagnostics post stabilisation.
Abdominal X-ray to establish a diagnosis, lower GI series (x-ray contrast per rectum) to examine rectum, large intestine and lower small intestine, upper GI series using barium via NGT to assess for upper GI obstruction (pyloric or duodenal atresia), and an abdominal ultrasound to view internal organs and their function as well as blood flow.
Echocardiography may be chosen to be undertaken to assess for cardiac abnormalities.
Treatment Atresia and stenosis require surgical correction, however surgical options differ depending on the location of the obstruction. Newborns must be stable before undergoing surgery, with all distension decompressed via NGT aspirates. To avoid dehydration from vomiting, intravenous fluid replacement will be given.
Management Post-operatively Babies will have an NGT left insitu until bowel function returns to normal, which could take from a few days to several weeks. In this time, nutrition is administered intravenously, before upgrading to NGT feeds once intestinal function normalises.
These children will however require follow up to monitor growth and development, as well as assessment of nutritional deficiencies (especially in cases where there was removal of a portion of the intestine).
Most babies however do well, and post-op complications are rare.
