Hernias
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Definition A protrusion of an organ or structure through the wall that normally contains it. Can entrap the intestines and cause intestinal blockage
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Umbilical hernia Usually congenital, appears at birth. Many resolve on their own, but might need surgery.
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Diaphragmatic or hiatal hernia Protrusion of stomach through the diaphragm via the esophageal hiatus. Can cause GERD. Acid suppression might help, but can do surgery.
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Incisional hernia Associated w/ vertical incisions, especially in obese pts. or if they have a wound infx.
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Indirect inguinal hernia More common, passage of intestine through the internal inguinal ring down the inguinal canal. May pass into the scrotum.
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Direct inguinal hernia Passage of intestine through the external inguinal ring at Hesselbach's triangle. Rarely enters scrotum.
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Femoral inguinal hernia Least common. Passes through the femoral ring.
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Treatment (all hernias) Surgical
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Lactose Intolerance (metabolic)
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General Lactose normally digested by lactase, which is produced in the SI. For a lot of the world's population, lactase production doesn't continue after age 12 --> lactose products not digested
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Symptoms Nausea, bloating, flatulence, diarrhea, cramping, vomiting
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Management Avoid dairy. Use lactase enzyme tablets.
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Esophageal Atresia (congenital)
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Commonly associated with tracheoesophageal fistulae
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Clinical presentation in newborns Excessive saliva and choking/coughing during feeding attempts
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Diagnosis Inability to pass an NG tube
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Treatment Surgical (use suction and withholding of oral feedings meanwhile to prevent pulmonary aspiration)
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Pyloric Stenosis (congenital)
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Definition The gastric outlet is obstructed by pyloric hypertrophy, M>>F
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Clinical Features Progressive, non-bilious projectile vomiting in a child who remains hungry, 4-6 weeks old. Weight loss + dehydration common. Might feel an olive-shaped mass adjacent to umbilicus after vomiting.
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Lab Findings U/S, barium swallow will show "string-sign"
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Treatment Surgery
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Phenylketonuria (metabolic)
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Definition Rare AR inability to metabolize the protein phenylalanine
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Consequences Phenylalanyne and its metabolites accumulate in the CNS --> causing MR and movement disorders
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How is it detected/managed early on? Screening at birth
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Consequences if not detected by age 3? Irreversible brain damage
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Management Low-phenylalanine diet + tyrosine supplement. Strict protein intake for life.
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Diaphragnatic hernia (congenital)
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Clinical presentation in newborn Immediate respiratory distress *the affected lung is compressed by pressure from abdominal contents)
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Diagnosis If bowel sounds are heard in the chest
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Radiography Shows loops of bowel in the involved hemithorax + displacement of heart and mediastinal structures
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Treatment Surgery
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Bowel Atresia (congenital)
- Occurs in ileum mosts commonly
- Presents with signs of obstruction in first few days of life |
Hirschsprung's disease
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AKA Congenital megacolon
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Definition Congenital absence of Meissner's and Auerbach's autonomic plexuses enervating the bowel wall
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Symptoms Constipation, obstipation, vomiting, failure to thrive
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Treatment Surgical resection of affected bowel
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