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