A protrusion of an organ or structure through the wall that normally contains it. Can entrap the intestines and cause intestinal blockage
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.
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)
Lactose Intolerance (metabolic)
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
Nausea, bloating, flatulence, diarrhea, cramping, vomiting
Avoid dairy. Use lactase enzyme tablets.
Esophageal Atresia (congenital)
Commonly associated with
Clinical presentation in newborns
Excessive saliva and choking/coughing during feeding attempts
Inability to pass an NG tube
Surgical (use suction and withholding of oral feedings meanwhile to prevent pulmonary aspiration)
Pyloric Stenosis (congenital)
The gastric outlet is obstructed by pyloric hypertrophy, M>>F
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.
U/S, barium swallow will show "string-sign"
Rare AR inability to metabolize the protein phenylalanine
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
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)
If bowel sounds are heard in the chest
Shows loops of bowel in the involved hemithorax + displacement of heart and mediastinal structures
Bowel Atresia (congenital)
- Occurs in ileum mosts commonly
- Presents with signs of obstruction in first few days of life
Congenital absence of Meissner's and Auerbach's autonomic plexuses enervating the bowel wall
Constipation, obstipation, vomiting, failure to thrive
Surgical resection of affected bowel