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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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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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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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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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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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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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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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