Tracheoesophageal Fistula and Esophageal Atresia
Features	Fistula + Atresia (many types)
S/S	·       Pt is salivating /drooling ·       failure to pass NG tube
Dx	X-Ray –> coiling of NG tube ·       You have to check for VACTREL (before surgery) o   Echo –> Heart o   X-ray –> vertebra o   US –> Kidney o   Examine anus –> imperforate anus
Tx	Surgical correction

Imperforate anus
Features	can be part of VACTREL
S/S	no asshole
Dx	·       dx on PEx –(then)–> Do X-ray (crosstable) “upside down so that air goes up” to check extent of dz. ·       You have to check for VACTREL (before surgery) o   Echo –> Heart o   X-ray –> vertebra o   US –> Kidney
Tx	·       If mild (close to the tract): surgery now! ·       If severe (far from tract) ·       Check for opening (fistula) –⊕–> Surgery before toilet training ·       No fistula –––––––> colostomy ––––––> ⤴️

Diaphragmatic hernia
S/S	·       Bowel sounds in chest ·       always left ·       scaphoid abdomen ·       issue is hypoplastic lung!!!! not the hernia
Dx	1˚ Intubate 2˚ NGT 3˚ X-ray
Tx	·       Delay repair 3-4 days to allow lung to mature ·       Intubate + ventilate + sedate + NG tube suction ·       Surgery

Days to months

 

	Pyloric Stenosis
S/S	·       non-billous vomiting ·       Olive shaped mass
Dx	1˚: CHEMISTRY 2˚ US
Tx	1˚ Correct electrolytes 2˚ Surgery

	NEC
S/S	Premature baby First fed –> doesn’t like it Abd distension Bloody BM ⤵️ PLT
Dx	X-Ray –> air in intestine wall
Tx	NPO + IV nutrition + IV Abx Surgery if ·       Medical management fails ·       Erythema of abdomen ·       Air in portal vein or peritoneum

	Meconium illius
S/S	CF Baby FTPM
Dx	x-ray: air fluid levels + Ground glass appearance
Tx	Gastrofringin enema (water-soluble enema) is both dxic & txic.

	Biliary atresia
S/S	No billiary tree Persistant DIRECT/CONJUGATED jaundice for 6-8 weeks
Dx	Phenobarbital → HIDA scan ·       give it for 1 week ·       then do HIDA
Tx	Surgery

Later in Infancy

	Intussessption
S/S	·       Completely normal happy chobby baby ·       Sudden abd pain that’s relieved by knee-chest position ·       stays for 1 min then goes away ·       Currant jelly stool (late sign)
Dx	Air/barium enema is both dxic & txic.
Tx	Air/barium enema both dxic & txic. (if fails –> surgery)

Meckel’s –> LGIB in peds –> Technicium scan

	Hirschsprung disease	Meconium ileus
Associated disorder	Down syndrome	Cystic fibrosis
Typical level of obstruction	Rectosigmoid	Ileum
Meconium consistency	Normal	Inspissated
“Squirt sign”	Positive	Negative