2. The First Sign of Life is Cry 3. Timely Passage Of The First
Stool Is A Hallmark Of The Well-being Of The Newborn Infant. 4.
Meconium is the First Stool Passed by New-Born. 5. What is the
Identity of Meconium? 6. Meconium is; Thick. Sticky.
Blackish-Green. 7. Timming of Passing Meconium? 8. In Full-term?
99% Pass Within 24 Hours. All Pass Within 48 Hours. In Pre-term?
37% Pass Within 24 Hours. All Pass Upto 9 Days. 9. Failure Of A
Full-term Newborn To Pass Meconium Within The First 24 Hours Should
Raise A Suspicion Of Intestinal Obstruction. 10. FAILURE TO PASS
MECONIUM Is It A Problem? 11. YES Failure To Pass Meconium Is A
Problem. 12. Is Breathing Problems caused by Inhaling Meconium
Serious? 13. Breathing Problems Caused By The Baby Inhaling
Meconium Are Usually Not Serious. 14. Clinical Presentation A 3.5
Kg male infant was born after 40 weeks' gestation. There were no
complications during the pregnancy and delivery. He did not pass
meconium after birth, and he had the onset of bilious vomiting. His
abdomen is distended, with palpable loops of bowel. The infant was
not able to feed. Whats the Diagnosis? 15. Diagnosis is Neonatal
Intestinal Obstruction. 16. Differential Diagnosis (of I. Obs:)
Duodenal Atresia, Malrotation And Volvulus, Jejunoileal Atresia,
Meconium Ileus And Meconium Peritonitis. 17. Clinical Presentation
A 3.5 Kg Male Infant Was Born After 40 Weeks' Gestation. There Were
No Complications During The Pregnancy & Delivery. He Did Not
Pass Meconium After Birth, & He Had The Onset Of Vomiting On
The First Day. His Abdomen Became Mildly Distended. The Infant Was
Not Able To Feed, And Abdominal Distention Increased. DRE reveals
Tight Anus. 18. On the second day 19. The Surgeon Performed An Anal
Dilatation. The Infant Subsequently Passed Gas And Meconium. 20.
After Discharge From The Hospital, The Infant's Mother Continued
Performing Periodic Anal Dilatation Because He Had Difficulties
Moving His Bowel. 21. Digital Rectal Examination By The Physician
When The Infant Was Five Weeks Of Age Revealed A Tight Anus And
Liquid Stool But No Impaction. 22. One Week Later, The Mother
Noticed A Bloody Bowel Movements. 23. Compare . . . 24. Whats Your
Diagnosis? 25. Diagnosis is; Hirschsprung's Disease . 26.
Hirschsprung's Disease Congenital Aganglionic Megacolon. Overall
Incidence Of 1 In 4,000 Live Births. 20 To 25% Of The Cases Of
Neonatal Bowel Obstruction. Male to Female Ratio 4:1. 8% Have Down
Syndrome. 27. Common Presentation Of Hirschsprung's Disease;
Newborn. Failure To Pass Meconium During The First Few Days Of
Life. Subsequent Passage Of A Meconium Plug Followed By Sparse
Bowel Movements. Gastrointestinal Bleeding And Diarrhea Are DANGER
SIGNS Enterocolitis. 28. How Will You Proceed? 29. Abdominal X-Ray
30. Barium Enema 31. Day 1 6th Week Showing Transition Zone 32. The
Presence Of Barium In The 24-hour Delayed Film Also Suggests
Hirschsprung's Disease. 33. Ano-Rectal Manometry 34. TREATMENT
Surgery To Remove Or Bypass The Diseased Bowel. Initially
Colostomy. Corrective Surgery In Three To Six Months. 35. Clinical
Presentation A 3.5 Kg Male Infant Was Born After 40 Weeks'
Gestation. There Were No Complications During The Pregnancy &
Delivery. He Did Not Pass Meconium After Birth, & He Had The
Onset Of Vomiting On The First Day. His Abdomen Became Mildly
Distended. The Infant Was Not Able To Feed, And Abdominal
Distention Increased. DRE reveals Normal Anus. 36. What is the
Diagnosis? 37. Hint: Contrast Enema Is Diagnostic, And Also
Therapeutic 38. Meconium Plug Syndrome 39. Meconium Plug Syndrome
Mildest & Most Common Form Of Functional Distal Obstruction In
The Newborn. Obstruction Caused By Inspissated, Immobile Meconium.
Incidence 1 Case In 500 To 1,000 Neonates.1 Etiology Is Unclear.
40. Clinical Presentation A 3.5 Kg Male Infant Was Born After 40
Weeks' Gestation. There Were No Complications During The Pregnancy
& Delivery. He Did Not Pass Meconium After Birth. Abdominal
Distention Is Present At Birth. Within Hours, The Distention
Increases, & The Infant Vomits Bile-stained Material. Bowel
Loops Are Visible Through The Abdominal Wall. Rectal Examination Is
Difficult. 41. What Is The Diagnosis? 42. Meconium Ileus. 43. Whats
Most Common Underlying Cause of Meconium Ileus? Cystic fibrosis 44.
Cystic Fibrosis Is The Underlying Disorder In 95% Infants With
Meconium Ileus. Meconium Ileus Occurs In 15% Of Patients With
Cystic Fibrosis. 45. Treatment ? Simple Meconium Ileus Gastrografin
Enema And Plenty Of Intravenous Fluids. 46. If The Gastrografin
Enema Is Unsuccessful!...? Operative Evacuation Of The Obstructing
Meconium By Irrigation 47. Clinical Presentation A 3.5 Kg Male
Infant Was Born After 40 Weeks' Gestation. There Were No
Complications During The Pregnancy & Delivery. He Did Not Pass
Meconium After Birth. Within Hours, The Distention Increases.
Perineal Inspection Reveals The Absent Anus What Is The Diagnosis?
48. High Type..? Rectum Ends Above The Levator Muscle. Low Type..?
Rectum Partially Descends Through Levator Muscle. Often, The Rectum
Ends In A Fistula. 49. Treatment ? 50. Anal Atresia Requires
Surgery. Goal Of Surgery Is To Preserve Bowel, Urinary & Sexual
Function. 51. Colostomy Is Initially Performed In Neonates With
High Anal Atresia. Followed by Elective Pull-Through Surgery. 52.
Fistula Can Be Gently Dilated To Allow The Gas & Meconium To
Pass. Fistula Can Be Corrected Electively When The Infant's
Condition Is Stable.
