Gastro

Question 1

Hirschprung’s disease

Answer 1

• Absence of PARASYMPATHETIC ganglion cells - rectum -> more proximal bowel ending at normally innervated, dilated colon
  
  • Myenteric - Auerbach plexus
  • Submucosal - Meissner’s plexus
• 1 in 5000 caucasian births
• RFs:
  
  • MALES (4x more likely)
  • Down’s syndrome
  • MEN2a
• Complications:
  
  • ​Perforation -> Hirschprung’s enterocolitis (toxic megacolon) + sepsis
  • Meconium plug syndrome
• Ix
  
  • ​Abdo XR + Contrast barium enema
  • Rectal biopsy
• Mx
  
  • ​Bowel irrigation + Surgery (Endorectal pullthrough)

Hirschprung’s enterocolitis

• Proximal colon dilatation 2nd to obstruction -> thinning of the colonic wall -> bacterial overgrowth -> translocation of gut bacteria from colon to blood
• Mx
  
  • Fluids resuscitation + Decompression (NG/rectal tubes)
  • Broad-spectrum Abx
  • Surgery = definitive Tx

Question 2

Pyloric Stenosis

Answer 2

• Pylorus normal at birth -> hypertrophies gradually (hence doesnt present at birth)
• Present 2-8wks (boys 4:1)
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