00:01
Welcome.
00:02
In this relatively
short little talk,
we're going to pick
up where we left off
with other lesions
in the GI tract.
00:10
This is going to be
Jejunal and Ileal Atresia.
00:14
So, the epidemiology of this.
00:17
Overall, it's much less common
than duodenal atresia
that we've talked
about previously.
00:23
The pathophysiology.
00:25
So what we're looking at here,
this is a pediatric problem
and neonate problem, actually.
00:31
We're looking at a baby.
00:33
What is on the
baby's chest here is
supposed to represent
bilious vomiting.
00:39
And so don't pay
attention to that
we're gonna look instead,
at his GI tract.
00:44
During normal development,
we have big loops of
bowel of the jejunum
and ileum that are perfused
by the superior
mesenteric artery
and branches of the
superior mesenteric artery,
that branch and
branch and branch.
00:58
If there is disruption in the branches of
superior mesenteric artery,
then the portions of the
bowel that would normally
be perfused and would normally
develop, don't do so.
01:09
So we have failure to develop,
and it can be anywhere
along the small bowel
segments jejunum or ileum.
01:15
And here we're just showing
an example of ileal atresia.
01:18
So we have big loops
a bowel that are fine,
and then we get to this area
that just never really developed.
01:22
It's atretic and food,
whatever is in the GI contents
cannot get through
that area of narrowing.
01:30
cannot get through
that area of narrowing.
01:32
So, clinical presentation.
01:35
It's pretty easy to predict
what would be happening here,
because the baby is not able to
swallow completely during development.
01:46
There will be polyhydramnios.
01:48
There will be much more
fluid within the amniotic sac,
because the baby is not able
to swallow and passage that
so that will also
potentially affect
the development of other
structures and organs.
02:03
At birth,
there will be bilious vomiting.
02:05
So the atresia, the atretic
component is distal
to where the bile duct
dumps in to the duodenum.
02:13
And so as a result of that,
when there is that stenosis,
things back up from that point,
the baby will have
bile stain vomiting.
02:21
There will also be
abdominal distension.
02:23
Food that's coming down,
keeps coming down
until it's completely
stuck at this point
where there's no
bowel development.
02:31
How do we make the diagnosis?
It's not that hard.
02:34
I mean,
if you just do a plain film here,
you will see dilated loops of
bowel with multiple fluid levels.
02:42
The management also
reasonably straightforward.
02:44
You need to resect
the area that's atretic.
02:47
So you just do a
surgical correction.
02:49
You cut it out,
so the two pieces
back together and
you're good to go.
02:54
And with that,
a very brief visit
to ileal and jejunal atresia.