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  #1  
Old 07-19-2011
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GIT Which intestinal segment caused meconium ileus!

A normal birth-weight, term, male baby with high APGAR scores fails to pass meconium within 36 hours of birth. The neonate also has a distended abdomen, has been vomiting, and has been feeding poorly. Digital rectal examination temporarily relieves the obstruction, but the baby fails to pass stool thereafter. Barium enema examination demonstrates a region of narrowed bowel. Which of the following is the most likely region affected?

A. Long segment extending from the splenic flexure into the rectum
B. Long segment involving the descending colon
C. Short segment involving the descending colon
D. Short segment involving the ileocecal valve
E. Short segment involving the rectum
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  #2  
Old 07-19-2011
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E. Short segment involving the rectum. Hirschsprung's disease.
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  #3  
Old 07-19-2011
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lol at the title .....that made my day

E. Short segment of rectum
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  #4  
Old 07-19-2011
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Hm, GOOD question!

I think this is Hirschsprung's Disease (aka Congenital Aganglionic Megacolon).

I'd say its A. Long segment extending from the splenic flexure to rectum.
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  #5  
Old 07-19-2011
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I think is E) Short segment involving the rectum

A)Long segment extending from the splenic flexure into the rectum...could be also, but they say they did a digital rectal exam and it worked temporarily...
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  #6  
Old 07-20-2011
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i go with E too. because affected region is aganglionic region which should be short and in rectum that relieved by rectal exam.
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  #7  
Old 07-20-2011
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In Hirschspring's , colon is dilated (megacolon), but in this question it says "narrowed".

any expaination?
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Old 07-20-2011
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Quote:
Originally Posted by usluipek View Post
In Hirschspring's , colon is dilated (megacolon), but in this question it says "narrowed".

any expaination?
ups!
Barium enema examination demonstrates a region of narrowed bowel, should be the sigmoid....in this case the correct answer is A)....I dont like this part though "Digital rectal examination temporarily relieves the obstruction"
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  #9  
Old 07-20-2011
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Default E?

My guess is E. - absense of myenteric ganglion constricts involved segment.
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  #10  
Old 07-20-2011
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E. Short segment involving the rectum
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  #11  
Old 07-20-2011
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the ans is E the affected part is narrowed with no peristalsis n the dilated proximal part is due to obstruction n here gut movement is intact
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  #12  
Old 07-20-2011
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Default Ans.

E.Short segment involving rectum.
One of the keys to answering the question is the fact that the patient is male, which are more commonly affected, as you know Hirschsprung disease is a failure for neural crest cell migration, so there is no ganglion cells in the Auerbach and Meissner plexus of the area affected, in this case the rectum, causing a dilated portion of the colon proximal to the aganglionic segment.
Females may have a long segment aganglionosis but will still involve the rectum.

Last edited by NGaleas; 07-20-2011 at 03:16 PM.
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  #13  
Old 07-20-2011
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Answer should be E....Distal Rectum is always involved.
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Old 07-20-2011
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Correct Answer answer

The correct answer is E. The infant has Hirschsprung disease, which is a congenital cause of constipation caused by an absence of ganglion cells in both the submucosal (Meissner) and myenteric (Auerbach) plexi of a segment of bowel, due to neural crest migration defect. The aganglionic bowel segment is narrowed because the lack of peristalsis keeps stool from moving into the segment. The distal rectum is always involved, and the lesion can extend proximally anywhere from a few centimeters past the rectum all the way up to the small intestine. Males, who are most commonly affected, usually have a short segment involved with proximal megacolon. In this patient's case, rectal examination dilated the narrowed aganglionic bowel, temporarily allowing passage of stool. Definitive treatment consists of surgical removal of the affected segment.
Long-segment aganglionosis still involving the rectum (choice A) would be more likely in a female patient.
Small left colon syndrome (choice B) is not associated with aganglionosis. It is seen in neonates born to diabetic mothers and is often self-limiting.
Neither the descending colon (choice C) nor the ileocecal valve (choice D) would be involved in isolation.
MedEssentials (2nd Ed.): pp. 342
First Aid (2008): pp. 310
Hirschsprung disease is a neural crest migration defect in which there is absence of the ganglion cells of both submucosal and myenteric plexi. The denervated section will appear narrowed. Remember that the distal rectum is always involved.
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  #15  
Old 07-20-2011
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Thumbs Up Amazing answer ,leaves no doubt

Quote:
Originally Posted by ricko335 View Post
The correct answer is E. The infant has Hirschsprung disease, which is a congenital cause of constipation caused by an absence of ganglion cells in both the submucosal (Meissner) and myenteric (Auerbach) plexi of a segment of bowel, due to neural crest migration defect. The aganglionic bowel segment is narrowed because the lack of peristalsis keeps stool from moving into the segment. The distal rectum is always involved, and the lesion can extend proximally anywhere from a few centimeters past the rectum all the way up to the small intestine. Males, who are most commonly affected, usually have a short segment involved with proximal megacolon. In this patient's case, rectal examination dilated the narrowed aganglionic bowel, temporarily allowing passage of stool. Definitive treatment consists of surgical removal of the affected segment.
Long-segment aganglionosis still involving the rectum (choice A) would be more likely in a female patient.
Small left colon syndrome (choice B) is not associated with aganglionosis. It is seen in neonates born to diabetic mothers and is often self-limiting.
Neither the descending colon (choice C) nor the ileocecal valve (choice D) would be involved in isolation.
MedEssentials (2nd Ed.): pp. 342
First Aid (2008): pp. 310
Hirschsprung disease is a neural crest migration defect in which there is absence of the ganglion cells of both submucosal and myenteric plexi. The denervated section will appear narrowed. Remember that the distal rectum is always involved.
I was confused between the first and the last option , more so because these was this bit regarding the narrowing of the bowel , I strongly feel that Eis the correct answer , thank you for the effort .
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  #16  
Old 07-21-2011
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Quote:
Originally Posted by ricko335 View Post
A normal birth-weight, term, male baby with high APGAR scores fails to pass meconium within 36 hours of birth. The neonate also has a distended abdomen, has been vomiting, and has been feeding poorly. Digital rectal examination temporarily relieves the obstruction, but the baby fails to pass stool thereafter. Barium enema examination demonstrates a region of narrowed bowel. Which of the following is the most likely region affected?

A. Long segment extending from the splenic flexure into the rectum
B. Long segment involving the descending colon
C. Short segment involving the descending colon
D. Short segment involving the ileocecal valve
E. Short segment involving the rectum
E. hirschsprung most commonly affects rectum
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