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ARM

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for www.dnbpediatrics.com

for www.dnbpediatrics.com

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  • 1. ANORECTAL MALFORMATION Approach Of A Pediatrician To A Case Of Newborn With ANORECTAL MALFORMATION Speakers -Dr.Sushmita Ghosh Moderator-Dr.M.K.Mohanty(Paed.Surgeon)Jawaharlal Nehru Hospital & Research Centre Bhilai Steel Plant Hospital dnbpaediatrics.blogspot.in
  • 2. INTRODUCTION Anorectal malformation- Complex disorder ranging from cloaca (most severe) to perineal fistula. Invertogram- in 1930 Upto 1948 Surgical correction-Rhodes Since 1982- PSARP by Alberto Pena dnbpaediatrics.blogspot.in
  • 3. ROLE OF PEDIATRICIAN Intramural Extramural(delivery-own hosp.)*diagnosis (outside delivery)*initial stabilization *diagnosed outside*referral to paed.surgeon *stabilization *treatment of sepsis,if any dnbpaediatrics.blogspot.in
  • 4. BABY DELIVEREDTHOROUGH CLINICAL EXAMINATIONANORECTAL MALFORMATION(ARM) MALE FEMALE dnbpaediatrics.blogspot.in
  • 5. NEWBORN WITH ARM (MALE) PERINEAL INSPECTION AND URINALYSISCLINICAL EVIDENCE(80-90%) QUESTIONABLE( 10-20%)PERINEAL FISTULA “FLAT BOTTOM” INVERTOGRAM“BUCKET HANDLE” MECONURIAMIDLINE RAPHE FISTULA AIR IN BLADDERANAL STENOSIS (XRay Finding)ANAL MEMBRANE >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DISTANCE dnbpaediatrics.blogspot.in
  • 6. BUCKET HANDLE VARIETYdnbpaediatrics.blogspot.in
  • 7. MIDLINE RAPHE FISTULAdnbpaediatrics.blogspot.in
  • 8. NEWBORN WITH ARM (FEMALE) PERINEAL INSPECTION FISTULA(APPROX.90%) NO FISTULA(APPROX.10%)SINGLE OPENING TWO OPENINGs THREE OPENINGsCLOACA VAGINAL CUTANEOUS OR (PERINEAL) INVERTOGRAM VESTIBULAR >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DIST. dnbpaediatrics.blogspot.in
  • 9. CLOACAdnbpaediatrics.blogspot.in
  • 10. VAGINAL FISTULAdnbpaediatrics.blogspot.in
  • 11. VESTIBULAR FISTULA WITH IMPERFORATE HYMEN dnbpaediatrics.blogspot.in
  • 12. VESTIBULAR FISTULA dnbpaediatrics.blogspot.in
  • 13. VAGINAL FISTULAdnbpaediatrics.blogspot.in
  • 14. INCIDENCE WORLDWIDE 1:5,000 LIVE BIRTHS GENETIC PREDISPOSITION IN CERTAIN FAMILIES ASSOCIATION WITH CERTAIN SYNDROMES- VACTERL,VATER,DOWN’S SYNDROME SLIGHT MALE PREPONDERANCE IN FEMALES-RECTOVESTIBULAR FISTULA MOST COMMON IN MALES -RECTOURETHRAL FISTULA MOST COMMON dnbpaediatrics.blogspot.in
  • 15. INITIAL MANAGEMENT RED RUBBER CATHETER INSERTION NBM & INTRAVENOUS FLUIDS FIRST LINE ANTIBIOTICS- CLOXACILLIN & AMIKACIN INJECTION VITAMIN K NASOGASTRIC DECOMPRESSION after 24 hrs dnbpaediatrics.blogspot.in
  • 16. ASSOCIATED MALFORMATIONS (50-60%) UROGENITAL- URINARY-UNILATERAL AGENESIS OF KIDNEY -PUJ OBSTRUCTION -HYPOSPADIAS -VUR GENITAL- BICORNUATE UTERUS -UTERUS DIDELPHYS -VAGINAL SEPTUM -BLIND HEMIVAGINA -ATRESIA OF CERVIX -HYDROCOLPOS CARDIOVASCULAR- 1/3RD Pts -ASD,PDA most common -VSD,TOF dnbpaediatrics.blogspot.in
  • 17. GASTROINTESTINAL-TRACHEOESOPHAGEAL ANOMALIES -DUODENAL OBSTRUCTION (ATRESIA/MALROTATION)SPINOVERTEBRA L -HEMIVERTEBRAE -SCOLIOSIS -HEMISACRUM -ABSENT SACRUM -BUTTERFLY VERTEBRAE - TETHERED CORD -SPINAL LIPOMAS -SYRINGOMYELIA -MYELOMENINGOCELE dnbpaediatrics.blogspot.in
  • 18. INVESTIGATIONS INVERTOGRAM(10-20% CASES) -by Wangensteen and Rice(1930) PRONE CROSS TABLE LATERAL XRAY -by K.L.N Rao et al(1991) BABYGRAM ULTRASOUND ABDOMEN ECHOCARDIOGRAPHY dnbpaediatrics.blogspot.in
  • 19. INVERTOGRAMDONE AFTER 16-18 HRS dnbpaediatrics.blogspot.in
  • 20. WHY?dnbpaediatrics.blogspot.in
  • 21.  AT BIRTH - GAS IN STOMACH 6-8 HRS - GAS REACHES ILEOCAECAL JUNCTION 12-18 HRS - GAS REACHES RECTUM dnbpaediatrics.blogspot.in
  • 22. INVERTOGRAM -position dnbpaediatrics.blogspot.in
  • 23. dnbpaediatrics.blogspot.in
  • 24. dnbpaediatrics.blogspot.in
  • 25. dnbpaediatrics.blogspot.in
  • 26. dnbpaediatrics.blogspot.in
  • 27. dnbpaediatrics.blogspot.in
  • 28. PRONE CROSS TABLE LATERAL XRAY-position dnbpaediatrics.blogspot.in
  • 29. PRONE CROSS TABLE LATERAL XRAY dnbpaediatrics.blogspot.in
  • 30. Visit and join dnbpaediatrics.blogspot.inFree blog for postgraduates in pediatrics