ARM
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This document discusses the approach of a pediatrician to a newborn with anorectal malformation (ARM). It describes the pediatrician's role in diagnosis, initial stabilization, and referral to a pediatric surgeon. It provides details on clinical examination findings for ARM in males and females. It also discusses associated malformations, initial management including antibiotics and fluids, and investigations like invertogram to classify the ARM.
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ARM
- 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 DELIVERED THOROUGH CLINICAL EXAMINATION ANORECTAL MALFORMATION(ARM) MALE FEMALE dnbpaediatrics.blogspot.in
- 5. NEWBORN WITH ARM (MALE) PERINEAL INSPECTION AND URINALYSIS CLINICAL EVIDENCE(80-90%) QUESTIONABLE( 10-20%) PERINEAL FISTULA “FLAT BOTTOM” INVERTOGRAM “BUCKET HANDLE” MECONURIA MIDLINE RAPHE FISTULA AIR IN BLADDER ANAL STENOSIS (XRay Finding) ANAL MEMBRANE >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DISTANCE dnbpaediatrics.blogspot.in
- 8. NEWBORN WITH ARM (FEMALE) PERINEAL INSPECTION FISTULA(APPROX.90%) NO FISTULA(APPROX.10%) SINGLE OPENING TWO OPENINGs THREE OPENINGs CLOACA VAGINAL CUTANEOUS OR (PERINEAL) INVERTOGRAM VESTIBULAR >1 CM BOWEL- <1 CM BOWEL- SKIN DISTANCE SKIN DIST. dnbpaediatrics.blogspot.in
- 11. VESTIBULAR FISTULA WITH IMPERFORATE HYMEN dnbpaediatrics.blogspot.in
- 12. VESTIBULAR FISTULA dnbpaediatrics.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. INVERTOGRAM DONE AFTER 16-18 HRS 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
- 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.in Free blog for postgraduates in pediatrics