2025 – PAGE 241 – GASTROENTEROLOGY

MISCELLANEOUS GI CONDITIONS & TERMINOLOGY

OMPHALOCELE

An omphalocele refers to a herniation of bowel ± organs through the umbilicus. The herniated material is SEALED in by overlying membranes. Associated Beckwith-Wiedemann Syndrome and various chromosomal defects.

GASTROSCHISIS

Gastroschisis occurs when there is herniation of UNCOVERED bowel NEAR (not through) the umbilicus. The organs remain in the abdomen. Treat by placing a nasogastric tube for decompression and keeping the bowel moist until surgical repair.

NASOGASTRIC TUBE FEEDINGS (NG TUBE FEEDINGS)

Mild diarrhea is common with nasogastric tube feedings (NG tube feedings). Bolus feeds are recommended for children struggling with oral motor coordination in order to “help them learn.” For all other patients, give CONTINUOUS NG tube feeds.

ESOPHAGEAL PERFORATION

There is a strong association between esophageal perforation and Marfan syndrome, Ehlers-Danlos, and Epidermolysis bullosa. Ingestion of bases (or strong acids) can also result in esophageal perforation. Weaker acids can cause esophageal strictures.

TRACHEOESOPHAGEAL FISTULA (TEF) and ESOPHAGEAL ATRESIA (EA)

A tracheoesophageal fistula (TEF) is a connection between the trachea and the esophagus. Esophageal atresia is a condition in which the esophagus “interrupted,” and the upper and lower segment do not connect so food cannot reach the stomach. In patients with TEF, the symptoms and the time of presentation depends on if EA is also present. TEF alone may be asymptomatic at birth and later present with frothiness in the mouth, coughing, gastric distension (especially when the TEF is distal), aspiration, respiratory distress, pneumonia. If EA is present, symptoms start immediately after birth with increased secretions, drooling, difficulty breathing, choking, and feeding intolerance. There are five types of situations to consider:

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• TYPE A: EA without TEF.
• TYPE B: EA with proximal TEF.
• TYPE C: EA with distal TEF (most common common).
• TYPE D: EA with proximal and distal TEF.
• TYPE E: TEF without EA.

PEARLS:

• Clinical presentation of TEF depends on whether, or not, an EA also exists.
• About 50% of TEFs are associated with VACTERL.
• Most cases of EA are associated with polyhydramnios during the mother’s pregnancy.