(jejunum) or distal region (ileum) of the small intestine. The small intestine immediately proximal to the obstruction become enlarged or dialated. Impairing ability to absorb nutrients Impairing peristaltic movement of the small bowel 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable JIA Type I: Mesenteric development and intestinal length are normal Mucosa and submucosa forms a web or membrane within the intestinal lumen Windsock Effect Increased pressure proximal to the obstruction causes the web to prolapse, pushing the web through the bowel distally 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable JIA Type II: Mesenteric development and overall intestinal length is normal Small bowel is not a continuous lumen Proximal small bowel ends in bulbous blind pouch Distal small bowel is flattened Proximal and distal small bowel connected by fibrous cord.
1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable Type IIIa: Similar to Type II Small V-shaped mesenteric defect is present, bowel length is shortened Proximal blind end is markedly dilated and aperistaltic No fibrous cord connects the proximal and distal small bowel 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable Type IIIb: Similar to Type IIIa Significant mesenteric defect is present Superior mesenteric artery is largely absent Small bowel supplied by a single ileocolic or right colic artery Known as Christmas tree or apple peel deformity Bowel wraps around a single perfusing artery 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable Type IV: Multiple JIAs of any combination Types I III Appears as a string of sausages due to multiple lesions
Likely result of multiple ischemic insults or inflammatory process 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable 1) Definition of JIA and anatomic site that it occurs, noting subtypes of this malformation if applicable Intrauterine vascular accident Necrosis of bowel segment Resorption of tissue IVAs caused by malrotation, volvulus (abnormal twisting of SMA), gastroschisis, omphalocele All result in blood supply / gut segment separation
Duodenal Atresia is usually a failure to recanalize versus vascular insult of JIA 2) Embryologic cause of this malformation; how does the mechanism differ from duodenal atresia? When does this malformation occur? Within the first day of life Vomiting green bile Bowel sounds absent in distal small intestine No meconium Abdominal distention 3) Describe the typical clinical patient presentation in JIA: symptoms, onset, age, physical exam findings. Prenatally Ultrasonography will likely show excess amniotic fluid (polyhydromnios) Intestines arent properly absorbing ingested amniotic fluid
First day of life Abdominal X-ray, with and w/o contrast enema Stomach and proximal small bowel will appear dilated Distal small bowel will appear flattened 4) Describe the recommended method for diagnosing suspected JIA 5) Typical X-Ray findings in JIA 5) Typical X-Ray findings in JIA Triple Bubble Presentation Immediately a tube is placed orally into the stomach to evacuate excess fluid and gasses Prevents vomiting and aspiration Relieves GI discomfort IV Fluids and Nutrients are provided until surgery is available Surgical intervention is necessary to repair the bowel obstruction and blood supply 6) Initial stabilizing treatment versus definitive surgical treatment and prognosis in JIA. After surgery, patients will have a feeding tube until bowel movements begin Typical hospital stay post-surgery is a few weeks or until patient is nutritionally stable
Regular follow-up is required to check bowel development and function 6) Initial stabilizing treatment versus definitive surgical treatment and prognosis in JIA. Types I, II, and IIIa have good prognosis Fairly normal small bowel length results in almost normal bowel function
Types IIIb, IV is associated with complications Shortened small bowel is associated with short gut syndrome and malabsorption 6) Initial stabilizing treatment versus definitive surgical treatment and prognosis in JIA. References Sadler, TW. Langmans Medical Embryology, 8 th ed. 2000.
Intestinal Atresia, Stenosis, and Webs. May 1, 2006. http://www.emedicine.com/ped/topic3043.htm. Accessed Nov. 26, 2007.
Bowel Obstruction in the Newborn. June 15, 2004. http://www.emedicine.com/ped/topic2857.htm. Accessed Nov. 26, 2007.
Intestinal Atresia and Stenosis in Children. Nov. 27, 2007. http://www.chp.edu/centers/03x_lit_disease_15.php. Accessed Nov. 27, 2007
Intestinal Atresia University of Michigan Pediatric Surgery. Apr. 23, 2007. http://surgery.med.umich.edu/pediatric/clinical/physician_content/a- m/intestinal_atresia.shtml. Accessed Nov. 26, 2007.
Intestinal Atresia and Stenosis, Cincinnati Childrens Hospital Medical Center. Apr. 2007. http://www.cincinnatichildrens.org/health/info/abdomen/diagnose/obstruction s.htm. Accessed Nov 26, 2007.
Anaesthesia & Intensive Care Medicine Volume Issue 2018 (Doi 10.1016/j.mpaic.2017.12.011) Kubicki, Mark Warrillow, Stephen J - Gastrointestinal Problems in Intensive Care